Wisdom from the well

Dr Douglas D. McMillan MD FRCPC I often dip into my ‘well’ (does wisdom come with age/experience?). Unlike a water well in which one brings up the expected clean result, my content is sometimes not so clear but still is often useful. Aware that my concepts may be difficult to integrate into performance, I offer younger (and not so young) colleagues the following thoughts. How (or whether) you use any of these is up to you. As a young cub scout, at each meeting the leader would hold up two fingers on each hand and say ‘dyb, dyb, dyb’ (do your best). Our response was ‘we’ll dob, dob, dob’ (do our best). This may be similar to ‘don’t leave it in the locker room, leave it on the ice (or court or field)’. My experience in sports (especially badminton) taught me that I was often going to lose but that I never wanted to lose because I had not tried hard enough. Although it cost me scraped knees and blisters on my feet, I could sometimes do better than those with much more talent—a great lesson for life. Many people have concerns about ‘credit’ or ‘recognition’. While we all like to be appreciated, you can get a lot more done if you do not worry about who gets the credit. If you work hard, are true to your word and help others, others will do the same with you. You often get more credit and recognition when you are not looking for it. Focusing on the goal (rather than the credit) also helps one more readily accept those times when our efforts are not better recognized. I once heard a Chief Medical Officer state ‘we should never punish those who try and fail; we should punish those who fail to try’. Malcolm Forbes said that even failure can be a success if you learn from it. I try not to say no when asked. I view it as a compliment when someone asks for my participation (presumably expecting a good chance of success). While I may not always have seen the ‘benefit’ at the time, each activity opened more doors, allowing me to meet new people, and learn new skills. Our education system often has us obtain ‘facts’ from the teacher (or another educational source) and repeat them back on examinations documenting our success. In school, I did memorize the times tables but I also learned concepts that you could arrange 12 marbles in three groups of 4 or take 5 marbles away from 12 and you had seven left. With concepts, we should understand not only the ‘what’ but also the ‘how’, ‘why’, ‘who’ and sometimes ‘where’ and ‘when’. During my training, I had the privilege of working with Dr. George Gregory who first reported the benefits of continuous positive airway pressure after identifying that babies grunted to increase their intra-airway pressure when their lack of surfactant was associated with hyaline membrane disease. I know observation and research have improved care and outcome for newborn babies and families and expect the same for other children and youth. It is said that half of what we know today will be shown to be wrong in the next decade—but we don’t know which half. While these numbers may be imprecise, many ‘truths’ are not so true anymore (e.g., sleeping newborns are now supine rather than prone; resuscitation does not start with 100% oxygen). New innovations (e.g., surfactant, inhaled nitric oxide) and a realization that the neonate has unique features which may render the baby susceptible to toxicity (intravenous benzyl alcohol, sulphonamides) have also benefitted babies. I must admit limited understanding when people say there is too much change. As paediatricians, we watch children grow up in an integrated manner never requiring them to obtain language skills before they have motor skills (or vice versa). While we do not want change for the sake of change only, change is the only way that we can provide better outcomes for children, youth and families. While my early associations with physicians (as a child patient) were on an individual basis, my training in medical school, paediatrics and neonatology has emphasized the importance of team work. I have a better understanding that those on the team are not only those who are directly involved with the patient but also include the unit aides, administrative assistants (formerly secretaries) and, yes, even hospital administrators and politicians. Improvements in newborn outcome are at least as much due to obstetricians and neonatal intensive care unit nurses as Neonatologists. Very few of us can be successful on our own. There have been multiple incidences when nurses, respiratory therapists or other physicians have stopped me from making mistakes which could have potentially harmed the patient—be it a miscalculation of a drug dosage or interpretation of my handwriting (not my best feature). I encourage questioning to minimize my mistakes, and utilize these opportunities to help educate others and myself. Those with whom one works are a great source of mental support (particularly during challenging times) as well as more direct assistance. I am appreciative of the value of physicians, administrative assistants and other health care personnel in contributing to my life and productivity in both Calgary and Halifax. Colleagues add greatly to our ability to work effectively and enjoy each day. Some conflict with others is inevitable; lack of conflict may mean that one is not thinking or doing enough. Sometimes conflicts can escalate to damage not only relationships but patient care. In the few incidences of this nature in my life, I have found it helpful to focus on the commonality of goals rather than differences. It is better to never back someone into a corner where their only way out is through you. Phraseology can help achieve the desired goals. Many nurses know that if they tell me to do something my reaction is going to be ‘why should I?’. If they suggest that I do something my reaction is going to be ‘why not?’. Relationships are usually more important that ‘winning’. If it is going to cause a major degree of difficulty, consider going with what others wish. They may be right (and you wrong). They will be happier and you may have built up future ‘credit’—a win-win situation. If I had not been exposed to the wonders and challenges of paediatrics by Dr. Bob McArthur and Dr. Gerry Holman, I likely would have had an entirely different career as a surgeon. If Dr. Ernie McCoy had not directed me to San Francisco where Dr. Dick Bland and Dr. Bill Tooley helped me understand the importance of critical thinking, my life would have been much different. When I first started as a Neonatologist in Calgary, Dr. Bob Haslam influenced my development as did Foothills Hospital Vice Presidents Jeanette Pick and Fernande Harrison from whom I frequently sought counsel as a new Division Head. I enjoy working with medical students and residents. Not only are they keen to learn, they often ask questions that keep me thinking ‘why?’ or ‘what if . . .?’. This helps me continue to learn best patient care. I only hope I have provided equal assistance to them. I hate the term ‘boss’. If I wanted to tell other people what to do, I would have gone into the armed services. A boss may get people to do what is wanted but seldom more. Allowing people flexibility will often result in more. Managers have their role in making sure that things run smoothly; however, good managers are also leaders. They look for ways that things and people can be better. Most people have the capabilities of being a leader or champion in at least one area. While in Uganda with the Healthy Child Uganda (HCU) Project, I once went to a meeting of the Village Health Volunteers at which several mothers had brought their children. A little 7-year-old girl in a pretty yellow dress had obvious microcephaly and was carried everywhere by her single mother. I could do nothing to change this. However, one man said he had a bicycle tire that could make a wheelbarrow so that the mother could move her daughter around (especially as she got older and larger) more easily. Two other women said they could help watch the child while the mother dug in the field (so that she could eat). HCU had provided opportunity so others could be leaders who helped this little girl and her mother. I (like most others who will read this) am privileged. My parents provided good genetics and in an environment which facilitated education without constant fear or lack of the necessities of life. In bringing my above thoughts together, I close with the advice given to me by my father ‘Always forge ahead and help others along with you’. Dr Douglas D. McMillan graduated from the University of Alberta in Edmonton. Following a Rotating Internship and 3 years Pediatric Residency at the Foothills Hospital in Calgary, he trained in Neonatology and Pediatric Pulmonology at the Cardiovascular Research Institute and University of California, San Francisco. His first academic appointment in 1976 was at University of Calgary (presently Professor Emeritus) before moving to Dalhousie University in Halifax in 2004 (now a Neonatologist and post retirement Professor). Throughout his career, Doug has been involved in clinical care, research in a variety of areas, education and administration. He is again Division Head (Interim) at the IWK Health Centre in Halifax after previously being Division Head in Calgary for 15 years and in Halifax for 6 years. Working on development and implementation of educational programs related to newborn care on a global basis has expanded his horizons as has his experience with two children and six grandchildren. While improved newborn care and outcome for babies and families is a great ‘reward’, he is similarly appreciative of the benefits of working with others and looks to share this knowledge with those who can learn from his experiences to make things even better for the future.

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