Dr. Lawrence Yang, Surrey
Among my most rewarding experiences as a doctor are helping patients who suffer from chronic diseases such as diabetes and major depression learn how to self-manage their conditions, and watching them shift from despair to a feeling of empowerment about their health.
I feel extremely fortunate. Having gone through medical training and survived my residency has given me the knowledge to be healthy myself – to know what foods to avoid, how much sleep I require, what exercise to do … I want to share that knowledge with my patients and help empower as many people as possible to improve their own health, fully enjoy their lives and pass on their knowledge to their children.
As doctors we are battling a lot of obstacles in today’s society: fast food marketers, the ready availability of alcohol and street drugs, physical and sexual abuse that is still all too common and not widely discussed. Many of my patients in the Surrey/Whalley area are low income. Some come from backgrounds where they did not enjoy the privileges of higher education, a stable family upbringing and positive parental role models.
There’s no way I can transfer all my knowledge to my patients in the short time they are in my office, so I provide them with resources about their conditions that they can take away and review on their own. This might be handouts, or for those who have internet access it might be links to good online resources I’ve found. I’ll have them come back to see me in a week or so, at which point we can discuss what they’ve read and I can assess how much they’ve retained. The knowledge they gain empowers them to manage their own health.
My days start with hospital rounds in the morning, where I typically see two or three patients who have been admitted because of the gravity of their illness, like an acute infection or cancer. I then have office hours, seeing patients from about 10 a.m. to 4:30 pm, followed by a couple of hours of paperwork.
I’m involved as a peer educator for my colleagues through Fraser Health’s Practice Support initiative. Next year we’ll be rolling out a module to share with other family doctors the latest care for rheumatoid arthritis and lower back pain. And in my practice, I teach medical students from Canada and other regions like the Caribbean, and work with a resident who shadows me once a week to gain family practice experience.
In my spare time I volunteer at health fairs, mostly about diabetes. I was recruited by my father, who has been a family doctor in BC for over 40 years. This kind of community involvement was instilled in me as a resident in New York, where I did my training, and I know UBC grads here do it too. We believe that health literacy and education are the keys to a healthier community. I try to talk to patients I meet at these fairs about the importance of finding and seeking their care from a regular family doctor. Many don’t know this is an option for them, or don’t know where to look.
Dr. Paul Mackey, Fort St. John
Family physicians in Fort St John do pretty much everything, in part due to the decreased access to specialist services. We are the obstetricians, the ER doctors, the palliative care and oncology cancer care doctors, the internists and minor surgeons to name just a few of the special skills we have. We do have support from our local specialists but, because they are also few in number, we share the load.
I see patients during regular office hours, but I also provide anaesthesia twice per week, care for my hospital inpatients and run the Family Practice Residency Site. I am also on call on average twice a week for emergency or anaesthesia.
I try to help my patients get the most out of their visits with me by encouraging them to be organized and to take responsibility for their own health. Health care is complex. Patients live with their health conditions 100% of the time, whereas they are only seeing me about 1% of that. As family physicians, we need to help them learn the skills and resilience to manage their own health.
There’s really no such thing as a typical day in my practice but we could simply pick yesterday to illustrate the “usual activities” of a rural family doctor: reviewing test results with patients, helping patients manage their chronic conditions such as heart disease or diabetes, doing an Immigration Medical, doing an initial maternity visit with a first-time mother. As I was the anaesthetist on call I also did the pre-op assessment clinic at the hospital and in the midst of it all was called out to do an epidural on a woman in labour. Later, at the end of the day I was back at the hospital adjusting the epidural and putting in another. Unfortunately (for all involved) we were all back in the hospital in the middle of the night to do two caesarean section deliveries.
This type of family practice has its rewards and challenges, but if I didn’t like it I wouldn’t be doing it. The rewards come from being able to offer such a broad skill set to my patients and the community .The challenges include trying to provide good health care service with the limited resources and health care workers we have, for people who are living in a pretty isolated community. And our patients recognize this: during my “yesterday” several of my regular patients were at pains to make sure that I got some time off in the summer. At the same time, it’s rewarding doing something for my community too. And we have to admit to taking some certain pride in being tough “northerners” who are willing to cope with adversities that our more southerly neighbours wouldn’t.
Dr. Tania Culham, Vancouver
My work takes place in one of three inner city public health clinics in Vancouver, and it’s definitely not a typical family practice.
I’m part of a multidisciplinary team whose goal is to provide care to those who have trouble accessing it because of issues like mental health, poverty, addiction, or illnesses like HIV/AIDS.
Our patients include individuals with mental illness, youth and the lesbian/gay/BI/transgendered/queer community (LGBTQ) to name a few. Many have been bounced around a lot by the health care system and may have been denied appropriate treatment because it was assumed they were drug seeking. We don’t judge; we listen. We try to find out what’s really at the root of the problem. Are they using drugs to manage an underlying medical issue, for example?
Patients feel like this is their clinic. They know that here they aren’t defined by their poverty, lack of education, inability to hold a job… It’s rewarding when they open up to us, because they’ve come to trust us and know that we are truly interested in what they need. An increase in openness leads to a better understanding of what the patient needs and ultimately results in better care.
I’m fortunate to work as part of a care team, with excellent front line staff, nurses with specialized training and counseling services who understand the specific needs of our patients. We share the care of patients, each providing our own expertise and ultimately I hope providing much of the care the patients need.
Youth can come see us during drop-in hours or they can develop a long-term relationship with us and make appointments during office hours. They’re a different type of patient, with expectations of immediacy. Many have been to walk-in clinics but did not receive follow-up care or continuity. We teach them the importance of having a family doctor and taking responsibility for their own health. We develop an ongoing doctor-patient relationship, and show them that it’s good to have one person who knows them and can care for them.
I guess to sum it up, I feel like I’m able do more than just care for my patients’ physical health. I am a role model, involved in all aspects of their lives – emotional, developmental and social. I love my job, because my patients trust me to treat them with dignity and integrity. They open up to me so that I’m able to truly help them.
My six-year-old son says I have the very best job because I have to learn and do new things every day. I think he’s right.
Dr. Charles Helm, Tumbler Ridge
Elliott was seven when I first met him. My wife, a volunteer athletics coach, had persuaded me to take an hour off work to run laps with the kids at the elementary school. Elliott was the keenest. Afterwards, he looked straight at me, and with a determined smile exclaimed, “I will be an athlete, I will run with you." I remember thinking that this was a kid to watch.
Elliott was seven when I first met him. My wife, a volunteer athletics coach, had persuaded me to take an hour off work to run laps with the kids at the elementary school. Elliott was the keenest. Afterwards, he looked straight at me, and with a determined smile exclaimed, “I will be an athlete, I will run with you.” I remember thinking that this was a kid to watch.
It was not to be. Weeks later he was in my office, short of breath, wheezing. Examination yielded the unexpected: fever, gallop rhythm, a diastolic murmur. If I closed my eyes, I could transport myself back to mission hospitals in southern Africa, where I would have resigned myself to the reality of another case of rheumatic fever. But here I was in northern Canada, with an unsettling deja vu sensation.
“Recent sore throat?”
“Yes, about two weeks ago,” said his mother.
I struggled to recall diagnostic criteria from two decades earlier: one major, two minor criteria…
I phoned the on-call cardiologist at BC Children’s Hospital.
“This sounds crazy, but I think I have a kid with rheumatic fever.”
He responded in a South African accent, and I felt relief in a bond of shared African experience with a disease now rare in Canada.
Soon Elliott was in Vancouver, “Exhibit A,” as he put it, for innumerable trainees to sense aortic regurgitation and a disease of yesteryear through their stethoscopes. Three weeks later he was back, heavily medicated, with the task of conforming an eight year old body and mind to the need for exercise restriction. Yet he adapted well, and would tell the story of his heart with a perfect mix of pride and wistfulness. His radiant, honest smile would melt the hearts of others by concentrating their thoughts on his own fragile one.
Over time Elliott developed a stocky, beefy build, tough and strong as one of the ankylosaurs whose footprints famously grace the local creek-beds. He looked like a scaled-down version of an Olympic shot-put medallist. Definitely not the ideal physique for a distance runner, even with a perfect heart.
I hoped that shot-put might give him a way out of the enforced rest, and phoned his cardiologist for approval. The response was deflating. Shot-put, javelin and discus involve a second of super-exertion just before the moment of release; too risky for a damaged heart.
I broke the news, trying to sound upbeat. “No worries, Elliott; one day I know you’ll be fixed, and then we’ll start over.” He replied with his usual equanimity: “Right, no worries, doc.” I struggled to remain composed.
Some years later Elliott probably forgot a few doses of prophylactic penicillin. Then he developed tonsillitis. A week later, he was in the ER, struggling to breathe.
Temperature 39 degrees, basal crackles, ESR 120, WCC 21 000, first degree A-V block, then complete heart block. I considered it the most important IV start of the decade, and Elliott’s veins were elusive. “Elliott, please just keep your hand still for me.” In it went, easily, a minor miracle. “I knew you’d get it first time,” he said.
In went the furosemide and antibiotics. In went Elliott into the air-ambulance that would deliver him to BC Children’s Hospital once more. I shook his hand, knowing that it was not certain I would see him again.
Those were dark days, punctuated by phone calls from his mother. Was this another attack of rheumatic fever, or subacute bacterial endocarditis, or an aortic root abscess? It didn’t matter to me; what counted was just that this was a very sick boy, from whom I felt hopelessly distant.
Finally, word came that his aortic valve would be replaced, years before what was deemed optimal. There were no dry eyes in the office when we heard that he had pulled through and had given the thumbs-up after a mammoth operation. The subsequent retrosternal haematoma and transient renal failure were minor hurdles by comparison. Elliott then left hospital to attend the Juno awards, tripped over a rock, and landed on his sternum. Mayhem ensued, but thankfully little damage was done.
Finally, three months after he had departed, he was back in my examining room, smiling. A new aortic valve. A new beginning, thanks to a wonderful team of caregivers, splendid family support, and raw courage. He brought with him a vial of benzathine penicillin. “I need this monthly; I’ll assume the position,” he said with self-deprecating resignation as he exposed his buttock. Easier than the last time I penetrated your skin with a needle, I thought.
It is no surprise that Elliott became a poster-boy for BC Children’s Hospital. His winning ways radiate appreciation of simply being alive; his successful outcome offers a message of hope that translates into the opening of wallets. I enjoy his triumphs vicariously.
I count my blessings. I am fortunate to be a family physician, privileged to end up with such family in such a magnificent part of the world; a place so little understood that in my spare time I can explore it, make discoveries, establish hiking trails, find traces of its dinosaur past, help create a museum, write its first books. I must be the most fortunate person on the planet. It matters not that many others can make such a claim, only that I believe it implicitly, and act with the same gratitude that Elliott displays for being alive.
I have now worked in this remote community for nineteen years. The colleagues and compatriots of my vintage have long since moved on to suburbia. I have bucked the trend and tried to perform an essential, simple task as best I could. Did I simply get stuck, did inertia overcome my youthful momentum?
No, I can go cross-country skiing after work, or for a trail run that begins at my doorstep at sunrise, and reflect with joy that I made the right career choice. Being a line of first defence when residents of this isolated place take ill, being their advocate in times of need, having the knowledge that anyone, with any imaginable ailment, can present anytime, and I must somehow provide adequate management: these are challenges, but challenges that are rewarding beyond measure.
Is this amply fulfilling way of life becoming obsolete like rheumatic fever, extinct like ankylosaurs? This is an age of angst and uncertainty – more work, higher expectations, fewer supports, fewer colleagues, little understanding from health authorities… a long list of worries. How long until I say, Lutherlike, “Here I stand, I can do this no more.”
Rather than wallow in doubt, I concentrate on the certain. Elliott is now in high school, active and muscling up. The last time he came for his injection, he said, “I am joining track and field. Javelin will be my specialty.” The smile was confident, determined. After seven years Elliott and I are back on track.
When the snow is off the ground, and my wife calls the first track and field practice, I’ll be there. This much is certain.