Tag Archives: doctor


Mark Speechley is a Professor of Epidemiology at Western University


The age-old debate over who should be addressed as ‘doctor’ lives again in recent letters to CMAJ. Of course, it is important not to confuse the public. Since more people get sick than get university educated, members of the public are more likely to have met a physician-doctor than a professor-doctor. As a PhD epidemiologist, ‘the population is my patient’. Consequently, when I meet my medical colleagues in the hospital, I do not expect to be addressed as ‘Doctor’, but should the whole population be in the hospital, and the crowding in the corridors be so acute that I would have the statistical power to practice my profession by expertly assembling the massed throngs of gurneys into long rows of cases and controls, or exposed and unexposed, as appropriate, I would most certainly expect to be addressed as such.  ...continue reading



It’s 1:15 am as I write this.

I’m tired. I’ve worked just under 17 hours today, but I can’t sleep.

Too bad. I will start at 8 am again tomorrow for another 8 to 9 hour day.

I can’t sleep because I’m thinking about my patient with the declining oxygen saturation. I worry that I may have missed something in the history, in the investigations… did the on call physician and I make the right decision?

...continue reading


KAYLAKayla Simms
University of Ottawa
Class of 2016

Upon being accepted to medical school in 2012, I received a special edition of “Oh, the Places You’ll Go” from a personal mentor; reminding me to not just look ahead, but to remember and cherish the distant memories that shape who we are. I recently stumbled upon this memorabilia when I returned home over the March Break, and sat down to write this poem.

This poem is a testament to the physician’s inner-child and the ‘art’ of medicine. ...continue reading

Rich-Roberts preferredRichard Roberts is Professor and past Head of the Department of Family Medicine at the University of Wisconsin School of Medicine and Public Health. He is immediate past president of the World Organization of Family Doctors (WONCA) 2013-2016. He is a family physician and an attorney.

During my term as President of WONCA, I toured hundreds of hospitals and clinics in more than 70 countries. I never expected to be a patient in one.

In June 2012, I was excited to be attending another national conference of the Spanish Society of Family and Community Doctors (semFYC). I looked forward to reconnecting with good friends and mingling with the several thousand family doctors in attendance . My three flights from Wisconsin, USA to Bilbao, Spain were uneventful. The real excitement began as I was settling in to my hotel room.

About 7 pm, I had the sudden onset of several fleeting episodes of lightheadedness. There were no other symptoms and I felt well between episodes. With a regular rhythm and heart rate in the 60s, I concluded that I had jet lag and dehydration. I pushed fluids and rested the remainder of the first evening.

Although I felt well the next day, I was determined not to be the stereotypical physician trying to be his own doctor. I sought the advice of the semFYC President. Within moments, I was ushered to a nearby health center where my exam and electrocardiogram were normal.

The following day, I had several more episodes while touring another health center. A quick electrocardiogram revealed atrial fibrillation with a controlled ventricular response of 92 beats per minute. My rhythm converted spontaneously to sinus in a few minutes. Even so, my hosts insisted on driving me to a major teaching hospital. Their faces betrayed a mix of sincere concern and worry that an esteemed guest would die on their watch.

My memories of my experience in the Bilbao hospital remain vivid. The 4 hours I spent there seemed an eternity, and yet passed by in a flash. I remember the 40 minute registration process, for someone with an acute cardiac condition! Bureaucracies are the same everywhere. The bright ceiling lights all seemed positioned strategically to make it impossible to keep one’s eyes open while supine. These minor annoyances were much less memorable than the people who looked after me.

Mostly I remember the nurses. The emergency physician breezed by me several times, but it was the nurses who made certain that I knew that someone cared, that I was in good hands. Perhaps that is why I found myself humming the Leonard Cohen song “Sisters of Mercy.” I did so quietly, not wanting to add to the suffering of those around me.

My exam, blood tests, chest x-ray, and electrocardiogram were all normal. The hours of waiting enabled me to call my wife, my family doctor, and a cardiologist back home to inform and to seek advice. Even before I left the hospital, they made arrangements for a more extensive evaluation on my return home.

I later reflected on the miracle of modern telecommunications and on the privilege of being a physician. Mobile telephony instantly connected me across the world to those at home, where I really wanted to be. My colleagues at home made certain that my eventual treatment was swift and skillful. The paroxysmal atrial fibrillation resolved after catheter ablation. Yet, it did not feel right that the system moved faster for me than I was able to make it move for my own patients.

Writing this blog prompted me to look back on the lessons learned and on the priorities I reset for myself as I went through the first major health episode of my life. As a physician, I understood well my condition and the murky state of the science that guided therapy. I was annoyed at the interruption in my busy life and anxious about the risks and possible failure of treatment. As a patient, I assumed and received clinical competence and technical prowess. Better communication and empathy were the two qualities that were sometimes lacking.

As a result of this experience, I resolved to work harder to spend more time with my family and to listen longer, and better, to my patients. A candid self-assessment confirms that I remain a work in progress.


* This blog is part of a series that CMAJBlogs is publishing in the lead up to the International Conference on Physician Health #ICPH2014 to be hosted by the British Medical Association September 15-17 in London, UK

Domhnall MacAuleyDomhnall MacAuley is a CMAJ Associate Editor and a professor of primary care in Northern Ireland, UK

Recognising achievement is important. A Fellowship ceremony at a Royal College marks the beginning of a career in a chosen specialty but it also bookends a difficult period of intense study, commitment, and sacrifice. It was a privilege to witness this milestone as a new wave of young doctors shared their pride and pleasure with friends and families. They are the future of medicine.

The academic procession of almost exclusively older men, predominantly grey haired and in elaborate academic robes, added gravitas to the occasion. But, I also wondered to myself what they might think of the changes in a profession undergoing a radical transformation.

Young doctors think differently. They expect a professional life with a work life balance. Work is not the only thing - an approach endorsed by working time directives and official guidance on duty and responsibility. Young doctors do not buy into the historical model of a male dominated competitive and career focused process of education and training. Expecting people to fit into an old style training programme is no longer realistic. The long and arduous rotas of previous generations are no longer acceptable and this means fewer hours.

Many senior doctors feel there is now insufficient exposure to patients- and they may have a point. If we simply reduce the hours without revising the educational model, this is unavoidable. It is simply impossible to squeeze traditional teaching into the time available so there will, inevitably, be less patient exposure, less experiential learning and, almost inevitably, inadequately trained doctors. We need to think differently. Education must adapt. We can no longer think of training towards an endpoint, but looking at training itself as a long term process.

The gender balance in medicine has also changed. Pregnancy is a reality. Yet, I am not sure that our medical leadership has fully accepted the principles of equality that must allow young women to integrate career and family, not to mention fathers. There is no equality without paternity leave. It is not sufficient to support the rhetoric of healthy pregnancy, shared family responsibilities and professional equality if we do not see it put into practice. Rather than see pregnancy as an inconvenience in medical training or an awkward gap where service needs are compromised, we need to accept it as the norm. It is unfair and unrealistic to expect half the profession to sublimate nature and delay pregnancy simply to fit with an archaic training model. We need to change the way we think and we need to change what we do

To create a caring empathetic and nurturing profession, we need to care, nurture and appreciate the needs and expectations of our colleagues. We need to be creative, and redesign, not just careers and curricula, but our mind set.

Uncomfortable as it may be, it is important that the profession has a radical rethink. True leadership means fostering change. It’s not just the attitudes of young doctors. Medicine has also changed; it is more technical, more ‘high intensity’, constantly monitored and increasingly less tolerant of uncertainty. On-call is difficult, work is tough, doctors’ quarters are long gone as are the comforts of the doctors’ mess. It’s the day job, except that it is at night.

Let’s recognise that doctors’ life aspirations have changed, the gender balance has changed, and the job has changed. We, the older members of the profession, need to change too.