Reflections on a career as a paediatrician

Dr Bob Hilliard I started out at university aiming to earn a PhD in mathematics, but in my first year, I realized I would rather be a doctor because people were much more important than numbers. It was during my three years as an undergraduate student at the University of Saskatchewan (Saskatoon, Saskatchewan) that I realized I wanted to be a paediatrician, to work with children. One summer I worked at Camp Easter Seal, working with children who were marginalized and with children who had a variety of disabilities. It was fun, but a lot of work helping them with games, arts and sports. But the smiles and laughs were infectious. It was rewarding watching them do new things they had never done and seeing how excited they were. Another summer I taught at several vacation Bible schools, and I found that when we met at the church I much preferred to sit at the table with the children than at the adult table. The children were filled with fun, enthusiasm and excitement. During my two years as the only physician at a small hospital in Kenya, I found that the problems the children brought were far more challenging and the successes far more rewarding than the work with the adult patients. So I was going to be a paediatrician. I have been a paediatrician for more than 37 years, and I still find talking with children the most important and enjoyable part of my work. I find the older I get, the more I talk with the children. I try to get as much of the history from the child, and I always explain the diagnoses and plans of management with the children, hoping that the parents will be listening attentively. I know that some parents get frustrated with me because they want my attention. But I believe children need to know what is wrong with them and what is planned. So I talk with children. Looking back over these years, I wouldn’t change any choices I made during my career. But as I reflect on being a paediatrician, I realize how important it is that we be child-like, not childish or immature or silly, but like children – our patients. Children have a real excitement about things. They have a sense of wonder. Whether it is a child chasing a floating balloon or soap bubble, skipping down the street, a child playing with a computer game or another trying on new clothes, there is a sense of excitement. I often ask my family or my students or residents, “So, what’s exciting?” It is a shame if we have nothing exciting in our lives, whether it is with our work or with our families at home, or with our interests or hobbies. I have always enjoyed my work, but I also enjoy time with my family canoeing, kayaking, hiking, or playing Monday night hockey or my trombone in a concert band. I think we need to find things both in our work and away from our work that are exciting, stimulating and fun. Children are constantly asking questions. Children have a powerful urge to find out about things, to figure things out. They ask many questions, often deep unanswerable questions and they love to play guessing games or solve riddles. The intellectual growth of children comes from exploration, testing and investigating rather than only from listening. I watch our students and residents dutifully do what they are told by their seniors or staff experts. But we need to ask more questions. What is going on with this sick child? What should we be doing? Why are we doing this? Expert opinions and practice guidelines are very important and useful, but we need to ask more questions and not just accept what we are told to do. Children are constantly learning. Some of this is involuntarily, learning to talk, to walk up stairs; some is formal learning at school; and some learning, eg, to ride a bicycle, to play hockey, to dance ballet, can be fun and exciting. Even though we have completed four, five or six years of formal paediatric training, we still need to continue learning, and we can learn from residents or students or, more often, from our patients and their families. As a teacher, whether it is in medical education or at Sunday school, some of my greatest thrills are to watch residents, students or children whom I have worked with, give a great presentation or clinical discussion or show self-confidence and maturity. Children are usually open and honest unless telling the truth will get them into trouble. I laugh sometimes when interviewing a family to hear a child blurt out something that happens in their home, something that the parents didn’t want them to tell me. Even with me, the paediatrician, children can be open and honest telling me what they like or don’t like. We have to be sensitive to the needs and feelings of our patients, our families and our friends and colleagues, but we also have to be honest in all we do. Children can show considerable empathy toward people and animals when their own needs do not conflict with the needs of others. My own two children were always supportive of one another, and when we were in Africa, they were concerned about all the people that came to our house. It is easy as we progress in our careers to become a little hardened and cynical, but I would hope that we would all have that same empathy, concern and caring for children that we had when we applied for a paediatric residency and started our paediatric careers. So as a pediatrician, I hope I will never out-grow being a child: open, honest, empathic, learning and asking questions. Bob Hilliard is a general paediatrician and clinician-educator at The Hospital for Sick Children (Toronto, Ontario). He completed his medical degree at the University of Toronto (Ontario) (1967) and paediatric training (1970 to 1975) at The Hospital for Sick Children and Montreal Children’s Hospital (Montreal, Quebec). He worked for six years (five in church hospitals) in Kenya, the Democratic Republic of the Congo, Uganda and Ethiopia. Bob later completed an MEd and EdD at the University of Toronto. Dr Hilliard has been active with the Canadian Paediatric Society as a member (10 years), a chair (six years) of the Annual Conference Committee, a member of the Bioethics Committee and served as Canadian Paediatric Society President from 2010 to 2011. One of his goals is to improve the standard of child health by helping in the formation of a thoughtful, compassionate, caring family of physicians and paediatricians. Bob has been involved in all aspects of teaching and faculty development. He has served as ward chief on the general paediatric in-patient unit and continues as consultant paediatrician in the general pediatric clinic and with the Children’s Aid Society of Toronto. He enjoys the interaction with students and residents who are open, honest, curious and willing to think about problems in a new way, the key being a mutual trust and respect, and having fun while learning. With his Africa experience, Bob has an interest in global child health and immigrant children, leading workshops addressing the medical and psychosocial issues of immigrant children. With the Royal College of Physicians and Surgeons of Canada, Dr Hilliard has been chair of the Paediatric Specialty Committee, examiner (15 years) and chair (seven years) of the oral examination boards. Family is equally important. Bob’s favourite activities are hiking, canoeing and kayaking with his wife Jean, playing trombone in a community concert band, Monday night hockey, jogging and teaching Sunday school. Most of all, he realizes that it has been a privilege learning alongside the brightest and best medical students, paediatric residents and health professionals.

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