Reflections for my junior colleagues

Paul Thiessen (MD, FRCPC) Paul Thiessen (MD, FRCPC) In reflecting on my 40 years of general paediatric practice here in Vancouver, there are a number of factors that stand out as contributing to the personal satisfaction I have experienced. Following my medical school at the University of Alberta, and my paediatrics residency in Vancouver (junior years) and the Hospital for Sick Children (senior years), I did a further year as a clinical assistant in neonatology in the NICU in Vancouver before joining my group practice in 1979. My practice group began in the pre-medicare era in 1955, when two paediatricians joined together and decided to adopt the model whereby they would work the same amounts of time in the hospital and office, and divide all income equally regardless of their individual billings. (The senior member of that original duo—who trained under Virginia Apgar in New York—is still alive and compos mentis at 94). This model of a shared group practice has persisted over the decades, and has served us marvelously as it creates a healthy and ongoing interdependence. Working in this manner means we rely heavily on our partners to assume full care and responsibility for our patients when we are unavailable, which means we do not need to worry about coverage when we are on vacation. This brings me to my first bit of advice for new colleagues entering practice—make every attempt not to practice alone. While unquestionably you relinquish some autonomy to practice with a partner or in a group, the benefits in collegiality and peace of mind regarding holidays and time off is abundantly worth any sacrifice of independence, AND you always have colleagues readily at hand to whom you can pose questions and discuss difficult cases. The latter benefit has been amplified greatly in my practice by adopting the use of Whatsapp to allow immediate access to your partners, and we have further enhanced the functionality of this tool by adopting separate chats for handover, scheduling, and social exchanges. Sir William Osler once wisely observed that “It is astonishing with how little reading a doctor can practice medicine, but it is not astonishing how badly he may do it”. One of my most important admonitions to colleagues commencing their careers is NEVER STOP READING. Not only is it deeply satisfying to stay abreast of emerging knowledge but it truly makes you a better doctor and it will gain you respect in the eyes of your patients. All medical journals will send you an e-reminder of their monthly table of contents, and I would urge you to take advantage of this. At the minimum subscribe to the alerts from Journal of Pediatrics, Pediatrics, Paediatrics and Child Health, NEJM and the AAP Daily Briefing. The single most helpful tool I have acquired in recent years to help me stay abreast of the medical literature is READ by QXMD (https://qxmd.com/read-by-qxmd). This is a free app which you can configure to your university library proxy server which allows you direct access to medical journal articles. I couldn’t live without it and heartily recommend it! Another piece of advice I would give is to proactively reach out and teach others in every clinical encounter, including medical students, residents, midwives, nurses, allied health, and of course the patients and families with whom you interact. I have found that folks at every level are very grateful when you make that additional effort to teach them, and the thinking process you engage in to teach helps to embed the knowledge in your mind. Others taught you and me at every step of the way as we advanced in our careers, and I would suggest that we should feel a gentle but steady obligation to pay back and teach others. Be constantly vigilant that what you are doing and teaching withstands the scrutiny of evidence, as pointed out so eloquently in Groopman’s superb book ‘How doctors think’. I love the quote attributed variously to several authors but most probably originating from Mark Twain—‘It ain’t what you don’t know that gets you into trouble, but what you know for sure that just ain’t so’. I self- consciously recall the way we confidently employed croup tents and suctioned the trachea of every newborn delivering through meconium with utter conviction that we were doing the right thing—until emerging evidence disproved it. Generously prescribing ranitidine and PPIs for fussy/crying babies is another current practice that is increasingly being discredited. Stay up to date! The ‘golden rule’ lies at the heart of civil behaviour, whereby you treat others as you wish to be treated. So in the same way that you benefit greatly from the efforts of others who work on your behalf to make the hospital and professional societies function effectively, I would encourage you to adopt an attitude of willingness to contribute by serving on committees, task forces etc. that ensure the effective functioning of our institutions. If you have been imbued with leadership skills, step to the plate and use them so others can benefit. Our provincial fee schedule in BC was greatly enhanced by the tireless efforts of individuals who worked selflessly and skillfully over the years to negotiate with the other sections in our provincial medical association—who are all jockeying to achieve maximal financial compensation for their members. I would encourage you to recognize and thank others for their hard work and be willing to roll up your sleeves and make a contribution. Progress does not emerge from inertia but rather from individuals making extra efforts. In the realm of work/life balance, I would urge you to develop the habit of daily aerobic exercise, as I firmly believe that you should do some activity every day that elevates your heart rate and makes you sweat. Make exercise an integral part of your daily routine like brushing your teeth and not an optional ‘I’ll do it if I can find the time’. The theologian Joan Chittchester once remarked that ‘you have all the time there is—you just need to decide how to use it’. I have observed that many who bemoan their inability to fit exercise into their day’s routine somehow find considerable time for TV and social media. There is abundant evidence that exercise improves the brains ability to focus and stay on task. My aerobic activities of choice have varied over the years with the ages of my children, but now include tennis, squash, hiking and swimming. If you are skeptical I would encourage you to read the book ‘Spark’ by John Ratey, a psychiatrist from Harvard who has devoted his career to exploring the benefits of exercise for the brain. (He says that “exercise is Miracle Gro for the brain”). Exercise is particularly important in this era when the seduction of screen activities tempts us to be increasingly sedentary. There is no app that will do this—we all need to keep moving! Find activities outside of your medical world that challenge you and keep your mind engaged, preferably including friends who are outside your medical circle. Plato said that ‘The mind ought sometimes to be diverted that it may return the better to thinking’, and these words ring as true today as when he expounded them in the third century BC. Your diversion of choice may be sports, crafts, music, dance, theater, art, reading, writing, restoring cars, etc.—but you need diversions. My favourites are reading, music, and film—and in particular foreign films. I belong to a men’s book club that has been extant for over 20 years and is a highly valued source of personal stimulation and companionship. The French renaissance philosopher Montaigne said ‘It is good to rub and polish our brain against that of others’, and a book club truly enhances the opportunity to do that. Consider a period of voluntary service abroad, as mutual exchanges with colleagues in other countries (Honduras, Ecuador, India, Ukraine, and Uganda) have greatly expanded my awareness of the immense challenges they face and the great privilege afforded me of practicing medicine in our economically advantaged society. Finally treat your office staff well and remunerate them generously, and you will be rewarded with their loyalty and hard work. I retired from my hospital practice in June 2019 after 40 years, and I look back on my career with deep gratitude. Dostoyevsky once presciently observed that ‘The soul is healed by being with children’, and I have found these words to be emphatically true. Dr. Thiessen obtained his undergraduate and medical degrees at the University of Alberta, followed by his junior years of paediatric residency training in Vancouver and his senior years at the Hospital for Sick Children in Toronto. He has spent his career as the member of a group of general consulting paediatricians in Vancouver with a strong emphasis in newborn care. He was the Medical Director of the Intermediate Nursery at BC Women’s Hospital from 1996 to 2012 and was instrumental in establishing a ward at BC Women’s Hospital in 2001 devoted entirely to the care of mothers and infants with substance use issues. He was the Medical Director of the Spinal Cord Clinic at BC Children’s Hospital for over 25 years, retiring in 2016. He has been actively involved with the Canadian Paediatric Society throughout his career, and is currently serving as a member of the Board of Directors and the executive, as well as a member of the Board of the BC Pediatric Society. Paul has been a well appreciated co-host of the CPS AGM Goldbloom Journal Club for the past several years.

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