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,
Over the past month, much of what is occurring in our political and social climate has been serving as a constant reminder of inappropriate behaviours/sexual harassment I've experienced as both a patient and a medical learner.
Do you have any advice in navigating these feelings?
Mohamad Matout is a Psychiatry Resident (R1) at McGill University
The debate regarding what should future doctors be learning during medical school is sensitive and convoluted. During the four years in which students learn basic sciences and acquire basic clinical knowledge, due to lack of time, little is taught with regards to major topics such as nutrition1, lifestyle changes, oral health2 and basic computer literacy3. One could argue that psychology is another field in which future physicians lack structured education. Our curriculum is usually centred around understanding the biology of pathophysiology and, when possible, the neurobiology of psychopathologies. While we may be introduced to the area of psychology and an understanding of pathologic defense mechanisms, the world of psychotherapy remains mysterious to medical students and physicians in general. ...continue reading →
Giuliana Guarna is a medical student in the Class of 2019 at McMaster University
I pulled back the large door and stepped into the room. It was early in the morning — just after 6 am. She was lying in bed, awake, with a smile on her face despite the fact that she was post-op. The evidence of surviving rounds of chemo were borne out in front of me. Her hair was peach fuzz, peeking through a silk turban wrapped around her head. Her cheeks were like little Timbits, but her frame was swallowed by her hospital gown.
“Oh, hi. Come in. Let me turn on the light.”
I walk to the foot of the bed. The sun had not yet peeked out from under the shades. The room was illuminated by a yellowish-white hospital glow as she pressed the switch.
Stephanie Hinton is a medical student in the Class of 2019 at Queen's University
It’s August 17th. My grandmother died today. She never made it to palliative care. Instead, she was kept in the corner of a hospital room surrounded by empty walls and a window looking out over a parking lot. She was confined to her bed, barely conscious, and at the mercy of those with little experience in end-of-life care because she had not quite been deemed “palliative.” I sat by her bedside for 12 hours a day, 3 days in a row, leaving only to sleep. I watched her grimace in pain and counted down the hours to the next dose of pain medication. It would finally come — four hours late and barely offering the relief she was looking for. We waited for a doctor to come check on her and answer our questions. We were told they didn’t know where the doctor was or when the doctor was coming, or — my personal favourite — “Doctor’s don’t need to keep you informed of every care decision.”
She had been refused IV hydration and kept NPO, and her vitals were never checked. When they were finally checked, she was saturating dangerously below 90%. On August 17th at 8:00 am, we received a call telling us she would be moved to palliative care. At 8:15 am, we got a call telling us she had died. She was alone. We had been given empty promises the night before that she “might pull through,” and we were unable to stay the night. We were given the “privilege” of seeing her 45 minutes after she had passed, the “privilege” of calling family members to ask them if they would like to come and say their final goodbyes. We had the “privilege” of sitting by her bedside and waiting for family to arrive long after she had transitioned between life and death, doctors and nurses nowhere in sight to offer the support we desperately needed. We sat with a dreadful feeling, wondering how we could have better advocated for her and knowing she was not given the dignified death she deserved. This feeling would linger and creep up months after her death....continue reading →
June Duong is a medical student in the Class of 2019 at Queen's University
Author’s note: This is a satire inspired by #tampongate on Twitter, which occurred on October 27, 2018 in response to policies regarding the use of menstrual hygiene products during the MCCQEII. All characters in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.
Dr. John Doe woke up on Saturday morning and cooked himself a large breakfast. It was doomsday, for he would be doing his exam this weekend. He was going to be out all day. He did not know whether he would be doing the exam in the morning or in the afternoon — not that it mattered in the end, since he would be sequestered for the rest of the time anyway. As far as the instructions he’s been provided with, all they said was, “Do not bring food. A light snack will be provided depending on your examination schedule.” Dr. Doe, with his three degrees, translated this statement into a big, fat maybe. You may get food so that you can focus on your exam, or you may have an empty stomach gnawing away at itself. ...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,
Looking back, I know there were many reasons I wanted to enter this field — but with the overwhelming and increasingly hectic nature of medical training and residency, it’s sometimes easy to forget what those were.
I don’t want to become jaded so early in the game, but can feel some of my initial idealism ebbing away and cynicism setting in. What are some ways to remind ourselves of our passion for medicine?
The 10th annual White Coat Warm heART exhibit, which celebrates and showcases the creative talents of medical trainees and practitioners from across Canada, will be held in conjunction with the Canadian Conference on Medical education (CCME) in Niagara Falls from April 13th to 16th, 2019.
Submission is via teachingmedicine.com — in order to have your art considered by the jury, you must register (it's free!) Entries can include, oils, watercolours, photographs, pastels, etchings, pen and ink, etc. Limited space will also be available for the display of small sculptures.
The deadline for submission is Sunday, January 27th by 5 PM PST.
Serena Arora is a medical student in the Class of 2019 at McMaster University
I love puzzles.
I love looking at the picture on the box, seeing what the completed version will look like and then pouring out all the little pieces — knowing that, somehow, they all come together to create something.
In some ways, practicing medicine is like doing a puzzle. It’s complex, intersecting, and incredibly rewarding when done right. At the same time, medicine is fractured into a thousand different components. As physicians, we look at our patients and we piece them apart into organs and body systems and tissues. We rip the details we think are important from the fabric of their narrative to focus on specific complaints. We take their words and distill them into our jargon, often so much so that their original story would be unrecognizable. Medicine is often an act of reductionism.
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 →