At the end of my high school years, I confirmed two guiding principles for my life. First, though I excelled in most of my academic subjects, I would never be the best in any subject nor at anything I tried to do in life. So, I made the decision that I should aim for, say, 90%. It would be so much less stressful! Second, when I prepared to make important decisions for my future, I realized I NEVER generated positive inner feelings to indicate I was taking the best course of action. I often envied my friends, those with specific talents who had a clear path in front of them, who knew what they wanted to do with their lives. Instead, I had NO feelings when I made a good decision for my future. However, when I was about to take a wrong path for my future, I immediately felt a deep, empty, negative feeling. I recognize that these reactions have remained constant and have guided my major decisions. How did do these important insights translate into my decisions leading me towards becoming a Family Physician?
In high school, I liked the arts, but I struggled and did not feel I was very competent. I was very comfortable with the sciences. I liked the logic of figuring out how everything worked and interacted. I liked all the sciences, so which one would I choose? I really liked the beautiful colours produced by chemical reactions – so I simply used that criterion to choose an Honours Degree in Chemistry.
In England, Dame Cicely Saunders opened the first residence for patients with no further active treatment possible, called St. Christopher’s Hospice. This was essentially the beginning of the hospice movement in the world.
Was it a good decision? I enjoyed and learned a great deal during my four years, augmented by spending summers in practical research assistant jobs. Near the end of my fourth year, the thought of a career in chemistry produced an emptiness within me – it would not be right for me.
During my four undergraduate years, I occasionally wondered what I would do once I graduated from my chemistry program. Serendipitously, one day, while supervising a first-year laboratory session, I noticed one of the students was a priest who assisted at our church. When I asked why he was doing first-year chemistry, he stated, “I can’t be effective in helping people spiritually when they are physically unwell.
So, I will become a physician, then do missionary work in poor areas of South America as both a physician and spiritual healer.”
Immediately, this resonated with me. “Yes, I could become a physician. I could help people!” And without further thought, I applied for the medical program at the University of Ottawa, then put the decision out of my mind while addressing a busy fourth-year workload. About three months later, I received an invitation for an interview. I was stunned, barely remembering that I had filed an application! I decided to accept the invitation if only to experience the interview process. Believing that my chances to be accepted were very small, I was very relaxed and enjoyed the process.
Then, again, I was stunned! I was accepted into the medical program. The idea of becoming a doctor did not generate any initial negative feelings. I went into my ‘observer’ mode, reviewed the curriculum, and accepted the offer. I believed I would do well in the first year which was essentially chemistry, biochemistry, and anatomy. My concern was for the second year. We had a mandatory course to teach us how to interview and examine patients. As a still a strong introvert, I believed, that through this course, I would demonstrate my incompetence in communication skills to my patients and professors. I was quite sure these experiences would generate my negative inner feeling leading me to change directions to another field. Still, I felt I had to try.
In Montreal, Canada, at the Royal Victoria Hospital, Dr. Balfour Mount opened the first hospice in the country. He had heard of the initiative of Dame Cicely Saunders at the St. Christopher’s hospice in London, England. He had spent some time with her and felt this type of care was very needed for patients at near-end-of-life in Canada. Dr. Mount called the new initiative ‘Palliative Care’ instead of using the term ‘Hospice Care’ used in England due to connotations of the word “hospice” in French (a place where unwed mothers stayed while waiting to deliver their babies).
Then, again, I was stunned! I was accepted into the medical program. The idea of becoming a doctor did not generate any initial negative feelings. I went into my ‘observer’ mode, reviewed the curriculum, and accepted the offer. I believed I would do well in the first year which was essentially chemistry, biochemistry, and anatomy. My concern was for the second year. We had a mandatory course to teach us how to interview and examine patients. As a still a strong introvert, I believed, that through this course, I would demonstrate my incompetence in communication skills to my patients and professors. I was quite sure these experiences would generate my negative inner feeling leading me to change directions to another field. Still, I felt I had to try.
I clearly remember the interview with my first patient in the hospital. I was given a form with the medical questions I needed to ask. When I entered her room, a saw my patient sitting in her bed, and before I had time to introduce myself, I observed how nervous she was. She had agreed to be interviewed by a medical student, but it was her first time, and she did not know what to expect. My heart went out to her, and all my fears dissipated in that moment. I introduced myself and asked if I could sit in a chair beside her bed. I put away my questionnaire and said, “Tell me what brought you to the hospital.” Then I sat back and waited for her to collect her thoughts and tell me her story. We bonded through that interview. I obtained the information I needed with only a few additional questions to supplement her story towards the end of the interview.
From that moment on, I knew I would be able to complete my medical degree. I had already known that I could easily learn the science of medicine. Now, I was being introduced to the art of medicine – talking with patients, listening to them, building trust, discerning their problems, and finding ways together to find solutions. I realized that this fusion of the science and art of medicine left me calm, with no negative inner feelings. My calmness gave me permission to continue towards my medical degree, but would I really be good at this process? I would only find that answer through time and experiences.
Throughout my four years as a medical student, people related examples of what they saw through my behaviour facing difficult challenges. Two specific examples reinforced for me their perceptions of my decisions making.
One day in the emergency room, the situation became chaotic with several very unstable patients admitted within minutes of each other. I was terrified, unsure of what to do and what was needed of me as a mere student. I just slipped into my observer mode for a few minutes – quietly assessing the situation, understanding who was there, what was being done, and how I could be the most useful with my limited skills. Outwardly, I appeared still and calm. A nurse came up to me and stated, “At your level of training how can you be so calm in crises?” I smiled. Though terrified, I could still assess the situation, appear calm to others, and find ways to be helpful.
I recalled another situation during the summer break at the end of second year. I was selected for an eight-week studentship in the oncology department of the hospital. I was assigned to an excellent physician to help her with several research projects and gain bedside experience in the clinical care of her patients. She cared deeply about her patients and was dedicated to finding better ways to treat all types of cancers. But she did not speak French, and she admitted she had difficulty talking to patients when her treatments were no longer effective, and they were close to dying. She observed me speaking to several patients and noticed my empathy, whether I spoke in French or English, and that the patients liked to talk with me. Because of these observed qualities, she often assigned me to ‘breaking bad news’ to her patients, releasing me from my research duties to stay with them when necessary to answer their questions and support them.
The fact that others recognized the bond I was able to build with patients combined with my lack of negative inner feelings gave me the confidence to continue for the four years and successfully obtain my medical degree.
Medical Specialty: Family Physician Program
Towards the end of the final year of my medical program, I needed to make another life changing decision, “What speciality did I wish to pursue?” I had had four-week experiences in most of the medical specialities. After the first few days of orientation, I enjoyed the challenges and nuances of each rotation. As usual I was drawn to the areas that were most reliant on science, drawing on my ability to quantify problems and find clear solutions. But I could not bring myself to complete an application form for any of these specialities, even though in Ophthalmology I was assured that my residency would be accepted.
My last rotation in fourth year was in Family Medicine. At the orientation session on the first day, as our preceptor explained the principles of Family Medicine and the structure of our experience, two concepts resonated with me. Family Medicine encompassed aspects of all the other specialities – so there would be no need to decide which field was most interesting. Family Medicine encompassed both the science and the art of medicine. We would learn how to care for patients and their families throughout the spectrum of their lives from birth to death, in health and in illness. Within a few days, I completed the application form for the Family Medicine Program at the University of Ottawa without generating any negative inner feelings. In due course, I was accepted.
I completed three years of the Family Medicine Program Residency, which equipped me with the base for my future medical practice. Listed below are the major insights gleaned from this teaching program.
Science of Family Medicine:
I gained a sound knowledge of Family Medicine concepts including the science behind the ideas and how to achieve them in the context of day-to-day practice. I used a supplementary third year to gain greater skills in clinical obstetrics and, as chief resident, I mentored younger residents in the program.
Art of Family Medicine:
I gained deeper understanding of the importance of the art in the delivery of Family Medicine, enhanced by making home visits. During a home visit, I could observe how patients lived and what was important to them. Often the visit included close family members while photos on the wall brought an awareness of the extended family. I took more time to understand the family circumstances, incorporating these into my solutions to their unique medical challenges.
Computerization:
I gained a respect of the power of computerization to assist the day-to-day documentation of our practices and provide easily accessible patient information for future research. The University of Ottawa’s Family Medicine Program was a pioneer in developing computerized patient databases into clinical practice. I immediately saw the potential for the future, while realizing that the effectiveness of the computerized patient medical records would take time, commitment, and financial investment.
Care of Patients at Near-End-Of-Life:
The structure of the Family Medicine program allowed for frequent monthly rotations within various specialties. We spent most of our time in the hospital to prepare us for acute emergencies and the care of complex patients. We saw our own family medicine patients once a week throughout the two-year period and more often during our monthly Family Medicine rotations within the unit. The Family Medicine program was not organized to allow extensive, continuous exposure for the care of patients at near-end-of-life, but I was able to follow a few of these patients. I learned the importance of advocacy, helping them navigate through their specialist visits, explaining the results of the investigations, treatment regimes, and the significance of their symptoms.
