Racism is alive and goes both ways…

I am a Caucasian doctor covering a maternity leave for a physician of Pakistani descent in Mississauga, Ontario.

She is born and raised in Canada, speaks English fully and has no accent.

She wears a hijab and other forms of dress consistent with her religion and culture.  She clearly identifies with her ethnic background and religion.

She is Canadian.

I had no idea racism was so prevalent in Canada when I agreed to cover her maternity leave.  It has shown itself in multiple ways in daily interactions–none so loud and overt as the video we have all seen about the woman yelling for a “white doctor” in a walk-in clinic in Mississauga, but present nonetheless.

Several of her patients, within minutes of meeting me, have asked me to become their permanent family physician since they “connect with me more”.  They known nothing about me or my skills, and have had no opportunity to connect or establish a rapport.   They simply know what I look like.

Then there are the many other patients who I have to work so much harder than expected to win over. They inherently don’t trust me, won’t listen to my opinion or advice and will automatically assume I am wrong.  They are often rude.   You may expect it’s because I’m not their regular doctor except there is a consistent theme as to who these patients may be.

The sad part is I am now able to predict which patients will love or hate me often based on their skin colour.   Something I never expected or anticipated.

Many of the patients of South Asian descent over 50 years old seem to have decided prior to meeting me they don’t like me before I open my mouth.  There have been a few who try to undermine me by asking the reception staff to call the doctor I’m covering for in an attempt to get what they want because they don’t trust me and others who have point blank said they won’t come back until their doctor is back.

There are only a few I have won over and now trust me with their health care.

I find both groups difficult but in light of the video,  I think it’s also important to point out how rude and degrading many people are to those from other ethnicities period. There is a nurse in our clinic who is of African descent and is black.   She faces significant attitude and rude behaviour from the predominantly South Asian descent patient population.

Honestly, I will think twice before I agree to cover another doctor of a different race. 

It wasn’t something I considered when I took this locum position because I know I am not racist.

However, I hadn’t realized so many of the patients would have such a problem with me and be so blatantly rude.

My own family physician is a male of South Asian descent.  I have moved away from him quite a distance, but I still always go back because he is great.

My Canada doesn’t discriminate.

healthoverrace

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Embrace the Exceptional Value of Inclusivity.

pexels-photo-87584.jpegWhat does it take to go to work feeling devalued because of your race, gender, religion or sexual orientation? I can tell you, it takes a toll, and it changes us a little bit each time we experience these prejudices. I know, because it happens too often and I have seen the effects over time. Let’s stop being bystanders to such behaviours. We need to speak out when we see such bullying.

I thought naively, that in 2017, in Ontario, we had overcome so many of the prejudices of our parent’s generation. After all, Canada prides itself on being the Mosaic of Countries; enriched by our multiculturalism, diversity and exceptional fabric of inclusiveness. This week brought our dirty secret out into the open once more. We were revealed to all the world as the haters we can still be. A mother, seeking care for her ill son, was filmed asking to see a “white doctor who speaks English and doesn’t have brown teeth.” Now, I have seen many instances of patients behaving badly, especially, when they are frightened, anxious, or in pain. We make allowances for minor transgressions of civility in most of these instances, and on a daily basis, I regret to admit. After all, who amongst us hasn’t been pushy or even rude when we are stressed? However, this woman went well beyond these lesser transgressions in her diatribe. She felt it was within her rights to denigrate a physician, because of his race and his appearance. All semblance of polite Canadian values fell by the wayside. The on camera footage stripped bare for us, our collective failings.

How did it come to pass that the colour of a doctor’s skin, his accent or his dentition, should determine his competency, let alone his compassion and his humanity?

Everyday, in clinics and hospitals, around the country, micro-aggressions play out against medical practitioners. Most of the time, our trainees face the brunt of these offences. I have had to intervene too many times to count, when a patient is refusing the care of my resident simply based on their gender. Whilst we strive to make all patients comfortable as much as possible, please understand that when you enter a teaching hospital, we ask you to be open minded and generous, so that we can train the next generation.  If for religious, or other reasons, you need to see a same sex provider, we will do all we can to accommodate your request. But, when your care is of an urgent nature, or the best clinician available is not of your preferred gender, we ask that you consider why we are recommending care by this physician. And if, by chance, our colleague, whether in training or as a licensed/experienced physician, is different from you, please see them for the human they are; the one who has chosen to make your life their life’s work.

We all want to be valued and respected for who we are and what we do. It’s what we must demand of each other.

Why I did (but shouldn’t have) become a doctor…

There are a million terrific reasons people go into medicine. Sometimes it’s to follow in the footsteps of a parent or cherished uncle. Sometimes it’s to harness your gifts with people to a higher purpose. Sometimes it’s to build on a budding career in science or community engagement. Sometimes it’s a passion to be in the ER or OR, in the thick of things to save a life, sleep be damned.
And then there are those of us in medicine for the wrong reasons.
I’ve identified five of them: ego; greed; spite; cultural conditioning; and a phenomenon I’m sure I’ll come with a catchy term for someday – the societal understanding that medicine is what smart, accomplished kids are supposed to strive for.
There’s naturally all sorts of overlap here, and I’ll admit to at least three.
Realizing that your place in life is to serve as a poster child for bad career counseling is disheartening to say the least, but it’s also somewhat liberating. I’m free to describe the realities of life as a doctor free from any sales pitch or sugar-coating.
Yes it’s a great career, but it’s not the be-all and end-all, even when you’re a smart and compassionate do-gooder.
So why did I go into medicine? I’m still not entirely sure. In hindsight, my calling might very well have been a wrong number.
(the following is an excerpt from my memoir, The Flame Broiled Doctor: From Boyhood to Burnout in Medicine)
LIKE ANY BRAINY big-city secular Jewish boy, I grew up with an impressive but limited menu of career options. At the top of the list, naturally, was Doctor. If I couldn’t hack organic chemistry, second choice was Dentist. If I couldn’t handle blood, Lawyer. If I wasn’t good with people, Accountant. Family Business was a fallback #5, but nobody in the family had built any kind of “empire”, and I had neither any passion for business nor a head for making deals. I seem to remember Pharmacist somewhere in the mix of recommended careers – “How hard is it to count pills?” my irascible Nana oft inquired – but that one was only pushed on the girls for some reason.
But bright and brainy I was, standing out even amongst the crowd I went to school with, the children of lawyers, psychiatrists, and professors. Granted, my grades couldn’t reach the rarefied heights of those on the Asian kids’ report cards. Too many hours of Nintendo games and reruns of Three’s Company saw to that. But I could walk into a two-hour calculus exam with nothing but a pen – I would never sully myself with something erasable – and stroll out forty minutes later having answered every question and double-checked my work. My aptitude for science didn’t fall far behind my gift for math, and my essay writing was never less than solid.
Coming into university, I was the Total Academic Package, maybe the best from either side of the family.
I was destined to be the family’s first doctor. As far as I knew, or at least convinced myself, that was the endpoint.
Get into med school, game over. You win. That part I understood. Medicine was as close as you could get to lifelong job security, if not always in the city of your choice. Your income ranged from respectable to stratospheric, depending on the specialty, although it honestly wasn’t about the money in my eyes.
And therein lay the problem. Why was I pursuing medicine? I craved the degree, to prove myself to family, friends, and the doubters from times I wasn’t on my game at school. A chip on the shoulder and a little ambition can take you pretty far if you have the right skills.
I just never put much thought into whether I wanted the job.   
forheadshot   Follow Dr. Frank Warsh at http://drwarsh.blogspot.com

My Godmother

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My  biggest hero has always been my Godmother.  She delivered me five decades ago, when my Mother was  considered to be an “old and high risk first time Mom”. My Mother’s age and previous miscarriages made her a high risk patient thus eligible to be consulted on by my Godmother.  My Godmother… She was the Professor of Obstetrics and Gynecology at the time … but also a 35 year old dynamo woman with a great knowledge and reputation.  She was brilliant, dedicated, and when she let her hair down a beautiful woman who had a tinkerbell laugh and smoked coloured cigarettes when she was out with a group..  In that day and age smoking was acceptable.

As I grew up she continued to play a passive role in my life, too busy to be involved on a day to day basis but appearing from time to time to visit and follow my progress.  Subliminally I wanted to be like her.  Have a profession, and make a difference.  She was so different from the other women that I knew.

What I learned from her was to be a role model at all times.  To understand the small differences that make the big differences.

I honestly believe that she played the largest role in me wanting to be a Doctor. I did not grow up knowing any other Doctors personally ~  just my Godmother who was different from all the Mothers that I knew.  She is still alive and was recently honoured by her department for “Outstanding Achievement re Women’s Health Issues”. Still a goal to aspire to.

 

 

It was 1964…

My mother was a young new bride, an Italian immigrant, and pregnant with her first child.  She moved to Toronto with her husband, leaving her family including her parents back in Italy.   Nervous, but looking forward to her new family eagerly, she prepared for me in the tiny apartment she rented with my father.

My mother had little understanding of how things worked in the human body and even less knowledge of pregnancy and what could go wrong.  Around the time she was due, she began to bleed.  She was terrified–remember there were no ultrasounds, no “Google”, no phone calls to Tele-health or her doctor.  My father wasn’t home.

She called her neighbour who helped and brought her to the emergency room at St. Michael’s Hospital.  She was wheeled up to Labour and Delivery where her Italian speaking obstetrician was on staff.

When my father arrived, they had to get his written consent in case she needed a caesarean section, not hers.  

That’s how things worked even in Canada in the ’60s.  Women needed consent from their husbands for treatment.

While my mother laboured, the nurses told my father to leave and go home.  Husbands weren’t allowed to stay in the delivery room back then.

So he listened and left.  What did he know?

You listened to the doctors and nurses, without complaining.  No questions asked.

My mother delivered me, but I was not well.  Her obstetrician told her not to worry, saying “la bambina c’ha un problema con la respirazione”  which meant “the baby has a breathing problem.”  

She was told they put me on her belly to hold and her doctor told her not to worry.  She was so happy to have had a little girl.  Caterina was what she would name me.

I was born with a congenital diaphragmatic hernia, but no one told my mother this.  I was whisked away to the Hospital for Sick Children where I was fortunate enough to have life saving surgery to repair my birth defect.

For three whole days however, my mother was unaware.  When she would ask the nurses to see her baby, they told her that they had already fed the baby and that I was sleeping.

When my father and their friends came to visit her in the hospital (back then you would stay in hospital for a week),  she noticed they all looked sad.   She would ask them “what’s wrong? …is my baby not beautiful?”  They all continued to with-hold the truth from her, thinking I might not live.

They even called a priest and had me baptized in keeping with the Catholic faith.

They kept this from my mother also.

On the third day, a tall doctor stopped by my mother’s room to speak to her.  He introduced himself as the surgeon from the Hospital for Sick Children.  My mother barely understood what he was saying.  He told her that her baby was fine; that I was very strong.  She was in shock.

My baby is fine?  What was he talking about???

The surgeon was in shock that she had not been told anything.  He explained to her:  her daughter had been born with a hole in her diaphragm and that her abdominal contents were spilling into her chest at birth.

But I was a very strong baby, and by then had passed the point of danger.

My mother was shocked, angry, worried and grateful all at once.  How could her doctor, nurses, husband and friends have all kept this from her for 3 days?

She felt betrayed for trusting the nurses when they told her that I was resting and fed.

But what did she know?  She was a young Italian immigrant with a grade 6 education.

My mother was brought to see me at the Children’s hospital but could not touch me for the incubator.  I was in there for 45 days and every day she took the bus to come nurse and hold me.

And so with this experience, my mother became determined that I should become a doctor.  She planted the seed in my head from when I was a small child.

When I was doing my paediatrics rotation in my third year of medical school, I went to medical records at Sick Kids hospital to track down my own records.  Wearing my own lab coat, I told them that I was there to retrieve my own medical history now.

This is why I became a doctor…for my mother.

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Why I became a family physician…

Watching a loved one suffer is one of the worst experiences you can go through… it’s worse than having the pain inflicted upon you directly.

My sister has always had health issues.  Throughout our childhood she struggled -hospitalizations, chronic illness. One thing after the other.  It shaped our lives as kids. My parents were always trying to stay on top of it…I saw how the struggled with the health system but of course I had no insight as to why.

This time was different.  I saw it the day she picked me up coming home for a visit from med school–her right eye was opaque.

“What’s wrong with your eye”? I asked her as I climbed into the back seat– “you need to go to ER!”

” I know,” she replied, “it just started a few hours ago and it really hurts but I want to wait till later so the ER isn’t so busy”

“No! It could be an ulcer, it could be acute glaucoma! You can lose your vision” …all my newfound knowledge flowing as I panicked.

But my sister was adamant. She did not want to wait for hours in the ER as she has been through this many times before.  She would wait.  She was “working” the system.

I went home and worried. Sure enough, she came home in the early morning with a patch over her eye,  antibiotic drops for a corneal ulcer and a plan to see the eye doctor (opthamologist) again in a few days.

The pain was excruciating-I could see it. She went straight up to bed, in the dark room with ice over her head and cried.  Nothing we had at home for pain would touch it.

I debated.  Who was I but a fourth year medical student to call the on-call resident?  But I knew. I knew that this pain was wrong; she needed more.  I even looked it up to make sure I wasn’t over-reacting.

I called.

I was a fourth year medical student.  I wasn’t certain about anything but I knew that I had to do something-in this case, I summoned up my nerve and called the doctor on call and pushed. In the end, the resident agreed to have my sister come to the clinic the next morning for re-evaluation and treatment.

That was my first time advocating for a family member directly and it taught me a lot about our system.

That it relies on advocates to speak for patients, to push for help; resources are stretched so thin that if there isn’t someone to speak up, that person will fall behind.

So where does that leave those who have no one to speak for them?  The ones with no voices?

That experience may have been the driver for why I became a family physician.  It is part of my role now – a big part.

It is my job now to speak for my patients-especially the ones who’s voices are not heard loudly.

It could have been me…

pexels-photo-341378She was 49 and was excited for her 50th birthday the following year.   We developed instant rapport–she had 2 young children and so did I.  I knew multiple members of her extended family.  While doing her introductory visit and exam, we chatted about our common interests–interior design and real estate.  She was my patient and about 10 years older than me, but we could have easily been friends in another setting.  

 I could have been her.

A little while after I met her, she had an episode of chest pain and went to the ER.    They checked her heart and lungs -all was normal. She went home, the pain having passed.

I called her when I got the ER report and asked her if she was ok.  She reassured me everything was fine, she was feeling better.  Nevertheless, we made an appointment to follow-up so I could check on her.

She didn’t tell me about  the severe headaches she had been having.  She didn’t think they were relevant.

When I saw her later that week, I questioned her about her symptoms.  She told me that one day, a few weeks ago, she noticed her mouth was drooping for a few hours.  It went away so she didn’t think it was anything important.

I kept calm and directed my questions but inwardly, I started to panic.  Of course I worried she had had a mini-stroke, and was at high risk for a full blown stroke.  I started mentally reviewing her risk factors as I did a neurological exam.  She had none–no family history, not a smoker, no high blood pressure, no diabetes etc.  

We discussed her returning to the ER that night for an urgent MRI but she declined.   I agreed. It was unlikely that they would be able to do one for a symptom from a few weeks ago.   But I knew it would take me months to get an MRI if I requested it so I asked a neurologist colleague to fit her in urgently.  I figured that would expedite things if there was a concern.

She postponed her appointment without telling me.  Things had come up with her kids and as a mother, she put their needs before her own. 

When she eventually went, and finally did a scan of her brain…it showed multiple tumours.  Her bone scan and other tests showed metastatic cancer but it took weeks to find out what type. Eventually a hip biopsy confirmed lung cancer.

A life time non-smoker, who’s only complaints were one episode of chest pain and a droopy mouth. I was dumbfounded. 

She could be me.

I remember sitting at the kitchen table in my office, reading the report.  I started crying as I filled in my colleague.

She’s so young.

Over the next several months, I left her medical care mostly to her oncologists and then her palliative care doctors.  I went to her home to meet with her husband and her–to provide support, and answer questions.  I had nothing to give them but my time.

Knowing  what was to come the whole time. 

She made it to her 50th birthday but died that year, surrounded by her family at the bedside.  I attended her funeral visitation because as her family doctor it was important to me to say goodbye. To give words of comfort to her husband and children. To let them know that no matter what, their mother’s love and her presence would always be with them.