Physician, Heal Thyself

Well, after a long absence I'm back behind the wheel. I thought that an interesting chronicle would be the story of the early stages of a research study that is about to begin. As I write this I'm waiting to enroll the first patient in a study that will try to answer the question: Does cooling the soft tissue at a fracture site get people out of hospital faster?

The process of designing and funding this research has been long and hard. It's taken me a lot of time and effort to learn the tricks of the trade in clinical research, and I've only scratched the surface: most of the learning ends up being on-the-job training.

So, over the next few months I'll try and post a bit more often on this blog and the Financial Post blog to talk about the early stages of recruitment for the study and to muse on the similarities of research and entrepreneurship.

Glad to be back!

More Debate on Obama's Health Care Plan: Canada Dragged into the Fray Yet Again

2009-09-17T20:37:00.000-07:00

Here's an opinion piece from the Globe and Mail.

Now I'm proud of our health care system and I'm happy to be working within it. I have said before that I feel free to practice medicine in a way that is in line with my values. I don't feel restricted in any way at this point. Maybe that would be different as an independent doctor (rather than as a surgical trainee), but I doubt it.

One thing that I do want to point out from this article though is the lack of any reference to the Social Determinants of Health. I have talked about them in a previous blog. It's the whole idea that we should be looking upstream for the causes of medical issues rather than devising ways to treat the problems that result.

The article doesn't give Canadian government programs, education and support as a reason for improved life expectancy, child mortality and decreased health care costs. It's not just the medical system doing a great job...it's also the ability of our society to avoid a lot of the problems that come from a lack of programs that knit a safety net for members of society.

I think this may be a way to focus our future efforts too. We, as a society, should take on the challenge of identifying ways to further improve our support systems and see if we can further the inconvenient truth the republicans fear.

Health Care Sinking the US - Old News for Employers and Workers

2009-09-15T20:49:00.000-07:00

It was about 7 years ago that I first read an article about the advantage Canada enjoyed over the US as a result of our more affordable health care. Sure, workers were paying more in taxes to support our universal health care system, but employers were locating their plants in Canada to reap the rewards...

Now, in a comment in the National Post this fact rings true again. Here's the link. Obama obviously sees this as a major challenge for the United States in his first term. He made it clear in his speech that he wants to see past tort reform to rejuvenate the American Health Care system.

I hope that others see it his way as well and help him to find the answer that will turn this ship around.

Post-speech Reaction: What I Heard From Obama

2009-09-15T15:43:00.000-07:00

If you haven't listened to Obama's Healthcare speech then here's the link to NPR's coverage:

http://tinyurl.com/opvp9t

There were several things that really stuck out for me in Obama's speech as a Canadian in the United States. I'm seeing the way the system here works for the first time, and Obama's message went straight to the heart of several issues I have seen playing out during my time here.

Is there anyone else out there who has some opinions about the speech? Any other Canadians out there living in the US who have a similar perspective on the speech? Listen and give your opinion!

Academic Medicine Article: Dull to Sharp

2009-09-04T21:34:00.000-07:00

The current edition of Academic Medicine has an article that I wrote in it. It is an account of what it's like to be at the other end of the knife. If you have access here's the URL and pubmed link:

Academic Medicine Link
Pubmed Link

Hope that those of you who can read it enjoy my account.

Dr. everyone Has Launched: Test drive the newest Consumer Health Website

2009-09-04T21:25:00.000-07:00

There's an new kid on the block! Yes, online health information is going to take a new shape. Online disease communities have a new place to turn that isn't focused on medical information. There's an option for those looking for more intimate knowledge of how disease processes affect those who suffer from them. This online community will allow patients to tell their story in a more natural, non-clinical way!

I'm proud to announce that Dr. everyone has now launched in Beta format. The site should be fully functional. We're looking for lots of input on how to make the site better. You can see how your comments and feedback change the look of the site. As a charter member you can drive the evolution of our community!

Come to http://tinyurl.com/l329dr and use the feedback button to let us know if you have any bouquets or brickbats to air about the web manifestation of our concept...

If you don't know what a brickbat is, just ask!

Innovations - Previous Blog on Financial Post

2009-09-04T20:33:00.000-07:00

Here's a previous blog entry that I thought I would re-post on the Doctor, Heal Thyself blog. I asked the question at the time if there were any thoughts on the reasons for IT and healthcare being the two front-runners.

The article that I referenced was about the greatest innovations of the past 30 years. The criteria were:

Did it improve quality of life, having a direct and/or material effect on quality of life?
Did it address a compelling need? solve a compelling problem?
Was it a fresh breakthrough with a "wow" factor?
Did it change the way business is conducted?
Did it increase the efficiency of how resources are used?
Did it spark an ongoing stream of new innovations on top of the original innovation?
Did it lead to the creation of a vast, new industry?

Any thoughts? Are these criteria reasonable? Any arguments on the selections?

Winnipeg Orthopedic Electives Page Now Up

2009-06-11T12:55:00.000-07:00

Well, hopefully the information that I previously published will bring in some more interested outside medical students for a visit. I have to wait for Google to index the new Pan Am Clinic website page that gives students details of all the opportunities that we have to offer in our program.

As a side note to that we have had a large increase in off-service residents interested in working with us this year. That's a change from last year and maybe a reflection of the emphasis that we have put on education in elective rotations. I think that the current residents are realizing that it is our duty to try and increase musculoskeletal knowledge in all subspecialties in the province.

Our next step is to undertake some outreach to communities outside Winnipeg through visits and telehealth in order to improve knowledge and decision-making on the part of primary care providers. More on that initiative to come!

Obama A Communist? The Dirt on American Socialism

2009-05-29T14:31:00.000-07:00

A gripping title: but this is old news now...

Here's an article from Business Week entitled: Socialism? Hardly, Say Socialists.

I agree with all the people interviewed by the author in believing that Obama is not a socialist, let alone a communist, as many US citizens believe. I also agree with many news items that call for increased controls on a capitalist system that has not served everyone in society well.

More importantly, I think this is a time when introspection on the current system is essential. Across the world we should look at how society provides for us. I know that the US is the land of opportunity. Many stories exist about rags to riches journeys. A capitalist system allows these to happen. The problem is only the success stories reach our ears.

I was in a square in Mexico with two US citizens. One, the older, proclaimed paternally to the younger one that he should find a well-paying job and save for himself and his family. The reason: no one was going to take care of him down the road. I couldn't believe the fundamental difference in philosophies that I had to this man. That's obviously an extreme, however, it makes a point. Self-sufficiency breeds big winners...but also leaves the 'battlefield' strewn with losers.

Looking at the system that I know best, I see that there are safety nets in place. I work in the healthcare system that provides care to all. I meet people who are caught by the safety nets of Worker's Compensation Boards and Employment Insurance. I can say that these supports exist, but I don't have the information to say that they are efficient uses of their budgets. I'm sure that would be the argument of nay-sayers. Private enterprise is always more efficient.

So, it would be interesting to find a way to allow people from different systems to talk about what works and what doesn't in social programs and economic regulations. Kind of like a Dr. everyone for society?

The Kind of Place I would Like to Work: CERN!

2009-05-22T05:02:00.000-07:00

Here's an article from a recent Business Week. It details the collaborative project CERN, a particle accelerator in Europe. Although it took many years to develop this project and the culture that defines its leadership I think that organizations can learn from the model that has evolved. Hopefully healthcare will catch this bug and implement some of the ideas of communities of practice that CERN realized were crucial to innovation.

Swine Flu and Health 2.0 - Opportunity to Push the Envelope?

2009-05-02T07:55:00.000-07:00

Coincidentally, I have seen a lot of articles about Internet infectious disease surveillance over the past few weeks. Here are a few of the links that I have received:

A Reuters article that came out before the Swine Flu Outbreak

Story about Googles' efforts

Here's Google.org's site

It's beginning to look like medical schools should add an IT class to their curriculum. I didn't learn about anything more than searching indexed internet databases during my MD. I guess a lot of the learning in that area came after through interest and mentorship. If this is the way that medical care is going then should we be ensuring that more physicians are properly trained to utilize the tools at their fingertips?

Maybe it shouldn't be physicians at all? Maybe we aren't the group to lead this revolution...I know that we aren't typically at the cutting edge right now. I'd love to hear readers' thoughts on this topic...

Success on Orthopedic Electives Post: Two Medical Students Found Us

2009-04-26T10:42:00.000-07:00

Keyword Optimization Works. It looks like two searchers found the post that I put up about Orthopedic Electives in Winnipeg. I also have a couple of people signed up on the Facebook group ( Manitoba Orthopedic Elective Information) that I started.

Now it's time to get more serious. I have a short description that will soon appear on the Pan Am Clinic Website. I'm hoping that site will see more traffic than my humble little blog. But, I'm going to preview it here. If you read it and think that I left out some important information then let me know in a comment and you will see your thoughts echoed in the final version.

Looking forward to getting the chance to show more outsiders what a good thing we have going here at University of Manitoba Orthopedic Surgery!

University of Manitoba – Orthopedic Surgery Electives

Manitoba Orthopedics is the perfect program for medical student electives. We offer a complete spectrum of subspecialty experiences to medical students interested in Orthopedic Surgery.

Our program features clinical and research activities based out of: The Pan Am Centre, Concordia Hospital/Hip and Knee Institute, Health Sciences Centre and Children’s Hospital. All sites accept rotating medical students for clinical and research rotations. Students work within the clinical team in order to feel what it is like to be a trainee in our program. Rotations can be tailored to student interests or can provide an overview of the program by scheduling time at each site.

Previous elective students have commented that electives in Winnipeg allowed hands-on experiences and close interactions with residents and staff. These students also liked being integrated in the Orthopedic Team and the responsibility and support that they were given. They have comment on the amount of teaching given by staff and residents in clinics and the operating room.

Here are some details about the various rotations you could experience:

Orthopedic Trauma

Level 1 Trauma Center for the Province of Manitoba
ATLS experience in the Emergency Department
Trauma ORs 5 days a week with complex fracture management
Clinics with referral patients from a catchment of 1.2 million people

Pediatric Orthopedics

Clinics with wide range of pathology and excellent staff teaching
Clubfoot and DDH clinic with casting and operative release experience.
High volume emergency department with trauma experience

Orthopedic Spine and Oncology

Weekly ORs with complex reconstructions.
Emergency consults with wide range of trauma, tumor and degenerative pathologies
Two staff and fellow dedicated to education

Orthopedic Sports Medicine

High-volume outpatient surgical practice
Cutting edge arthroscopic techniques
Coverage of two professional sports teams and Royal Winnipeg Ballet

Upper Extremity

Open and arthroscopic surgical practice
Shoulder and elbow replacements performed regularly
Only referral center for the province so wide exposure to varying pathology

Hip and Knee Reconstruction

New Concordia Hip and Knee Institute with
Large hip and knee revision practice
Innovative system for increasing volumes of surgeries and tracking outcomes

Orthopedic Research

Program-wide database will be in place in the coming year
Multiple clinical research projects ongoing with potential for student involvement
Accessible staff willing to provide mentorship on research

For more information about our program or to find out how to book an elective call or E-mail Donna Shepard (204) 787-1219 or dshepard@exchange.hsc.mb.ca

Fast Company, Disruptive Technologies and Healthcare

2009-04-22T20:09:00.000-07:00

Today was a confusing day...but one that showed me the complexity of merging healthcare and technology.

I received an article published in Fast Company in the morning. It shows some success stories of how social media is changing medical practice.

I also read about disruptive technologies in the Harvard Business Review. Is social media the answer to providing 'good enough' service to health seekers? Will it take over from the medical establishment? Are we changing enough in our medical practice to keep up?

It all makes me realize what the basis of medical practice is. It's really the people that we treat and the lives that we improve. That's whether it's performing a knee replacement or preventing the spread of Hep A or counseling an expecting mother on nutrition in pregnancy.

If we don't keep up with the needs of people what are we left with?

Pinning Down the Online Health Information Seeker

2009-04-14T20:58:00.000-07:00

If Google can't hit the target it must be moving fast!

It really surprises me that restaurant expert reviews are less popular than health expert reviews on the web. I see the expert opinion under constant attack by proponents of evidence based medicine yet consumers are warming to the idea of expert health opinion in the Web 2.0 space.

Here's the article that inspired that thought...

http://web2.sys-con.com/node/917749

Dr. everyone is about to launch. I would say that our initial idea was to launch a website that would supply healthcare seekers with the ability to distill information gleaned from the wisdom of crowds. Now it seems this editorial is saying that we should be partnering with experts.

What do you think? Is Google going down the right path in enlisting expert opinion?

Forgot to Mention: New Blog Entry in National Post

2009-03-22T07:38:00.000-07:00

If you're interested, the update on the life of Dr. everyone went up yesterday. We're just debugging the alpha site with the beta launching soon after. We're hoping to launch very soon, but no dates. I don't want to jinx anything! Read the blog entry at the National Post for more info.

I'll be publishing biweekly on the Entrepreneurship Blog with stories from the past and updates from our launch.

Canadian Healthcare: Universal ->Socialized ->Unconstitutional?

2009-03-22T07:11:00.000-07:00

I was checking on a favorite blog (Plain Brown Wrapper by Kishore Visvanathan , a Saskatoon urologist) and notices a link to an article in the Wall Street Journal. His tongue-in-cheek title to the post was Tales from the Crypt, which is appropriate to describe the impression that more conservative Americans would have of our 'Socialized' Healthcare system in Canada.

It seems to me that our system is a real enigma to some people. The fact that there is no direct link between payment (income tax) and the provision of service looks to a lot of outsiders like a free system. Many of those same people would grumble, 'I don't trust anything that's free'. I think that the more important thing to look at is how one experiences the system when it's needed.

I would argue (without having used the American healthcare system(s)) that, from a patient perspective, there would be little difference in the feel inside the hospital. I was just in some US healthcare facilities and noticed the same polished concrete floors and same sterile smell that pervades Canadian hospitals. There was the same bustle of people and the same crammed waiting rooms. Outside there were a similar mix of playing children and sombre adults.

I would be that similar stories to the ones recounted in the Wall Street Journal article exist in the US. I have heard of people left behind by the system, only they don't have the money to pay for their treatment, let alone the connections to find a lawyer to challenge the unconstitutionality of their dispair. Even retired Bank of America executives are forced off-shore to be treated (Based on a NYTimes article published yesterday).

With that mirth out of the way, I think that exchanging information across the border could provide a means to enhance both of our systems. I hope to spend at least a year in the US seeing how things function. I would recommend coming up here if you don't believe that Canadian healthcare is doing the job. You might be surprised at the results we're getting, despite the word on the street about a few unfortunate cases.

Orthopedic Training in Winnipeg - Orthopedic Electives Information

2009-03-20T18:28:00.000-07:00

Our training program just went through a search for new residents about a month ago. Our 'match', organized by CaRMS, an Ottawa organization matching medical students with the best program possible secured us two great candidates. We're really happy to have them on-board on our team. We didn't fill one of our spots though, in spite of the fact that we interviewed 36 applicants!

I think that it's a failure of marketing. We didn't have many visiting medical students last year...that's despite the fact that every medical student that comes has a great time. The one that I worked with this past year from Thunder Bay had a great time, and I'd like to think that if her personal situation was different she might have come here. So, how to get people to come? I think it's all about putting out the word - Guerrilla Style!

I started a Facebook group tonight:

Manitoba Orthopedic Elective Information

I'm hoping with that I can try and get working on Search Engine Optimization (SEO) of some keywords in google to have our site pop up when someone types in orthopedic elective, or even orthopedic residency (but that's a stretch goal. This is also a little experiment in the techniques of SEO. It wouldn't hurt given the fact that Dr. everyone is about to launch.

So, if you have any questions about orthopedic electives, send them to Donna Shepard (dshepard@exchange.hsc.mb.ca). She will get you set up!

And stay tuned to get debate results soon...and fill out the survey if you haven't already!

Link to Online Survey (one question)

Orthopedic Recertification

2009-03-16T19:23:00.000-07:00

I'm conducting a debate in Orthopedic Grand Rounds this week. Our resolution is:

Be it resolved that:

‘Orthopedic surgeons should be required to re-certify as often as pilots’

I hoped to have an idea of public opinion on this topic. I'm going to compare it to the opinions of my researched and informed colleagues and mentors. Please fill out the one question survey below if you have an opinion on this topic. For reference, pilots have a medical exam every 6 months and a test of ability/competence in the form of an exam and a simulation every 9 months.

http://www.surveymonkey.com/s.aspx?sm=gUBxAApntIwr5HVPFzlxFw_3d_3d

I'll post results after the debate is done (and if I get enough answers to this survey to make it interesting! So, please distribute it widely...

Thomas Friedman - Stern Message, Great Optimism

2009-03-11T08:33:00.000-07:00

I wanted to post the link to an article I was sent from the New York Times. It's by Thomas L. Friedman and it is entitled: The Inflection Is Near?

I know this doesn't exactly fit in with the previous theme of the blog. The article does take a more holistic view of global health though. It also presents a very interesting view on the current state of affairs. See what you think about the quote from The Onion. I've definitely wondered about my buying behaviors and how they would look to people in other countries.

www.dreveryone.com - About to See What Happens

2009-02-21T22:35:00.000-08:00

Well, at long last Dr. Everyone is about to make the mainstream. I hope that the viewers of this blog will go and see what it's all about. I know that some of you made contributions to the early stories. They will be anonymously included, so check them out. Also, give us feedback on the site. The format came out of four guys sitting in a room together (Story to be posted on the National Post Blog in the coming days). Your comments will help us to work out all the blind spots we may have had.

Another post on the NP Executive Blog is coming in a few days. I'll give you a sneak peak at the article I refer to so you can form your own opinions before you read mine...It's a Wharton Business School initiative. I'm interested to hear people's comments on the order. Many of you will probably be in medical fields. You may agree with the choices...however, if you're like me you may have other ideas!

Enjoy, and check out the NP post on the 24th if you have time.

Another Post on FP Executive - A continuation on Creative Capacity

2009-02-14T20:09:00.000-08:00

Here's the link to the latest post on the Financial Post Executive Blog post.

Parkinson's Law is catching up with me!

New Location for Blogging - Financial Post Executive Blog

2009-02-13T05:12:00.000-08:00

Everyone,

Sorry that I have been silent for a while. I was authoring content that will appear on a Financial Post Entrepreneurship Blog. I have 2 posts up already there.

I will be detailing the launch of www.DrEveryone.com which is a startup that I'm involved with. I'll keep posting some random notes here as well, however, the majority of my writing effort will go into publishing at:

Bio: http://network.nationalpost.com/np/blogs/executive/pages/biography-dr-jesse-shantz.aspx

Posts: http://network.nationalpost.com/np/blogs/executive/archive/tags/Jesse+Shantz/default.aspx

It should be an exciting few months for me with Dr. Everyone launching. Hopefully I can get as much down as possible about the experience so you can all share it with me!

Can You Teach Without Learning? The Teacher as Learner

2009-01-25T04:11:00.000-08:00

I have spent the past few days at work with some time to think a bit more deliberately about incorporating some teaching into the tasks that come up. If you have the time a teaching moment can be extracted from almost any situation. It's the way doctors have learned their trade for a long time; an apprenticeship.

My thoughts were focused a little further in the distance though. I realized through my lack of answers to some of my learners questions that I can't help but learn while teaching. Applying textbook knowledge to naive questions makes you go beyond knowing and head towards understanding material. That was also the way it was in my MBA class. Having to teach the class a concept always felt awkward, but in the end it made you learn and explain the concepts.

Now, if doctors can adopt the idea that each patient interaction should involve some teaching then does it not follow that we will become better at our craft while educating patients? Does opening up the floor for questions identify our knowledge deficiencies and also identify areas we could research and innovate in?

I still think that the first treatment a doctor should prescribe is education. Knowing about one's illness is the key to taking control of it. If a fringe benefit is to improve ourselves as physicians, then I don't see what is holding us back?

Innovation in Medicine - Farther from the bedside?

2009-01-01T03:58:00.000-08:00

In the past few days I have had a few experiences that have caused me to pause and think as 2008 morphs into 2009. One was a screwdriver crumbling during an operative case with no replacement around...and luckily no harm to a patient. The other was a conversation about the development of many implants and surgical tools in the past here in Winnipeg by small, local companies.

Now, I am learning about a specialty that has many innovations that impact the way I will practice. I also completed a business degree so I know that there is a pressure to merge and consolidate many industries to lower costs and improve efficiencies. In fact, that is the goal of many entrepreneurs, be acquired by a larger company!

Now, many companies involve doctors in the development of new medications and devices. I have talked to a physician where I am in residency and he works to develop implants clinically with a major manufacturer and talks to engineers to let them know how the designs could be better. That being said, the history of Winnipeg is that implants could be modified on site to be used in surgeries. This is truly innovation, with new ideas directly tried out of patients. Companies were also local, so surgeons had more of a voice. I'm sure the same was true with formulations prepared by apothecaries. But, what is the risk to patients? That also has to be weighed with the benefit that a paradigm-changing discovery can have on many future patients.

So, what models are out there to engage physicians in product innovation in a non-biased way? Does anybody have any examples? What about patients? This is the next wave. Patients should have a say in product development too. What is the best way to give patients a voice in this process? I'm going to look on the web and see what I find, but I'd love to hear of any examples others know of.

A Physician's Perspective on the Patient-Physician Relationship

2008-12-21T05:02:00.000-08:00

I just read a great article on 'How to Talk to Your Doctor' (click the title to read it for yourself). It made me sit back and think about truth and the exaggeration of the article based on my experience. I think that it requires a companion article as well entitled 'How to Talk to Your Patient'. I'm sure some readers will agree with that sentiment.

I'm going to post it now and work on the response to it. Any readers have thoughts on this? I'm sure some of you reading this blog are physicians yourselves. I heard one person refer to the phenomenon as 'Google Moms' recently. This was a reference to patients armed with print-outs from the internet. I'm sure that family physicians are more exposed to that sort of patient interactions. How is it sculpting the relationship you have with patients?

Are We There Yet: The Distance to Adventure

2008-12-19T03:46:00.000-08:00

Yesterday was my first normal day of sleep-wake cycles after a fort'night of working overnight. Although I did have some time to sleep between midnight and 6AM I still ended up sleeping away part of the day, and I can say that I didn't get out much (That may have also been in part due to the cold that I just wrote about in my last posting).

All that captivity thrust my thoughts to previous trips to far-flung places. Those kind of thoughts in the depths of winter can really tarnish a view of the here and now. It was that wish for a better place that caused me to remember Alain de Botton's 2002 book 'The Art of Travel'.

I read the book about 4 years ago, well before I knew I would be coming to Winnipeg; a city that causes the most hearty person to think if desert islands and steamy jungles (my skin could use that kind of humidity right now!). The book is a philosopher's look at the phenomenon of travel and points out some interesting things.

The chapter that I was thinking about recaps the idea of the fictional Duc des Esseinte, who after traveling far and wide, decided that staying home and imagining a trip is just as good. Now that the economy is changing in a way that may constrain our travel budgets I think this may describe a lot of people's travel itinerary.

On my drive up Sherbrook Street in Winnipeg these thoughts made me turn my head left and right. I started to realize that I had been missing some of the beauty contained within this city. And I think that's the danger of the ability to travel, and also the danger of staying put for too long. I had failed to see the interesting achitecture at the corner of Portage and Sherbrook (Manitoba Telephone Building). Had I really appreciated the angular forms of a billboard at Portage and Colony atop the closed surplus store, thrusting themselves into the clear blue sky? Had the condensation spewing from the many buildings south of my apartment given me any moment for pause as it was lit up by the pink hues of dawn?

So, that being said, I'm leaving town tomorrow for Phoenix, a striking city. But when I come back I plan on appreciating what's at my doorstep.

I also plan on writing a bit more about medicine. I have some ideas about responsibility versus pride and about failure. I also have a series of posts on a venture I'm entering that I've been saving. I may start posting them early in the new year. It's an interesting story of chance meetings and eye openings!

Seasons Greetings to all!

True North, Cold and Free

2008-12-11T10:08:00.000-08:00

I feel that those who have never lived in Winnipeg need a description of cold. I'm a transplant here, and so, I'm one of the best to spread the word. The reason for that is that Winnipeggers have grown up with the cold of Southern Manitoba and outsiders call this place Winterpeg, but have never experienced the true meaning of that word.

I also have some new perspective on the winter wind as I'm now seeing another transplant in slow evolution. Watching another person go from squealing at the biting nip of the North wind to laughing in the face of Ole Man Winter brings me back to 2 years ago.

One of the first memories I have of cold is in the Jetway at the airport here, when I came in for an interview for residency. Walking out the door of the plane visitors are hit by a guillotine of cold. Worse yet, when I left it was on a small plane. In that case one has to walk across the tarmac and get on the plane...a cold goodbye. Adding insult to injury, the plane door stays open and only a gaping curtain covers the door to keep the cold out. Not a great way to leave warm-hearted memories of a great town!

Ice Crystals -- Sounds like a type of diamond or some mythical castle. In reality it is a meteorological term. I think, after 3 winters here it means snow without clouds. Although I haven't had a scientific explanation of the phenomenon, I think that it basically means 'so cold the air is freezing'. I Never heard of that in Ontario?

Finally, until you have filled up your gas tank in frigid temperatures you don't understand cold! When the car is turned off you feel the slow creep of the cold first on your ankles, slowly climbing up your legs. As the gas tank needle edges towards full it seems like it is not indicating the level of the fuel, but rather the temperature inside the car or the height of your goose bumps. The only thing that's worse is self service! Get out your gloves!

That being said, I love the winter here. The scrunch of snow is something I miss when it's not there. I love skating up the river and shooting around the puck on a frozen rink. It's another experience as far as I'm concerned.

Big Questions, Big Stakes: Public versus Private in Canada

2008-12-07T12:55:00.000-08:00

This post may not discuss the topic you expect it to.

The thought that I just had today was not on how to answer the age-old question about whether Canada has the right idea in providing healthcare for the population. It was actually whether answering this popular question is useful, or whether it obscures what is important.

I don't want to review the debate too much. Here's some CBC background on the subject. I've also blogged about this topic a bit. You might want to check out 'The Mission of a Medical System' for some thoughts on the general idea of missions. Many of my thoughts are based on a podcast from the Stanford Social Innovation Review called: 'Missions That Really Inspire'.

So, here's my new question...

Is the question of whether health care is a right or a commodity really useful?

Having grown up in Canada I have seen this question debated on many occasions. Most notably, elections have been won and lost on this question. It was also a prime topic in my MBA Health Sector classes at Ivey. The mention of privatization evokes strong and passioned responses from many people, but I am beginning to wonder if the answer would change the underlying problems that need to be fixed? Does talking about the philosophical debates that are undercurrents in a society improve care? Does enshrining health care as a part of national identity lead to a freeze on innovation and prevent us from making the system more resilient?

I'm interested to hear the stories of others who have come up against resistence to change. I'm also curious to hear about other systems and approaches from around the world...

Any takers?

White Coat, Black Art Follow-up

2008-12-04T04:03:00.000-08:00

Well, I had sent a note to Dr. Goldman regarding his comments several weeks ago. He responded immediately with a very thoughtful email. I wanted to put a couple of excerpts into the blog as his response to my rant...It's only fair to allow a rebuttal in a debate!

'Generalizations are cruel to those for whom they don't apply! Sorry if you were offended. I've had 25 years of experience in the ED seeing residents from GIM and ICU have these conversations with patients and their families. I've seen what I've seen and I'm not backing away from that. I didn't just say what I said on the show. I tested out my experience with a noted bioethicist who agreed with me. I didn't ask him to.

I haven't worked in ICU, so you've got a huge advantage over me in that
area. I did a show last season on medical futility, in which I was able
to visit with and speak to staff at the medical ICU at the Halifax
Infirmary. I can certainly confirm that what you have seen and
experienced tracks with what others have. My sense is that the ICU
provides a place not just for patients to either get better or not, but
a parallel space in which families are able to understand and
(hopefully) accept what is taking place.

Jesse, context is everything. My experience is in emergency, the front
door to the hospital. I have witnessed a hospital-wide mind set that
patients are only the hospital's responsibility if and when they are
admitted. Thus, there is subtle yet powerful pressure to "think twice"
about admitting patients -- whether to GIM or the ICU. In that context,
my sense is that residents have assimilated the subtle message not to
admit patients to ICU or medical step down unless absolutely necessary
and to obtain advanced directives to obviate such transfers if and when
they become necessary. I believe the "brutal" honesty that I've
witnessed comes from the inherent role conflict that residents feel when
thrust into the gatekeeper role.'

Thanks Dr. Goldman for taking the time to reply to me. I do enjoy the show as I find that it really explores the 'religion' or 'sisterhood/brotherhood' part of medicine and opens it up to the light of day. I think that's a good thing. It will lead to the openness in medicine that I've talked about before in this blog. Maybe we're on the same mission in the end?

Interesting New York Times Article on Online Health Information

2008-12-02T06:00:00.000-08:00

The New York Times has nicely summarized the ways to find and digest health information online. Here's what they had to say...

http://www.nytimes.com/2008/09/30/health/30pati.html?_r=2&8dpc&oref=login&oref=slogin

I definitely see two sides to the proliferation of online health information. One side I have already articulated. That is the empowerment that people can develop related to diagnosis and treatment and the teamwork that can start to develop between doctor and patient. If the methods of communication between doctors and patients evolve then more effective 'service' can be provided by two active participants in the therapeutic partnership.

On the other hand, even if every shred of information on the Internet related to health were true, there's too much to digest. As I turn to my bookshelf as I write this post I see 18 volumes covering some of my specialty area. That's only a portion of what I need to read, evaluate and integrate in order to take my exam. In other words, that's the information regulatory bodies think it is important to review to develop competence in my specialty.

As the Internet is so full of information, and growing daily the 'book shelf' that we will all have to go to in order to find the information we need will keep getting longer and longer. What will be more important that being able to find it will be filtering it. Another thing that will be key to using the Internet will be developing new, more patient-centred ways of collecting information. If the methods used for collection of patient feedback are properly designed we may see new insights into the treatments we use...and really find out what's working and what isn't.

White Coat, Black Art...

2008-11-18T08:00:00.000-08:00

I was driving back from the hospital on Saturday and my attention was caught by the program 'White Coat, Black Art' on CBC. The topic was 'Physician Lies', and I had to admit to myself that I have lied to patients. I found the program interesting for the fact that the guest Brian Goldman was interviewing was referring to Hippocrates and stating that the ancients had said that patients were only entitled to the truth when it was beneficial to their treatment. I think that is a gray zone in medicine that deserves some debate, however, it's another part of that program that spurred me to write this post...

Dr. Goldman made a comment about residents and the discussion of end-of-life care with patients. I think that he did a disservice to residents in his sweeping generalization. He referred to the tone and content of these discussions as 'brutal'. I think that some background is required in that debate, and talking about that subject in the context of a show on 'medical lies' is not appropriate. I'm sending this post to him to let him know that his comments really offended me.

First, I want to acknowledge that death is still a taboo subject in our culture. I don't think that many feel comfortable talking about the end of life or what they would like done if their heart were to stop. This is not dissimilar to the way that cancer was a taboo subject (evidenced by Susan Sonntag's 1977 book 'Illness as Metaphor'). As with cancer though, we need to move beyond this prudish fear of an important subject.

I want to keep this rant short. The foil that I want to create is thinking about an aging loved one sitting in their home at an intimate family event, fully aware of surroundings and healthy. The second image is that of a family member in the intensive care unit, unable to communicate due to the breathing tube in their throat, countless tubes running this way and that. An unknown physician asking you to decide whether to continue providing respiratory support to keep them alive.

I've been in the position of the provider, talking to wide-eyed families. It's obvious who has had the conversation of end-of-life decision-making with family.

Dr. Goldman, I had a discussion with 2 patients this weekend regarding this subject. I was HONEST about what to expect should a code blue be called...I was sensitive, but firm in by recommendation that the subject of end-of-life decisions should be discussed. I'm not perfect at talking to families about this, I know that I cause some pain...but I also make sure that the patient's wishes are respected, either on their current admission, or in the future...and that's what matters to me.

I hope you realize how your insensitive comments sounded on national radio. They did a disservice to medical trainees everywhere.

Patients Heard: Patients Hearing

2008-11-17T17:45:00.000-08:00

The New York Times is again innovating in the area of patient information. I found a page on the NYT today that lets patients hear the stories of patients with Parkinson's Disease. I know that I would feel at least more in control if I listened to some of these stories before seeing a physician or talking to family about a new diagnosis. It gives people a couple of differing experiences with an illness to help them identify some of the symptoms related to a recent diagnosis. Basically, it's important to limit the number of surprises that a diagnosis can throw at you. This is a positive development for both patients and physicians!

I think that one of the first treatments a patient should receive is education. Knowing what's to come is empowering for people. Understanding the reasons for pain, physiologic changes and functional limitations opens the black box of medicine for many patients, and I hope that providing that information to patients improves their perceptions of their illness. I'm going to keep prescribing education until someone tells me differently about the effectiveness of information in disease modification.

Soft Spot for Crutches

2008-11-15T20:49:00.000-08:00

In follow-up to the last post I published and as a response to Karyn...here's one post that I wrote previously after holding a door for someone with a cane...Seemed to fit in here.

I'm not sure exactly how this is going to sound...but I have a soft spot for anyone with a 'mobility aid'. Walking into my apartment right now I just held the door for an elderly woman walking with a cane. I wonder if that's empathy working within me? Do I have a better understanding of the pain that necessitates crutches and the disability that requires a wheelchair because of my close association with people who live with musculoskeletal pathology.

My big question is: Does this translate across medical specialties? Does a dermatologist really feel for people with bad acne and eczema? Can a respirologist really empathize with the air hunger of an asthmatic patient?

I guess that I'm lucky in my profession. It's easier to empathize with pain. We've all had varying degrees of that symptom. All this begs the question of other professions and their similar empathy stories...

Does a banker feel the anguish of debt and financial ruin? Can a plumber empathize with flood victims? Does a teacher hang their head with the student who fails a test?

I don't even know if all doctors feel the same empathy that I do. That being said, I am going to continue to preferentially treat hobbling people with the respect that they deserve, both inside the hospital and without.

Election Results - Leadership, finally!

2008-11-05T04:24:00.000-08:00

I imagine many were watching the election results trickle in last night. I know that there would be mixed feelings about the results based on the popular vote, however, I hope that we can all agree that this is a vote for leadership.

There is no question that intelligent policy is needed to lead a country in the right direction. More important is the ability to have people listen, understand and act on that policy. I feel that Barack Obama can bend the ears of the US and possibly the world. That's why I think he was the right choice last night.

Listening is another skill that a great leader needs. Listening to the world will repair the broken relations of the last two terms. Listening to a complete cross-section of American society will help Obama shape social programs to ensure that even though there is still industry and self-reliance there is also a following of the statement, 'You are your brother's keeper'. Some call this socialism when times are good. When times are bad it is called survival, and it has worked in much of Europe and Canada.

I think that the prevailing sentiment this morning is hope. The entire news report was taken up by stories of the election. People are jubilant. There's been a change.

We all need to listen, talk and follow, helping Obama on his journey so we ensure the change is positive.

Healthcare and Baseball?

2008-11-01T07:47:00.000-07:00

With the World Series still top-of-mind for many people the New York Times published an Op-Ed piece that should be of interest to both healthcare providers and baseball fans alike. The article is called:

How to Take American Health Care From Worst to First

Now, I have heard of "Moneyball" before. It was discussed in a few of my MBA classes, including a case that looked at the value of Alex Rodriguez (ARod). At the time I thought that these cases and examples were a way of convincing us lazy MBAs that 'doing the number crunching' was fundemental to understanding the business problems we were studying. Now it appears that a 'data-driven' approach to healthcare could be just around the corner. I think this is a great idea, but I see a major shift needed to implement the idea.

Currently, many hospitals are still relying on paper charts to record patient information. I use a pen to write down patient information that I think is relevant (which, as an orthopedic surgeon-in-training isn't all that much...). There are other binders that contain medication information and another clipboard that has patient vital signs recorded. To transfer that data to one database for analysis would be an epic and frustrating job.

An electronic medical record (EMR) could solve that problem (and will be here in Winnipeg at St. Boniface Hospital, where an EMR is currently being implemented). What isn't so easy to change is the attitude of providers. There's a fear of 'being watched' that even I get when I think about having my every move catalogued on an EMR. That being said, I know that analysing patient data will protect me and standardize my practice, probably improving patient outcomes and reducing medical errors.

Personally, I'd rather think about ways to advance medicine than try to remember thousands of drug dosages and treatment protocols. Having an EMR and data-driven medicine shouldn't feel like being watched by big brother...it should give physicians, nurses and other medical practitioners a sense of security, freedom and hope that we are improving the care of patients.

Coming soon: What should data-driven medicine use as potential measures of care. I'll think of some, but I also want to see what readers have to say. How would you track patient outcomes and care performance?

Tongue-in-Cheek response to "Battling Parkinson's Law"

2008-10-28T16:35:00.000-07:00

I received a message from a friend in response to the article in CMAJ - Battling Parkinson's Law. This person said...'I used to think a lot about Parkinson's Law when it came time to lay people off. It was amazing how the work still got done with less people.' Pretty interesting perspective with all that's going on today. Maybe this speaks to the need for stretch goals to boost our performance?

Hans Rosling - Follow-up.

2008-10-21T07:50:00.000-07:00

I hope that some readers enjoyed the TED talk by Hans Rosling. It's a good entry into the wealth of information and entertainment that TED talks contain. I wonder if any of you took a look at the tool that he used on the internet? It's available at http://www.gapminder.org/ for free. You can compare any countries to one another. It might be a good way to find success stories in health around the world and help us clear up our 'Healthcare system mission'.

Although Rosling seems to be suggesting that gaps have narrowed over the past half-century, which I agree with, I think there is another point that can be taken from the lecture. It combines his ideas with those of Jill Eisen, the host of a two-part CBC program on 'Sick People or Sick Societies' which laid out the social determinants of health and their importance of determining the health of communities and nations.

Health services are only one of many, and not the most important! That's an important fact and one we forget often in medical practice. The analogy of fishing drowning people out of a river and never going upstream to see who or what is causing them to fall in comes to mind.

At her lecture on debt Margaret Atwood referred to 'Universal Education' as a possible solution to social problems in Canada. She also didn't sound optimistic about the adoption of that idea...

Do you see any connections between the other determinants of health and the use of the healthcare system? It might stem from a mission for a healthcare system you read about below. Write in a comment and let's learn from one-another.

I Fought the Law: Article in Canadian Medical Association Journal

2008-10-21T05:58:00.000-07:00

http://www.cmaj.ca/cgi/content/full/179/9/968

Before leaving Winnipeg to go to Ivey to complete the Health Sector MBA I was working 'nightfloat' shifts here in Winnipeg. That meant that I was working overnight and sleeping in the day on the Orthopedic Trauma Service at Health Science Centre. Although it can be really busy on-call, I had the luck of several nights of relative quiet. It gave me the time to record some thoughts that were born while I was shooting a puck around an outdoor rink that winter, listening yet again to CBC's Ideas on my iPod.

The program mentioned Parkinson's Law, and the description given immediately made me think of my life as a resident. I had a lot to say on the subject related to medicine, and so I started crafting a storyline in my head then and there. I refined it over the next few months and in June 2007 I put it down on 'paper'.

So, in this week's CMAJ it is published in the Salon section. I hope that you all enjoy it. I'm sure that some of you have heard me quote this law that states, 'tasks will fill the available time for their completion'. Read on in the CMAJ!

The Mission of a Medical System

2008-10-19T11:27:00.001-07:00

I made a comment on Andre Picard's article 'Taking on Our Sacred Cow' posted on Oct. 16, 2008. I agree with the thesis of the article, that even though the economy overshadowed healthcare as an election issue the future of medicare will need to be discussed in the near future as it's one of government's major costs at all levels in Canada.

Before we start debating medicare's future I want to suggest that we talk about what the mission of medicare is. I guess we can start my repeating the tenets of the Canada Health Act:

1 Public administration
2 Comprehensiveness
3 Universality
4 Portability
5 Accessibility

That already complicates things though. At a very basic level we need a simple mission within healthcare policy and delivery. We need a mission that applies as well in Japan and Ghana as it does in the U.S and Canada.

What about: 'Decrease the burden of pathology'? That would include trauma and acute illness as well as chronic conditions. I think that it would also force healthcare and prevention to be considered in the same discussion. Can we combine that many areas, currently operating in isolation, into a new system though?

Even more encompassing would be: 'Making people better'. This might be too vague though. A mission has to communicate goals clearly to everyone who would be active in achieving them.

Here's a final try: 'The right intervention at the right time'. We should be intervening to improve the non-healthcare social determinants of health immediately. This statement acknowledges that. We should also be ensuring that there is enough capacity to deal with life-threatening conditions and trauma while managing wait times for elective procedures.

These are off-the-cuff mission statements I came up with on a Sunday afternoon. Let's get this discussion going with some ideas from the audience. Tell me what you think of my missions and post your own!

Patient Trust: Web Edging Out Doctors!

2008-10-18T08:08:00.000-07:00

I received an email with a pretty startling quote the other day.

'85.6 million Americans say they have doubted a medical
professional's opinion or diagnosis because it conflicted with
information they read on the Internet.'

The source is a consulting firm and I don't have access to their methods of making this claim (which makes me immediately skeptical of the claim), however, I'm not entirely surprised.

I think arguing that number is not important though. I think what's more interesting to ponder is whether the number signifies a loss of trust in conventional medicine (and by association, doctors) or whether it suggests that the internet is improving as a source of medical information?

In my daily work I have seen many print-outs from internet sites on strange diagnoses and false claims related to patients' illnesses. I admit that I have cringed when having to spend extra time explaining that the claims don't fit with the current standard of care, sometimes enraging patients. I'm by no means the least open to that kind of discussion in my profession, others are offended by this questioning of their clinical judgement.

We, as a profession, have to accept the fact that the internet will continue to improve as a source of information for patients. With official sites like The Mayo Clinic, and WebMD improving and a new crop of social networking sites devoted to health coming forward it's just a matter of time until people can accurately find the information they need without an appointment to see us.

I want to be a part of the Health 2.0 revolution. I'd rather be at the negotiation table while the format of health information is being molded on the web. That's why I will be joining a team launching a new website in the coming week. In my next post I'm going to be giving the URL so you can all see what a blend of medical knowledge, Web 2.0 expertise and computer logic virtuosity can come up with!

Should doctors get into the Health 2.0 space? Start a discussion. I'm interested to hear what you have to say.

Payback - The Massey Lecture by Margaret Atwood on Debt

2008-10-18T07:24:00.000-07:00

I guess it was just luck that I bought the Globe and Mail last weekend and saw the review on a new book by Margaret Atwood called 'Debt and the Shadow Side of Wealth'. Being a medical trainee in Canada I'm pretty well-acquainted with the idea of debt so the article really twigged my interest. It wasn't long after that I heard an announcement on the CBC of a lecture that was to be delivered here in Winnipeg by the same author on some of the material in the book. Naturally, I bought tickets.

Now, these lectures will be broadcast on the program Ideas on Nov. 10 - 14 and will surely be put out in podcast form after that. I don't want to spoil them by giving away the thesis of the Winnipeg talk. I will give a little story of ancient debt that I experienced though...

In 2004 I spent 2 months in the highlands of Papua New Guinea, Enga Province to be exact. Beginning to even slightly grasp the culture of the area, only 'found' by outsiders in the 1940s, was a challenge. I had been prepared for the blurring of friendship and debt by my hosts there, but I needed to experience it to really understand.

One day I was hiking with my friend Florian in an area up the valley from the hospital. As it was the land of a different, unfriendly tribe our usual guide couldn't come with us. We followed a path that lead into a collection of a couple of houses and some gardens with sugarcane and beans. As we came around a corner we stopped when we saw a man with a machete, its sharpened edge gleaming in the sun.

This is a pretty common sight there. We both went up and shook his hand and found out that his name was john. He was preparing sugarcane for eating and wanted us to stay and chew some while he asked questions. After a stalk or two and many more questions I pulled out a Toronto subway token and gave it to him saying that he was probably the only person on the island to have one. We said goodbye and left.

The next day we were at the hospital again, and when we came back we found out that John had come calling and wanted to give us a present. He had left 12 sugarcane stalks, 2 bags of beans and too many cucumbers to eat. He came back several other times to give us more presents...or what we thought were presents.

It turned out that he was confirming our friendship. In PNG debts bind friends together. If I owe you then you are connected to me, cementing our relationship. Think about the complications that ensued when we re-gifted some of the food so that it wouldn't go to waste! A nuclear chain-reaction of friendship was set off bringing in even more 'friendship gifts'. You should have seen the looks on our hosts faces!

What a difference from the relationship that I have with a large bank which lends me money. My only friendship gift from them is a monthly statement letter. I guess that's the price of advancing civilization?

Hans Rosling - Another way of looking at the world

2008-10-02T21:42:00.000-07:00

I just wanted to throw this up without comment. I hope that some readers will watch and comment. I just don't want to influence the debate on this Swedish scientist's opinions.

Enjoy!

Lingo and Humour on Rounds - Getting by with laughter

2008-09-28T09:08:00.000-07:00

I just had a friend send me a link to a BBC article that really sums up some of the humorous release that goes on within medical circles. A lot of it (the North American equivalents) can be found in Samuel Shem's book, House of God. The article claims that the art of obtusely making derogatory statements is now on its way out. I agree with that thought. In orthopedics we tend to take shots at one-another rather than make comments about patients.

Humour is one of the coping strategies that medical professionals use to deal with the daily emotional bungee jump. Without a coping strategy the amount of work and significance of the problems providers face would definitely drive many people to look around for a more relaxed job (Rheuma-holiday - as per the article?). Psychologists tell us that humour is a mature and constructive coping strategy. The article definitely shows the dark side of that.

The best coping strategy is seeing patients doing well though. Being in clinic when a patient returns satisfied with the results of treatment is the moment that many physicians use to power through all the tough times and long hours. Laughter is good, but patient satisfaction trumps all.

Creative Capacity

2008-09-19T06:43:00.000-07:00

In the medical education literature there's something called Attentive Capacity or attention. In the operating room it manifests itself when a surgeon asks for the music to be turned down at a difficult point in the operation. She needs to use all of her concentration to focus on the task at hand, and the music is using part of that concentration.

Being so busy back at work the past few weeks I begin to wonder if creativity is also governed by a similar capacity limit. Accomplishing tasks in the hospital is difficult and requires thinking outside of the box. All doctors are advocates for their patients and spend days making sure that they get the right care. Does that take up their ability to focus on creative outlets? Is that why coming back to residency has put a stop to a lot of my reading?

Having just been away doing an MBA the first solution that comes to mind is to standardize patient flow to make sure that I don't have to put in all this legwork to treat patients. But, working with orthopedic trauma also reminds me of the varied needs of patients. Better to have strong advocates and personalized care.

How else can we maintain our creative pursuits and our personalities when working hard? I'm going to keep looking for the balance and the solution to increase my creative capacity. Maybe it's this blog?

Business to Bone Setting...Seeing Emotions in the Hospital

2008-09-13T21:01:00.000-07:00

Last night was my first call shift back after a year away. It was also the official end of my first week back in the medical saddle after a year away in the classroom. It's amazing that after one week I am already remembering many of the things that I learned over a year ago. That includes both theoretical knowledge and skills. It's easy to fall back into old habits and routines (like my 2 hour nap on the couch post-call. It was delicious). There is one thing that I see differently having been away for a year.

I have now witnessed the patient experience in several of its forms over the past week. What I mean by this is the way that personality manifests itself in times of trauma and sickness. I think that many physicians (and providers in general) become numb to the human element of medicine after several years of practice. Having been away I am now better able to appreciate the manifestation of emotions that occur in patients. I actually feel the anxiety, strife and relief again. I had lost that ability before I left and relied mostly on cool clinical reasoning and logic in my patient interactions.

I'm glad that I can see these emotions again. The question in my mind is: How sustainable can empathizing with these emotions be over a busy career? Can a doctor maintain a close connection with all patients and try to step into their shoes, if only for a moment? I find it hard to even appreciate how it would be to spend more than a day fasting for surgery, let alone coping with multiple fractures and long periods of non-weightbearing, bed rest and pain.

In several months I will look back on this blog and respond. Has anyone else tried to keep their humanity while tending to the technical aspects of medicine? Has anyone reading this met human providers? Share a comment if you have.

Risk and Surgery: The Canadian Way!

2008-09-10T17:43:00.000-07:00

I was poking through all the mail that accumulated over the year that I was away from Winnipeg last weekend. There was a box piled high with journals reminding me of all the knowledge that I had left behind when I started my MBA. Somewhere in the mess was an old CMAJ (Canadian Medical Association Journal). I looked inside the back cover and found an interesting article.

When I first read about Risk Characterization Theatres I immediately thought of all the times that I spent 10 minutes trying to explain a surgery and its risks to a patient. I have had many times when I left a room convincing myself that a patient understood the risks of surgery that I just explained. I always remember what I was told in medical school, 'Patients only remember 10% of what you tell them.'

Being in an orthopedic residency you bring a lot of bad news to patients; more bad than good I would say. No one likes to go to the operating room, or at least as a patient. I looked at the article by Mr. Strauss and thought we surgeons might be able to alay some fears that linger after our surgical explanations. Stay tuned for a potential research study on this topic!

My only concern is that most Canadians may not identify with the theatre. I think a major opportunity is being missed here. Why are there no Risk Characterization Hockey Arenas?

MD to MBA: How did that Happen?

2008-09-08T18:30:00.000-07:00

Many people that I meet find it hard to understand why a doctor would postpone finishing training to complete an MBA. In fact, many of my colleagues were skeptical of my reasons for opting to go to Ivey. I think that many of them thought that I would never return to my training program after graduation (but today was my first day back...and it felt good).

I needed to have an eye operation when I started residency. I didn’t know how long it would take to recover my sight after it, and so I thought it would be the perfect time to complete a master degree (now almost a prerequisite to getting an academic position in medicine in Canada). I thought very seriously about a Master of Education (M.Ed.) but upon telling my program director and mentor about my interests in a yearly review he offhandedly said, ‘Why don’t you do an MBA?’

That gave me some food for thought. I immediately started to do some research on MBA programs and found that many were 2 years long. Those wouldn’t fit with my schedule. Ivey had a one year health sector program. I remembered that a medical school professor, Kellie Leitch, was cross-appointed at Ivey. She talked to me about the program and its utility in practice and I was sold. A year before I started I studied for the GMAT while listening for Code Blue to be called in St. Boniface Hospital. Having successfully completed the test I spoke with 2 members of the Ivey interview team, and found out that I was accepted.

In producing a poster for the annual meeting of the Royal College of Physicians and Surgeons last year I found that the reason American physicians are going to business school is primarily to regain control of their work life. For me the MBA has given me a different perspective on the problems facing the Canadian Healthcare System. It has strengthened my resolve to be part of the solution.

And after today it turns out that I also just like working in the system. For all the complaints that surface there is a fulfillment that working in healthcare gives that keeps me going. It even makes the 5:30 mornings worth it.

...Like riding a Bike: Back on the Wards

2008-09-06T10:30:00.000-07:00

It's funny how knowledge and experience sticks with you over time. I just returned to the hospital after a year away. During my MBA I didn't have any patient contact. I didn't do any Orthopedic Surgeries and I left all my Ortho textbooks on the shelf. I've been afraid that my knowledge would have slipped by this point. After sitting with a couple of colleagues yesterday I found that all that knowledge just comes flowing back when it's dusted off.

You hear a lot of stories about career switching these days. Apparently, people of my generation only stick with a given job for 2 years on average. Are we looking for something better, or are we just stimulated by constant change? I read an article in the Atlantic Monthly entitled 'Is Google Making Us Stupid?' (http://www.theatlantic.com/doc/200807/google). When I thought about the premise of the article and all the career change stories that I encountered in the business world it really made me think that the internet may be spurring my generation to take these leaps in order to keep life interesting.

In my case, I'm going back to my old job. One thing that I can say for the Ivey MBA (www.ivey.ca/mba) though...My year there has made the hospital and my life in it look completely different. Although that knowledge remains my perspective has changed.

I wonder if others who have gone back to previous jobs after an MBA have the same experience of looking on old careers in a new light? Any stories?

Next time I'll go into how I ended up in an MBA: where the journey began.

...Steps on a Doctor's Journey

2008-08-26T08:12:00.000-07:00

The last hours of my MBA are evaporating. My time to walk across the stage is coming. I'm just about ready to start doing hip replacements and ACL repair surgeries again. I feel some butterflies in my stomach about both.

My name is Jesse Shantz. I'm a doctor and orthopedic surgery trainee. I'm also now an MBA, which has given me an interesting perspective on the Canadian healthcare system. I'm also a member of two website startups. So, many of you will understand the regulated environment I operate within in the hospital. Others will appreciate the creativity unleashed in startups and MBA programs.

This blog will give some thoughts and links I assemble based on my experiences on the wards and in the 'boardroom' over the next few years. I'm also going to put in some links to the sites I'm involved in and some articles I'm having published in the coming months.

The blog will remind you of Pulp Fiction a bit since it will jump around in time...but I'm hoping to add some perspective on previous events.

Most of all I hope to encourage some comments from you, the audience. So, let me know if you're another MD/MBA reading. Definitely comment on anything you disagree with or send your support for everything you like the sound of.

Sincerely,
Jesse