Small Changes Big Impact

Exploring new ideas in medicine and the future of technology in healthcare with Dr. Ross Upshur

December 11, 2019 University of Toronto - Department of Family & Community Medicine Season 1 Episode 7
Small Changes Big Impact
Exploring new ideas in medicine and the future of technology in healthcare with Dr. Ross Upshur
Chapters
Small Changes Big Impact
Exploring new ideas in medicine and the future of technology in healthcare with Dr. Ross Upshur
Dec 11, 2019 Season 1 Episode 7
University of Toronto - Department of Family & Community Medicine

Today's episode is in combination with Dr. Ross Upshur's podcast called Conversations in Complexity. Today's episode focuses on the emotional, psychological, and existential exploration of current topics in medicine. 

Show Notes Transcript

Today's episode is in combination with Dr. Ross Upshur's podcast called Conversations in Complexity. Today's episode focuses on the emotional, psychological, and existential exploration of current topics in medicine. 

Dr. Rezmovitz:

Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. Today's episode is in combination with Dr. Ross Upshur's podcast called Conversations in Complexity. Today's episode focuses on the emotional, psychological, and existential exploration of current topics in medicine. I hope you enjoy the show. So thank you A, for coming in today. But B , I'm sure you have a big - you could talk about the impact that's had each of those things have had on your life and the people around you. Today's conversation though, if you, if you want, let's talk about fun stuff, whether it's personal or professional about, about a small change that you had and, or made and the impact that that had on you, your systems. You know, we can talk about complexity.

Dr. Upshur:

Yeah. So , um, I think change is a, is a really appropriate frame for how people's careers and lives , uh, evolve. Um, so I've been constantly - small changes and big changes, I think I'm constantly changing. I'm a restless , uh , um, sort, as you note from the variety of roles I play, I have a kind of variant of intellectual ADHD so I can never stay settled doing one thing for , uh , for a long period of time. So change is constant in the sense that , uh, I think , uh, being deeply inquisitive - I've always got , um, you know, a few thousand questions to ask and uh , no time to get them properly answered. So the, the, the most significant small change that I think I made, and it's actually fairly self evident and obvious, is learning to take care of myself a bit better rather than , uh , leaving myself open to , uh, uh, all of the forces that , uh , were impinging upon me with clinical research, teaching and administrative roles. So the smallest change that I made that had the biggest impact, I think on my own life and by virtue of that, the lives of others was actually getting up early in the morning to , uh, exercise to take my dogs out for a walk. So I start the day with a very nice - uh, I live in the beaches. I get up very, very early in the morning and I walk out by the Lake and it's just me and two dogs. And , uh , sometimes they can see the sun rising in the spring and fall, but these days it's a very dark. And this morning it was really nice and foggy, but it's the smallest change that had the biggest impact because the simple fact of, you know, getting up to get outside at five in the morning , uh, brought me a kind of sense of - I start the day happily, right? So nothing can go wrong after. And whether it's snowing, raining or windy , uh, making your dogs happy , uh , makes everybody happy. And so that's kind of a small change.

Dr. Rezmovitz:

That's the paradigm, right? Happy dog. Happy life.

Dr. Upshur:

Yup. Absolutely. So, and uh, of course, if you're taking better care of yourself, then you're actually a more effective , uh, uh, parents, spouse, clinician and researcher. So I think , uh , small changes to actually take care of oneself can have tremendous spinoff benefits to virtually every aspect of your life.

Dr. Rezmovitz:

Yup . So obviously it begs the question, how did you get to that change? What was going on?

Dr. Upshur:

Well, so , um, I think like many of us, I went through a phase of saying yes to everything and was probably around the time that - probably just before I met you. I found a, you know, put on , uh, extremely , uh, a large amount of weight and we have high blood - don't mind, you know , talking about health issues we're physicians - uh, but uh, I developed extremely high blood pressure. So , uh, like 245 over 160. And I actually - you're gonna laugh at this - I diagnosed it while I was on call and didn't tell anybody. So it was one of the classic things. We had those BP true machines. I said, nah, it's gotta be wrong cause I'll just get through the clinic. But it wasn't wrong. Uh, so that was kind of a wake up call that it was time to really take a step back and take good care of myself. And so since that time I've been very well behaved , um, not so much younger man anymore.

Dr. Rezmovitz:

So I took a genetic test recently and it , it, it, it showed me that I have a genetic defect also. I say yes to a lot of stuff.

Dr. Upshur:

I was looking for CRISPR that's going to go in and insert a no gene in my head somewhere.

Dr. Rezmovitz:

I've been waiting for that specific focus of my brain for the telomerases to die off so I can just say no again. Um, okay. So then where do you see it had the greatest impact? So you're walking your dogs at 5:00 AM and um, you know, you've already said , um , you know, this adage of happy dog happy life, but, and you said it also will impact every other part of your life. So where do you think it's had the biggest impact?

Dr. Upshur:

So one of the nice things is if you're up out early wandering, your mind starts to wander. So you think and you start to think , um , a little bit more, I would say freely. So I've always been interested in reflection and thinking - I started out before I went into medicine as a philosopher. So having time that you can actually just think and think through things so you can puzzle through problems and issues that you're working on. And uh, you know, it's no mistake that certain ancient traditions of philosophy were wedded to walking. So Aristotle founded the what's called peripatetic school. Uh , they used to walk and philosophize simultaneously. So getting up and walking and thinking is a really nice way to start the day because then you say, "aha!" So I can't think of - I mean there's been numerous ideas for papers, studies, things to think about, things to explore , uh, that have emerged from those early morning walks. It's a really productive time cause that's time that's just for me. And of course I've got to keep an eye on the dogs, but they're reasonably well behaved. So it's a nice time and it's a nice space to get your day going.

Dr. Rezmovitz:

And it's outdoors obviously.

Dr. Upshur:

And it's outdoors.

Dr. Rezmovitz:

And so if we think of ourselves as systems, it probably gets your gut system working really well too. Um, right? We know that walking , um, activates gut motility , um, which leads to, you know, certain things being evacuated better outside than inside. Does that means your system at home is going to be better cause your , your , whoever's living at home with you wife and daughter probably are like, Oh thank God he's gone.

Dr. Upshur:

He's gone. He's out of there.

Dr. Rezmovitz:

Yeah. So it's obviously going to have benefits far reaching benefits of, of you being outside. Um, so tell me about , um, something that you thought of on your, on your walk that , um, actually was an aha moment that , um, you know, grabbed you and you said, you know what, that that's wow. I can't believe this came.

Dr. Upshur:

So I think there's at least three or four , um, essays. So one of the things, um , more recently - so I'll give you a recent example - is that , uh, AMS foundation came and asked me to write a paper on the impact of artificial intelligence on family medicine that they wanted presented in the May leadership forum. And , uh, originally I had hoped to have a postdoctoral student work with me and do most of the legwork , but then he had to leave the country. So it was left with me. So I was puzzling like, how am I gonna put this all together? And as I was walking on the beach, I started to think about how technologies have, well, not just duality, but they have - they're multi focused or multi-focal in their impacts in human lives. And then I got thinking about , um, Roman philosophy and, and Roman mythology. And I started to think about Janus, who's the two faced god. And then I remembered, of course, that Janus was one of the key educational initiatives for the College of Family Physicians.

Dr. Rezmovitz:

Yeah it's one of the grants.

Dr. Upshur:

Yeah, exactly. And then I thought, aha!

Dr. Rezmovitz:

Bang!

Dr. Upshur:

Here are these, here's this notion of the kind of - and even though it's a two faced god, it's actually - if you look in, in Roman literature - that bridge between - that two faced-ness is actually , um , multiple different things can come in and go out on different sides. It's not just a simple dichotomy.

Dr. Rezmovitz:

A fluidity.

Dr. Upshur:

It's a fluidity between various different kinds of transitions. So when I was thinking through that and then I thought, "Oh, this is the obvious hook to the Janus Foundation." So that's why when you look at the paper, there's a picture of the two faced God. And then I start the paper by talking about the dual nature or the multi-focal nature of um, technologies and how we might want to start. So some people might want to drive to the kind of a Pollyanna technological future where artificial intelligence solves all of our problems. Others might want to go down the dystopic view of it's going to ruin everything, hollow out cognitive labor and replace physicians. And somewhere in between that, those two poles of the dialectic lies probably a more robust answer. So through walking on the beach that morning, making that connection, then I was able to sit down and went right to work and - you know, it was one of those, got to keep it in mind, got to keep it in mind - sat down and wrote almost the entire draft in one sitting, which was kind of fun.

Dr. Rezmovitz:

Wow. So where is this treatise?

Dr. Upshur:

It's a actually linked to, on the Canadian College of Family - on the, on the journal, on the CFP, on a Canadian Family Physician, and it's on the AMS website.

Dr. Rezmovitz:

Okay. I'm going to have to check it out.

Dr. Upshur:

16 pages. I wrote clearly as I can.

Dr. Rezmovitz:

And so what was your conclusion? For all the listeners who aren't going to read 16 pages right now and are in tune with podcasting instead ?

Dr. Upshur:

Yes. So there's a podcast on this as well, so they can - well, the conclusion was that I think that we have as - not just as family physicians, but as a medical profession - not only an obligation, but an opportunity to engage with these technologies early rather than later. The other thing that I wanted to highlight is that there are fairly potent economic interests behind the movement of the tech sector into medicine. And we may want to not repeat the same mistakes we made in the early days with pharmaceutical companies. Um, forewarned is forearmed , uh, we need to invest in digital literacy. We need to invest in that at the undergraduate , graduate and postgraduate level and certainly in continuing professional development. Uh, one of the fears I do have is this kind of separating into the coders and non coders as we move forward. So more and more of our students will be coming into medicine, probably having some facility with coding and will know how to work with these technologies. Uh, but there might be a large number of , uh, physicians who will feel somewhat alienated from the technologies because they can't get under the back behind and learn how to use it for themselves. So there'll be actually , uh , dependent on what's presented to them rather than crafting something for themselves.

Dr. Rezmovitz:

Do you think there's going to be a role for both of them in the future?

Dr. Upshur:

Yeah, I think it's , there's always - it's interesting as specialized technologies come in, there's usually kind of a settling out. You've got a - like on a pyramid, just kind of like how we've envisioned medicine in some ways with, you know, super specialists all the way down to generalists. Um, so I think that there will an equilibrium with the new technologies. Some of them are just frankly not going to work and not pan out. And that's kind of the ethos of the industry is to, you know, try and fail fast. That's hard for people in medicine because you want some sort of stability and certainly don't want to fail fast on the backs of your patients. So I think it's going to be a very interesting , uh , next decade or so as these new technologies integrate into clinical care and make no mistake, they will integrate into clinical care in ways that we can see and ways that will be unforeseen.

Dr. Rezmovitz:

Yeah, I think they actually printed that , uh , what you just said in the JOD last week. Do you know the JOD?

Dr. Upshur:

No.

Dr. Rezmovitz:

Oh, the Journal of Duh.

Dr. Upshur:

The Journal of Duh. Yeah.

Dr. Rezmovitz:

So yeah, I think, I think physicians have a role to play as the interface between the technologies, whether or not those technologies are impacting how we practice or whether or not how patients come in and , and ask us about our opinion. I mean that it's going to do that, right? Like , um, I don't think the technology is the solution. I think the dialogue that happens, you know, that interface that you're talking about - that's going to be the solution of how we progress forward. If we can focus on that and creating dialogue , um, whether it's interfacing between , um, you know, do you know about the doctor patient relationship?

Dr. Upshur:

So I've heard about that somewhere.

Dr. Rezmovitz:

Have you ever heard about the doctor computer relationship?

Dr. Upshur:

That's uh , well I remember when , um, we transformed over to the electronic medical record, they sent us this picture and it was actually what I would call server centre medicine, right? So they had it - at the centre of it all was the server and uh, they had this picture of patient or doctor seeing patients where doctors were looking at computer screens and patients were little triangles with circles on top. So that gave you a good idea of how the computer physician interface was being seen from the tech side of the equation.

Dr. Rezmovitz:

Oh yeah. No, it's a, it's a real relationship.

Dr. Upshur:

Yeah.

Dr. Rezmovitz:

Yeah. You can actually see it , um , in clinic when you, when you start looking for stuff and you, you know, there's a patient beside you. So I've actually started turning the computer towards the patient and we scroll together now.

Dr. Upshur:

Yes.

Dr. Rezmovitz:

It makes for way better - it's a much better relationship.

Dr. Upshur:

Well, I'm a hopeless typist still. So when we made the conversion over I used to joke to my patients for them to bring their laptop in so they could Skype me and I could see them. It was just a bit of a joke, but eventually I just turned away from the computer entirely and would make all my notes after.

Dr. Rezmovitz:

Yeah.

Dr. Upshur:

Yeah.

Dr. Rezmovitz:

No, I think that's key. It really is. Unless you can make a little bit of notes as you're going , um, you're going to be disconnected from the patient.

Dr. Upshur:

Yep.

Dr. Rezmovitz:

And so really , um, where are we going in medicine from , um, technological , um, bureaucratic, political way - uh , like manner. How do we maintain that, that, that connectedness with our patient? Is it, is it all or none? Do you really just turn it off?

Dr. Upshur:

Well, I think we have to teach - and that's one of the strengths of family medicine - the importance of the , uh, fundamental relational nature of medicine. If you want to , um, revert it all down to some sort of interface with a search engine and a , and a technology that will be what we get. Uh, but I think if we continue to teach that the fundamental nature of medicine is in that physician patient relationship in some important, robust sense , um, then we can continue that. Otherwise we will be displaced by machines.

Dr. Rezmovitz:

So one of the best places where you can see that we haven't been , um , replaced by machines yet is on house calls. Cause it's, it's somewhat awkward sometimes. You go into the house and you don't know their wifi password, so you're not bringing your computer in and setting up a , you know, a station there if you will. And so you get down to basics. Um, and so I finally remember bringing , um, some learners with me on house calls and then being, you know, completely , um , mesmerized by the fact that we're offering like medicine. Which is a surrogate of it's care. You're just offering care. Yes . So do you see - how do you see the future with respects to , um, to the care that we offer? Um, do you think it's going to change? Uh , do you think that we as family physicians will still be the stewards of, of care - the gatekeepers of our healthcare system?

Dr. Upshur:

Uh , that's a , uh , a very good question. And I can envision , um, uh, several , uh, possible scenarios. So there are definitely interests that wish to displace , um, the presence that is the face to face meeting , uh , between a physician and patient as the kind of central interface between medicine and patients. Uh, that's why there's such a , a move and push towards virtual care. Um, virtual care is still face to face, but it's not presence to presence.

Dr. Rezmovitz:

It's not face to face. It's distributed.

Dr. Upshur:

Well it's mediated through screens and other things. Uh, but it's got an attractive allure to people who are time pressured, busy , uh , find that it meets their needs. So I hear a lot of people talking about the virtues of virtual care. Um, and actually considering, you know, basing primary care systems in some variant of virtual care. Good example of that is Babylon AI's GP at hand, which was implemented in the UK and now is coming to the , uh, Canadian. Uh, and it's got a very explicit marketing strategy and it's a displacing , uh , form of primary care. So I think family physicians are going to need to be savvy, organized and dare I say somewhat political , uh, to make the case that the kind of care that they bring is actually what is best for patients and for their families in the short, intermediate, and longterm. So it would, and there's, you know, fairly considerable research evidence that suggests that that's the case. So the move towards a patient's medical home , uh, you know, supported by the College of Family Physicians is an attempt, I think to sort of ground the care of patients and families through the life course. Some of it will become virtual. I think almost everybody would agree that there are some efficiencies to be had through not making sure, you know, making people come in for every little thing. We needed regulatory permission for example, to start to use email, text messaging and other ways of interacting with patients to make sure that it met certain security parameters, et cetera, et cetera. So I can see - I can envision several different futures that have various degrees of technological mediation written into them. Uh , the worst case scenario would be a complete displacement of face to face medicine. And I think there's probably a happy medium in between though I'm conscious of the kind of historically conditioning forces as different cohorts of people come through with different expectations that will definitely transform how we do our business.

Dr. Rezmovitz:

As you speak. I can't think - I can't, but think of like how art reflects society and um , I think about some, some really standout , um, paintings and images in my head of, you know, doctors kneeling bedside that - we've seen these pictures before, like really like bubonic plague representations , um , uh, people that have just been around. And so I started thinking also as you're talking about the future of what it will look like , um, uh , of what the, what the museums are going to be housing , uh, of reflections of society with , with an Apple laptop and, and , um, and , and virtual care being , um , demonstrated here and just have like two computers and you don't even see the people's back. You just see the backs. And so just trying to understand , um , because -

Dr. Upshur:

I'm looking forward to future , um, you know , uh , garage sales and lawn sales when all of the newest , uh, you know , uh, gadgets for help that have gone the eight track way are all being recycled across the neighborhood.

Dr. Rezmovitz:

So, so someone came up - a patient, and I hope he's okay with me talking about this, but , uh, he says, we're , you know, everybody's busy. You know, you made a comment, you know, the biggest change, the smallest change that you made this, that had a big impact was going for a walk. You made this change. And he said, this Fitbit that he's got on, he says, it needs to be replaced. He says, we're so busy now, he needs a "sit bit". Do you know about the "sit bit"?

Dr. Upshur:

No, tell me about that.

Dr. Rezmovitz:

Yeah, you got, you got to sit down. It tells you when you should stop. You're so busy doing everything. You write up your kids, you're trying to make dinner, you're trying to make lunches, you're trying to answer emails. You're trying to watch Netflix. You're trying to do everything.

Dr. Upshur:

Yeah, the pause bit.

Dr. Rezmovitz:

Yeah. The pause bit. Yeah. Pausing is so important. So , so you take your morning walk, your stroll. Um, so are you trying to achieve a certain number of steps in a day?

Dr. Upshur:

Nope.

Dr. Rezmovitz:

Amazing. Um, where else do you find that you pause during the day?

Dr. Upshur:

So there's a couple of things that I've done throughout my , um, adult life. I , I need to read every day and I need to read a lot. Um, and so I usually try to carve out at least an hour, an hour and a half to two hours a day simply to read. And that's a habit that I've had since I learned to read when I was like three or four years old. I've always been a reader. Uh, and if I don't read, I'm grumpy. So I need to have at least seven or eight books on the go. And then of course, you know, 40 or 50 journals that I keep my eyes on. Uh, so that's one thing that's to me is non- negotiable. It's, it's , uh , feeding my brain with new ideas from various different , uh, uh, areas of inquiry. And I read broadly and widely as I can. I like to - I was sad when we lost the journal rooms, you know, in the library. Over at the Gerstein they used to have the periodical room and there'd be stacks and stacks of shelves with every journal you could think of. And I would just randomly pull journals off and sit down and try to see if I could understand what they were talking about - what be it, biochemistry or anthropology, whatever. Uh, now you have to be a little bit more - it's harder to do because it's hard to find lists of journals and just randomly access them.

Dr. Rezmovitz:

I think they, they took it away because the library was supporting one person going in and -

Dr. Upshur:

There was only one person actually picking up the paper journals. Yeah. There was a couple of oldsters like myself.

Dr. Rezmovitz:

Yeah. Right. I mean, how often can you support - I mean, it's a lot of money to support that habit.

Dr. Upshur:

It's a lot of money to support the electronic version as well.

Dr. Rezmovitz:

It is a lot of money to support. So what um - give me your top five. What do you, what do you think people should be reading right now?

Dr. Upshur:

Wow. That's a really good question.

Dr. Rezmovitz:

And I said, what do you think people should be? And you know what, in the last interview we did, I told them that we don't "should" on people here. So how about this? I'm going to reframe my question. Top five journals or, or top five areas that people should be - not should be - ought consider reading.

Dr. Upshur:

Ah, that's a fabulous question. Um, so I think right now one of the most dynamic and interesting areas of scholarship is actually in philosophy of medicine. So there's some very interesting new journals and some very good papers coming out. Uh , really foundational debates. They're a bit of ahead of the curve in Europe. So in Europe and the UK , there's established programs on philosophy of medicine. Uh, one of my , uh, doctoral students who was the, actually the first , um, MD PhD student to do a PhD in philosophy of medicine, and he just actually signed on at the University of Pittsburgh. So he's writing a lot about causality , um, a lot about , uh, uh , disease taxonomy - so how we understand and appreciate diseases, how we think about causation and extrapolation of, for example, the results of clinical trials to individual patients. So there's a lot of really interesting stuff there. There's a lot of really interesting work being done in planetary health and environmental health.

Dr. Rezmovitz:

Is that like the health on Mars?

Dr. Upshur:

That's right. The health on Mars. Whether a mass coronal ejection of solar energy is going to end us.

Dr. Rezmovitz:

I thought they were just , um , trying to figure out the health system on Mars and see if we could adopt a planetary - interplanetary health system .

Dr. Upshur:

And you know, it's important , uh, for everybody I think to be engaged with literature so I won't be normative as to which fiction they want to read, but my , uh , my wife is a novelist, so we have a large number of , uh, you know, novels in the house. So I always have a couple of , uh , novels on the go and poetry. You should read poetry everyday . So Goethe said he had this triad that everybody should listen to music, read a poem or look at a painting every day. So I've been working on that Goethe triad for a long time. And it's easy because there's a , the American Academy of Poets has a , - you can sign up for it and they send you a poem of the day and there's all these acts, you know, there's a wonderful set of contemporary poets and it takes like three minutes on your inbox to read a poem and, you know, go to the Art Gallery of Ontario. So read widely. Uh , science and nature are always good for, for taking a look at what's happening on the cutting edge. You know, I look at the New England Journal, the Lancet, the British - all the major medical journals as they come in weekly. Um, and sometimes my two hours of reading actually extends to four, and then I have to upbraid myself for not getting any work done because I've gone down a wormhole.

Dr. Rezmovitz:

You did get work done.

Dr. Upshur:

Yeah, I did. It's the, it's the work that , uh, that most sustains me and that's because I know I've been a reader all my life and as I said, inquisitive with intellectual ADHD. So.

Dr. Rezmovitz:

So , um, I'm going to do a shameless plug for myself and say, look up CFP. Um, my understanding is I was their first poet , um, to submit something.

Dr. Upshur:

Oh, congratulations.

Dr. Rezmovitz:

Thank you .

Dr. Upshur:

Well done.

Dr. Rezmovitz:

So I have two - I have two poems. Um, and then , um, interestingly enough - so I sent one of those poems to CMAJ and the editor wrote back to me - "thank you for your, for your submission. After reading your poem, we've decided to no longer offer poetry in the CMAJ." That's Barb Sibbald. I'm just calling her out - I've met her, we've talked about it. It's funny.

Dr. Upshur:

That's very funny.

Dr. Rezmovitz:

The importance of the arts and humanity. Um, but um, but it was really important actually because the editor, I did another one. Um, I submitted an , um , a third poem to CFP and it was called "Joy Anemia", because I think it was happening in medicine. It was happening to me. It was happening to other people. Um, do you know about joy anemia?

Dr. Upshur:

Yeah it's when it's all just like gets sucked out of you, like you're [inaudible] any life blood interest.

Dr. Rezmovitz:

And so I offered - in the poem I offered some , um , tips and tools and the response that I got back has changed me in medicine from then on. Um , what the editor wrote back was "show me, don't tell me." Has anyone ever said that to you? "Show me, don't tell me." Cause I think so often we just tell people without actually showing them. And so my question to you is what are you doing now and has that small change you go out for a walk? Has it, do other people in your family go out for a walk? Has it translated to other people walking now or, or being more physically active? Or what are the things, are you doing that you're showing people how to do that has had an impact?

Dr. Upshur:

So I think , uh , all of our family members are pretty active, so don't think that that's , uh , uh, exemplary role modeling. Uh, it's just , uh, me joining the crowd. More on the, more or less. Um, yeah, I actually would say at this stage of my career, I don't have much to show. I get these , uh , re, you know, requests that we'd like to come and shadow you. And I'd say, well, not sure what I can show you except a little bit of wrist action on before I press send on my emails. So I'm doing a lot more , uh, administrative work today and I think it's more or less, you know, what do I show people? I would say, you know, how to be committed and uh, try to keep things moving forward. I mean, working in academic leadership, you've got to herd cats, you've got to get people motivated to do things. I often say my job is a cross between, you know, Elvis, Dumbledore and Tom Sawyer. How do you get people to paint your fence for free and how do you wave a magic wands and make things happen , uh, with , uh , you know, finite resources.

Dr. Rezmovitz:

Oh, so you're priming yourself to become the chair of the university?

Dr. Upshur:

No, I think I've reached my highest level of administrative competence. I don't think there's much beyond where I want to be.

Dr. Rezmovitz:

So I'm going to challenge you the next time someone asks to shadow you. Say yes. And I'll tell you why. Invite them to read. Sit down and say hi. I'm going to be reading right here. Um , I'm going to be showing you what I'm going to be doing. I'm going to be reading for the next hour and I challenge you to invite them to read. In fact, I want to get an invite from you to come over and read and read and then we, and then we talk. While walking.

Dr. Upshur:

Yeah. That's a good way to live.

Dr. Rezmovitz:

Yeah. Don't you think?

Dr. Upshur:

Yeah, no, that's absolutely correct. So when I - with my PhD students, I tell them that they get a free year and I tell them to go and read as widely and as deeply and uh, and without actually - and this is a bit , um, you're not supposed to tell your PhD students - without any purpose, right. Because they're going to spend the rest of their lives.

Dr. Rezmovitz:

But you're just messing with them.

Dr. Upshur:

I know, but it's true. But I do send them off -

Dr. Rezmovitz:

But they don't get it yet.

Dr. Upshur:

Yeah, they do.

Dr. Rezmovitz:

Do they?

Dr. Upshur:

Yeah. So I've had several of them come back and say, "you were right." That this was, you know - they've all since been, you know , hired as tenure stream professors and then they've got the life where they think that they were going to have time to read and research, but they're incredibly busy. So that time that they had when they were graduate students is the most magical time in their lives to be free and unconstrained in an intellectual fashion because otherwise we're just disciplined all the time.

Dr. Rezmovitz:

But it's not without purpose. You have a purpose.

Dr. Upshur:

It's a - it's a subversive purpose.

Dr. Rezmovitz:

Yeah. It's obvious to me. Do they not see that you're trying to get them to just be as general and wide as possible because you can actually generate ideas? That's what innovation is. Innovation is taking one idea and putting it - something of value and taking it and putting it in an area that didn't have that.

Dr. Upshur:

Yeah. That's the whole goal is to just to get them to open and free their mind to think as broadly and freely as possible.

Dr. Rezmovitz:

Yeah. So there is purpose. So you worth and value? Can't believe I have to sit here across and tell you that Ross. Okay. Do you have any last parting words? Like what would you tell someone - two people. Here's what I want you to - one, I want you to tell , um, a new , - someone calls you up and says, "Hey, my son or daughter is interested in becoming a physician." Um, what would you tell them? And two , what would you tell yourself, you know, when you were a young whippersnapper , um, I guess what, 20 years ago?

Dr. Upshur:

Yeah. The, the, the 20 year old me would be very disappointed in the 61 year old me .

Dr. Rezmovitz:

Really?

Dr. Upshur:

Yeah.

Dr. Rezmovitz:

Why?

Dr. Upshur:

Well, because I think - I mean, I'm so conventional. I'm a University of Toronto professor.

Dr. Rezmovitz:

How are you conventional? There's nobody I know that reads two to four hours a day.

Dr. Upshur:

I'm the very instanciation of what is the establishment. And when I was 20, I was involved in, you know, radical environmental politics. And , uh, uh, so , uh , as my mother said, when I was admitted to medical school, she said - she was a hospital administrator. U m, and her job - she ran admissions and records, so she was always battling with physicians to get their records signed off and if they didn't, they would be suspended. So s he actually didn't like doctors very much. And so when I went from philosophy into medicine, she said, "I'm so disappointed. I thought you were an interesting person."

Dr. Rezmovitz:

Wow. We can take this therapy off air.

Dr. Upshur:

Secretly, she was proud. But , uh, so someone coming into medicine, I would really like to have a long conversation about their motivations. I think , uh, many young people are drawn to medicine for a series of motivations that they haven't really reflected upon. It's a stable, it's a safe profession. Um, when I applied to medicine, I wrote an essay saying that if I were to say that it was my lifelong ambition to be a physician, I would be guilty of a grievous lie. I think that's what got me interviewed at McMaster. I didn't come from a pre-med - I made one application and I was accepted and I was grateful for that because the , uh , future for PhDs in philosophy was not particularly rosy . And , uh, I've never regretted , uh , for a minute actually , uh, starting medicine. I'd actually worked in hospitals , uh, all through , uh , high school and undergrad as an orderly. So I knew healthcare from the bottom up because I'd been wiping up bodily fluids and moving injured and sick people around and listening carefully to how physicians and nurses talked and asking questions about x-rays and, you know , what does this mean and what does that mean? So I picked up quite a lot of clinical medicine before I'd even got to medical school just through osmosis. So the real question for people entering medicine is why do they want to be a physician? Do they realize , uh, how profound a commitment this is to the wellbeing of others? Uh, what demands it's going to make on you? Because it is a very intellectually, psychologically, existentially demanding profession. And as much as it looks good on television, as much as it sounds good, you really need to be prepared for the vicissitudes that a medical career is going to impose on you. I would definitely not say that it's the easiest way to proceed, but it certainly authentic, meaningful and engages you and family medicine across anything that can and will happen to a human. You will learn about , uh , in your years as a family physician and there is no greater gift that can be given to somebody than to be present and to witness that in someone else and to try to help them through that. It's really, you know, if they don't appreciate the profound nature of what it means to be a physician, then they should maybe think about arbitrage or some other form of existence.

Dr. Rezmovitz:

Okay. On that, I'm going to just say thank you.

Dr. Upshur:

Oh, thank you. It was great fun.

Dr. Rezmovitz:

Oh yeah. It was great fun and um, wow. Um, maybe we'll have part two and we'll talk about , um, you know, the life's that could have been. Um, thank you Ross.

Dr. Upshur:

My pleasure.

Dr. Rezmovitz:

Have a great day.

Dr. Upshur:

Thanks.

Dr. Rezmovitz:

This podcast was made possible through the support of the Department of Family and Community Medicine at the University of Toronto. Special thanks to Allison Mullin, Brian Da Silva and the whole podcast committee. Thanks for tuning in. See you next time.