Author Archives: CMAJ

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,

I've experienced the death of patients before — but this one feels different. I can’t help but think of small things we spoke about, like their dogs and their season tickets to the theatre. How do you navigate the intersection of professionalism and mourning another human you felt connected to?

Signed,

Mourning in Secret

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Noémie La Haye-Caty is a medical student in the Class of 2019 at McGill University

 

Katy is sleeping on the exam table. She came in looking tired, talking with a weak voice, and walking with small steps. I tried to ask a few questions, but her lack of sleep was evidently preventing her from answering.

She is here today for a follow-up appointment. She was admitted two weeks ago because she wanted to end her life.

I try to gently wake her up. “How are you doing, Katy?”

“Better.”

“Great! What’s better?”

“I was confused, before.”

“Why were you confused?”

Katy is 24 years old and has three young children. She is now a few weeks pregnant. Two of her children were recently taken by the Director of Youth Protection (DYP), while the youngest lives with Katy and Katy’s own mother. Katy tells me that the father of her kids used to be violent with her and has been in prison for the past week. ...continue reading

Danielle Penney is a medical student in the Class of 2021 at McMaster University

 

“Doctors are jerks.” It was a statement that I had always steadfastly believed to be true; a matter-of-fact statement, just like saying the sky is blue. Though I had no shortage of concrete personal examples to justify my belief, the irony was not lost on me as I stared out from behind the glass of the nursing station, ready to begin my first clinical experience as a new medical student.

I was in the child and adolescent psychiatric ward. From the nursing station, I could see the ward’s common area: the bolted-down tables and chairs, the colourful pictures adorning the walls, the patients scattered about the room—some in groups, some alone. It was a scene that was familiar, yet different. This was far from my first time in a psych ward, but it was my first time being on this side of the glass. ...continue reading

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Curtis Sobchak is a medical student in the Class of 2019 at the University of Toronto

 

It is well-known that workplaces strive for diversity and inclusion. Studies have shown that diversity improves productivity and contributes to creativity and new ideas. In medicine, this diversity is just as important. Having physicians from under-represented and marginalized communities provides unique views on what may be best for the patient. As medical schools continue to support new initiatives, such as specialized admission pathways for African American and Indigenous students, it is clear diversity is on the agenda. However, for those who are not of the majority ethnicity, diversity may not be enough. There also needs to be representation.

This idea was at the forefront of my mind during an elective rotation. After I had mentioned my interest in Indigenous health a number of times, I was asked by my attending whether I was of Indigenous background. I understood the hesitation, of course; sometimes it can make people feel uncomfortable to ask about your background or where you are from. Nonetheless, I was happy they had asked and I responded with a firm “yes.” ...continue reading

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Sahil Sharma is a medical student in the Class of 2020 at Western University

 

It was my first week on service for internal medicine as a third-year clerk. I had finally begun to figure out the labyrinth of charts, forms, and computer apps that went into my interactions with patients. I still had four of the eight pens I’d started with and had managed to misplace my sacred “pocket guide” only twice — so, all in all, I was off to a good start.

I was told by my senior to go see a patient who was in ICU step-down and had recently been transferred to our care. I hurriedly went to the computers and started reading up on the patient’s history.

Mr. C had a long and complicated history. He had initially presented to the hospital with signs of cholecystitis but later developed multiple complications landing him in the ICU. After a flurry of resuscitative measures and close monitoring, Mr. C was finally deemed stable enough to be transferred to the ward. ...continue reading

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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,

I am a recently retired physician, and your blog seems like a great idea to me. Support and acceptance are needed at all stages of our careers.

Burnout is a reality in our profession, as is ageism. Because of ageism, it is often difficult to balance limitations with outside expectations and many physicians simply choose to retire. My hope is that will change — our profession will see, acknowledge, and embrace the value of our aging colleagues — but that is simply not true now. How can the profession both assist the transition and get maximum value from its most experienced colleagues?

Signed,

Twilight

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Shaun Mehta is an Emergency Medicine Resident (R4) at the University of Toronto

 

In elementary school, I always dreaded bringing my report card home. My grades were good, but the teachers’ comments that followed could go either way — and were unfortunately of much more interest to my parents. I was often described as “disruptive,” and it seemed that relinquishing this quality was the key to making something of myself.

Two decades later, I’m finding out that being disruptive is one of my most valuable assets.

To clarify, we probably shouldn’t praise students for being disruptive in the classroom. But outside of the classroom... now, that’s an entirely different story. The health care industry is ripe for disruption; strapped for cash and bursting at the seams, we need better ways to manage today’s volume and complexity of patients. Forward-looking individuals and organizations have heeded the call and are making huge strides in health care innovation, yet patients continue to suffer as a result of systems-level issues.

By shifting our paradigm of innovation, creating an environment to foster disruption, and educating future leaders to drive change, we stand a chance at driving maleficent creatures (like hallway medicine and eternal wait times) to extinction. ...continue reading

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Ruth Habte is a medical student in the Class of 2019 at the University of Manitoba

 

I have been privileged to take part in implementing global health programming while in medical school, both at my own school and across the country. Throughout this time, I have often been prompted to answer the infamous question: “What is global health?” I have also encountered the misconception of global health being synonymous with international health. Based on my learning and experiences, I have come to define global health in my own terms.

While global health is an incredibly broad field, the cornerstone of global health (in my opinion) is attaining health equity for all people. That means that a person with less privilege in life should be afforded greater means to reach the same health outcomes as those with more privilege. ...continue reading

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)!

 

Pieces of a puzzle inherit meaning not by their individual qualities, but by being pieced together into context. Good medicine — and good healthcare — are similar: they rely on understanding patients as people, and clinical presentations as brush-strokes forming part of a bigger picture. ...continue reading

Maggie Hulbert is a medical student in the Class of 2020 at Queen's University

 

First Year Out: A Transition Story
(Singing Dragon, 2017)

Earlier this fall, over the course of a tense dinner table discussion, it came to light that a dear relative of mine held some blatantly transphobic beliefs. I was greatly distressed by this — not only because these beliefs were at complete odds with my own, but because I had no idea what to do. I felt that it was my responsibility to educate them and keep communication channels open... but having had little success with blunt confrontation, I was at a loss.

Then I read First Year Out: A Transition Story, the second graphic novel by Vancouver-based author Sabrina Symington. First Year Out describes the story of Lily in her first year as an openly trans woman, and covers everything in Lily’s life from the basics (such as how she gets dressed and her first experience with online dating) to the harder conversations (like confronting her mother about her TERF [trans-exclusionary radical feminism] attitude and telling her boyfriend that she wants sexual reassignment surgery). Through the incredible medium of graphic story-telling, we get to literally see how Lily grows into herself. ...continue reading