8. Psychiatry at last

To be completed

6. Family Practice Residency First

As I may have mentioned before, there were two things that attracted me to Family Practice. The first was that this was a discipline of medicine that could best be said to pay attention to the whole person.  I cannot speak for others but for me, I believe this relates to my faith and my concerns for  a holistic approach to individuals that I believe grows out of that.  The second is that, not unlike the first, I saw this discipline as providing the best opportunity to relate the practice of medicine to the community, again seeing the last as a whole.

There were two other factors that related to my ultimate choice of residency. One was that all four of my best Christian friends in my medical will class were going into Family Practice. The other was that there was a certain amount of excitement around Family Practice. I used the word discipline with respect to it in the previous paragraph. Some would equate discipline with specialty and might still not see Family Practice as a specialty. This goes back to the time when this branch of medicine was known as General Practice, which it still is too many. It was seen as the branch of medicine that individuals went into if they did not get into a specialty. Even if they did choose this area of medicine, it was, and to some extent, still is by some, seen as inferior to being a specialist. However, in Canada, the College of Family Physicians had been formed and had been successful in creating a separate residency program  under the rubric of Family Medicine, not General Practice. Those involved believed that being a good and successful Family Practitioner involved specialized training.

So it was that my three friends and myself, plus a couple of other fellows that I knew reasonably well, found ourselves part of the group of 12 residents in the Family Practice Residency Training Program run out of the St. Boniface Hospital in July 1976, my year of graduation from medical school.

I was never disappointed with this choice and with the program. I think it was a well set up and run by Family Physicians for Family Physicians.

There was one other aspect of career choice that was involved which I will mention at this time. My concerns for community had led me to believe that these would be more easily realized in the smaller setting of a rural practice than in a city such as Winnipeg. In the larger centres, it seemed to me that the lines around what might constitute your community of practice would be quite blurred. I had already also come to the understanding that the challenges and variety of rural practice generally outweighed that in urban centres. My two summers of working up north as a primary care clinician with nurse practitioners had already made me quite comfortable with those prospects. 

Indeed, I was also aware of a couple of other factors that, to my mind, detracted from the greater possibilities of a rule practice if one stayed in the city. One was that it would be too easy to quickly refer any problem to a specialist without working at resolving it yourself first. The other was that there was already a somewhat established practice of specialists really limiting what family physicians could do in hospital settings, particularly when it came to emergency and obstetrical work, as well as anything to do with anesthesia and surgery. Much in these areas has been done by general physicians over the years, and those of us who wanted to do general or family practice, wanted to hold onto as much of that as we could. We realized we needed extra training in those areas, particularly if we were going rural, and that was already being offered, particularly when it came to emergency medicine, obstetrics and anesthesia.

In Family Medicine, we also had elective periods offered. I was interested in neurology and knew that there was a lot to learn in the field of endocrinology, so chose those two areas for two of my three electives.  I also knew that I had difficulty with cardiology and that there was a lot to learn in that area, so I faced my anxieties about that area by getting right into it for my third elective. I did not do any extra obstetrics or anesthesia. However, I had already taken an elective in Plastic Surgery as a clerk, or fourth-year medical student, which I enjoyed and stood me in good stead during my years in family practice.

Retirement V Post-retirement - Lessons from Beyond

Lessons from beyond? No, I have not died. Engaging in séances? No, not that either. Not necessarily even messages from The Creator, although there may be some of that in the reflection that follows. If you have been reading some of my other recent postings on this blog, you will realize I am talking about retirement.

I have written two postings with the word 'blues' in them related to retirement. I want to address two subjects in this regard that are somewhat related to some of the content of those previous postings. This was triggered today when I was part of a large team interviewing a prospective candidate for a position in the Department of Psychiatry from which I retired over 18 months ago.

One of the three candidates we interviewed today for three different positions was in many ways a top-notch candidate when it comes to academics, intelligence, seemingly keeping up with literature and doing a good job of thorough clinical care and documentation. However, he was really seemingly at a loss to answer a question about what he did or envisioned doing beyond his clinical practice. This is something I have seen before and in the cases of some clinicians, the outcome has not been good. It is all good and well to devote yourself strongly to your career, but not at the loss of, for example, your family.

The third candidate we interviewed today seemed to have a better understanding of that. Both of them referred to having a spouse and children, but the latter one made specific reference to having learned about balance and having to give his family time.

There are two things I wanted to highlight as a result of this. The first is that young physicians, but people entering any career really, need to also look at this issue of balance. This is important not only in terms of giving proper due to the personal relationships in your life. It is important to cultivate some recreational pursuits. Some of us have interests that we seem to be born with or have acquired early in life that we want to have time to pursue. Others of us need to work at this. This is not only important in terms of having something to which you can turn to in order to not burn yourself out prematurely by giving your all to your work. It is important so that you do have something to help sustain you when you have no work or when your career has come to an end.

I served for a time on a committee involved in interviewing prospective medical students. We always asked them questions related to this whole idea of community involvement; the idea of giving something back to the community. From my current vantage point, I see two important reasons for doing this. One is simply ethical. As social beings created to live in community, we need to be involved in the community beyond what our career dictates. The other, and this is the second point I wanted to make, is that it is good to be involved in the community to become known. Some readers might say that they don't really care to become known, but this brings us back to the ethical question. When your community has put a lot into your education, you do have a responsibility to give something back. This refers not necessarily just to during to the time of your working career but could even refer to the period of your retirement. If you have not been out there, and your community doesn't know about you, your expertise, your experience and what you have to offer, you probably can't expect them to come knocking on your door after your retirement. Again, some of you may be perfectly fine with that. You might want to contribute to your community in ways that have nothing do with the nature of your career. Others of you may still want to contribute with the knowledge and experience that you have acquired through your career, even though you have retired. It all depends on you and your goals for retirement; what keeps you occupied and happy, but remember: balance and the community.

Retirement IV Post Retirement-blues Re-visited

Eight months ago, I wrote about some of what I was experiencing ten months after retirement. The intervening time has given me more opportunity to reflect on what retirement is after 18 months.

I think, for me, not having an occupation where I had to go out and find customers, or make things to sell to earn a living, or even to be a salesman, probably had its downsides. On one hand, it made life easier. For a physician, there were always more patients. And the government always paid. Unfortunately, health in this imperfect world being what it is, there was no sign of loss of ‘material.’ One never had to advertise one’s services.  The downside perhaps is that what I did was always in a way because someone expected something of me. The demand came from outside; it was external. I had the call, the training and did what I could when called upon, but there a lot of expectations of others’ to meet.

Retirement is different. To a large extent, you have to create your own purpose. That is not something that comes automatically.

To be sure, I have registered for things that do provide somewhat of that external call. They are all voluntary though, and some more so than others. In the latter cases I don’t always have to do what is put out there as a call. There might be others who are willing.

But these things do not occupy my time fully. Those things I looked forward in my pre-retirement days to doing in my new free time once retired, I now find myself struggling with somewhat. Perhaps those pursuits were deemed more precious before because I had little time to do them. I refer to things like art. I have done some drawing. I started on painting. I do spend time while watching or listening to the evening news colouring in adult books I have bought or got as gifts.

I can refer also to music. I have tapes and now even some mp3 versions of my own compositions. However, I always wanted to get the many songs I have written recorded, ideally by a good studio band. Or, I wanted to lay down tracks of guitar, piano and voice, all of which I could do myself, on my electronic keyboard or with a program like Apples’ Garage Band. It hasn’t happened and the older I get I seem to have less interest in doing so.

Then there’s photography. I still take too many pictures, especially when travelling. But that leaves too much work labelling and organizing them after. I do work at it, but with less enthusiasm, as I have begun to accept that all my pictures seldom get viewed, apart from Facebook and the odd e-mail missive, so what’s the use. Until the end of 2014 I pretty much kept up printing photos and placing them in albums to continue my life’s pictorial record. With the onset of the digital camera, and the veritable exponential multiplication of pictures one seems to take with that, most stay on the computer or a backup drive though, and who ever gets to see those? So, what’s the point. I did print off 60 photos and perhaps a few more, to fill one small album for 2015. However, although I have started a folder for 2016, I have not completed that, let alone print anything.

Then there is reading. I do continue to read, fiction and non-fiction, but mostly only for the last minutes before going to sleep – an old habit from when ‘daytime’ reading was kept for work-related print. I read on areas of interest, such as First Nations or Israel-Palestine issues, and the Church.

There is also writing. I thought I would work more on a novel I started years ago, but that has seen little action. I have this blog and my other one, Reflections from Lulu Isle. I have never made a commitment to write in either on any kind of regular basis. However, once when starts on this experiment of blog-writing, a funny thing happens. You discover you have readers. You really don’t know who they are for the most part.  You just see numbers of viewers for your postings, at least on Google’s Blogger. Somehow that makes one think – oh – people are reading. I need to keep it up, the writing that is. So, there is some external reinforcement or call to action there. At the same time, one doesn’t want to write for the sake of writing or one might produce little more than drivel.

Yes, 18 months into retirement, I do find myself wondering a little more often – what should I do now. Is that a sign of post-retirement depression? Sometimes I just don’t feel like doing much at all. Other times I will accomplish something and feel like, well, that’s it for today. I’m done. I suppose it’s a natural development at this stage. Maybe it's a bit seasonal too. In the winter I have been doing more teaching and leading of church small groups etc. and that means studying to prepare. There are church-related committee meetings...

I am realizing that to make my days meaningful still requires discipline, although now it really has to come more form the inside, as no one out there is expecting much any more, or so it seems. Funny thing, my wife never seems to have that problem.  And she often has tasks for me, which I am generally happy to assist with. And hey, she just said, let’s go for that 2-for-1 e-mail coupon McFlurry treat you had [at the newly re-opened McDonald’s at the end of the block]. Hey, there is relief from the blues. Let’s go!