Author Archives: CMAJ

Arnav Agarwal is an Internal Medicine Resident (R1) at the University of Toronto. Check back the last Thursday of each month for a new featured piece as part of his series (Doc Talks: Reflections to Reality)!

 

Once an elastic band is stretched beyond its limits, it is difficult for it to return it to its unstretched state. Burnout represents a similar phenomenon: an erosion of one’s sense of self and a reflection of emotional over-exhaustion, leading to disinvestment and depersonalization. Years of intensive training, long working hours, increased managerial responsibilities, resource limitations, emotionally-involved patient and family encounters, fear of limited job prospects and litigation, and mounting clinical and non-clinical responsibilities, among other demands: physicians and other health care professionals represent a highly vulnerable group susceptible to burnout, with some estimates suggesting close to 50% of physicians being affected. Evidence suggests that physicians experiencing burnout are more likely to make poor medical decisions, share more tenuous relationships with co-workers, experience more individual and personal relationship challenges, and suffer higher risks of anxiety, depression, and suicidality. Physician burnout has also been associated with differences in overall quality of care, system-level costs, and rates of staff turnover and absenteeism.

This piece focuses on the compromise some residents and physicians make in placing themselves second while dedicating themselves to the care of others, and the silence that some encounter while struggling with burnout. It is encouraging to observe that dialogue around burnout and mental health is growing at individual, institutional, and systemic levels over time. This piece is part of that conversation. ...continue reading

Matthew Lee is a medical student in the Class of 2019 at Dalhousie University

 

I was totally unsure. Meeting a patient who knows they are going to die... wouldn’t it be intrusive, at the end? A student coming into your life: asking questions, getting signatures, asking you to share your precious time. In the same position, I don’t know if I would say yes. That thought makes me feel a bit uncomfortable. Checking in on the floor, with information hurriedly scribbled into the margins of a notebook. A brief run-in with her mother in the crowded room, then twenty minutes spent in the hallway — trying not to be obtrusive while staff hurry by. There are visitors every day, and I doubt I looked out of place.

In some ways, I chose to take on this project in order to become more comfortable with death. It’s something I have faced before, and it took years to move past my friend dying from lymphoma. He quickly stepped away to take a phone call at our convocation. It was a biopsy result. Nearly six months to the day and it was all over. It took nearly everything I had. ...continue reading

1 Comment

Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

It seems everyone is always talking about the importance of having a strong support system around you. While I’ve managed to make casual acquaintances among the pool of colleagues and co-learners I see from time to time, these relationships feel fairly superficial. Yet no one seems to have the time to forge deeper connections...

How do you build your "tribe" in medicine, given how busy everyone is?

Signed,

Lone Wolf

...continue reading

Shubham Shan is a medical student in the Class of 2019 at the University of Toronto

 

She arrived on an inclined stretcher, grasping her Venturi mask like a child holding on to her favourite toy. Flanked on both sides by paramedics, her eyes were splinted wide open by shock and her chest heaved up and down rapidly. She was a queer shade of purple — like spoilt red wine diluted with water — and her gaze flitted around the emergency department as if looking for someone familiar. The paramedics passed her off to the doctor then left, shaking their heads. I remember watching the doctor take the patient’s puffers. The patient swore loudly and snatched them from his hands; first the orange, then the blue. She cocked the puffers like guns, inserted them into her mouth, shot the mist deep, and inhaled. She coughed for what seemed like an eternity. She was what we called a “blue bloater.”

When I saw her again, she was lying on a tattered mattress with bright blue sheets in a freshly bleached acute care room in the emergency department. Her condition had gotten much worse. Her abdomen caved in paradoxically whenever she breathed in. Her eyes were bloodshot. Every time she exhaled, it sounded like an infant's rattle. ...continue reading

1 Comment

Hilary Drake is a medical student in the Class of 2021 at the University of British Columbia

 

On my first day in a new family practice, my preceptor asked me to take a history from a patient who had listed their “reason for visit” as a sore throat. I stood in the hallway and made a mental checklist of questions to ask and observations to make. Have they had any sick contacts? Does their voice sound hoarse?

When I opened the door and asked them if they could tell me what brought them in today, they responded as expected: “My throat is sore.” When I asked what they thought might be causing the pain, they unwrapped a scarf from their neck and stated, “I think it’s because the noose didn’t work.”  At that point they started crying.

They had tried to come in before. They had recognized their pain and wanted to reach out for help, but they were unable to out of fear that their physician would not believe the pain if they could not see it.

That was the day that I learned how stigma can kill someone. ...continue reading

6 Comments

Mitchell Elliott is a medical student in the Class of 2019 at the University of Toronto

 

Doctors are amongst the intellectual elite of society. In many cases, with decades of training and continuing education in clinical practice, our expertise grants us the opportunity to do things that would be deemed invasive and inhumane if performed outside of the context of medicine. Selectively poisoning people with chemotherapy; carefully dissecting fascial planes and removing organs; asking invasive and personal questions... all in the name of symptom management, remission of disease, and prolonging the inevitable: death. For physicians, these daily rituals become almost routine. In many cases, we have spent the majority of our lives training for the uncertainty of each day, rigorously memorizing each disease presentation and management principle, habituating to these processes and procedures. With the heavy clinical demands on physicians, it may be difficult to fully realize the impact of our actions on each patient. ...continue reading

Yipeng Ge is a medical student in the Class of 2020 at the University of Ottawa

 

Humbled. I am so truly humbled that I get to work with and learn from so many passionate medical students with such strong and refined values, morals, and dedication to their causes.

I am specifically speaking about the shift in the medical learner community to respond more attentively and compassionately; to acknowledge the importance of health and social inequities as they affect and inform our medical education and profession, and — more importantly — how they ultimately affect our current and future patients. Patients do not experience the health system not as an isolated entity (though for many of us in the healthcare field, it can certainly feel as though our assistance is limited to clinic rooms); instead, they are affected by the many determinants of health and wellbeing beyond the direct control and impact of clinicians in the healthcare setting. ...continue reading

Welcome to this week's edition of Dear Dr. Horton! Send the anonymous questions that keep you up at night to a real former Dean of Medical Student Affairs, Dr. Jillian Horton, and get the perspective you need with no fear of judgment. Submit your questions anonymously through this form, and if your question is appropriate for the column, expect an answer within a few weeks!

Dear Dr. Horton,

With CaRMS applications open, the pressure is definitely piling on... yet no matter how much I tell myself I need to get started on preparing personal letters for the different programs I'm applying to, I just keep putting it off.

I know a great letter isn't going to pop into existence the night before applications are due, but I'm also at a loss in terms of where to even start... any advice would be much appreciated.

Signed,

Procrastinator

...continue reading

Noren Khamis is a Family Medicine Resident (R1) at the University of Toronto

 

 

 

Early morning: the student comes by in a daze
Disoriented in the hospital maze
He’s frantic and sweating, the hallways all crossed
But one look at me and he’s no longer lost

The happy father and toddler walk by
One look at me, and yikes, what a cry!
Dad lifts his daughter up from the ground
And smiles in relief when she calms down ...continue reading

Beatrice Preti is an Internal Medicine Resident (R2) at Queen's University

 

 

 

The list is long, but I know your name
Each day before, its spot was the same
Second from the top, the second room on the right
The one with three windows and a broken bathroom light

But today something’s different; the list I have’s bare
I looked for your name, but it wasn’t there
Something has happened, and, in my heart, I know
That though I fought to keep you here, you found a way to go ...continue reading