Small Changes Big Impact
Small Changes Big Impact
What you can do to change the world with Dr. Michael Kidd
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In studio today, we have Michael Kidd, family doctor and head of the Department of Family and Community Medicine at the University of Toronto, and director of the World Health Organization Centre for Family Medicine and Primary Care. Today's episode focuses on what you can do to change the world.
Small Changes, Big Impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. In studio today, we have Michael Kidd, family doctor and head of the Department of Family and Community Medicine at the University of Toronto, and director of the World Health Organization Centre for Family Medicine and Primary Care. Today's episode focuses on what you can do to change the world. I hope you enjoy the show. Thank you so much for coming in today.
Dr. KiddThank you Jeremy.
Dr. RezmovitzSo you've done a lot. You've been around as they say. Or maybe you've just been up and down the block and you've noticed different things over the world that you've seen. I looked up your bio - I've been doing some Googling. I don't know if your ears have been burning since I've been Googling you. So you've done a lot as a past president of the Australian Royal College of General Practitioners , past president of WONCA , World Organization of Family Doctors. And now you're here as the chair of the Department of Family and Community Medicine at U of T. And so one thing I've noticed is that the name is different in every single country for primary care or family doctors or family and community doctors , GPs. I just want to hear your take on that. If there's any important things that we should take from the name. What's in a name?
Dr. KiddHmm . What's in a name? It's a really good question. I don't think the name actually matters so much as what people do. And what we're talking about here is the context where people work. So doctors who are working in the community, doctors who are the first point of contact for their patients who are seeking medical advice, doctors who are providing care over the lifespan of people - so what we call continuity of care, doctors who are providing comprehensive care - so looking after - managing the breadth of conditions which may impact on their patients and their communities. And doctors who are helping to coordinate care with other healthcare providers and other services , both our hospital services and also in the community. So that's what a family doctor is - in Australia we call it a general practitioner - that's a specialist who's been trained in family medicine - has done specially postgraduate training. In Canada, we call it "family physician." In other parts of the world it may be a primary care doctor or a primary care physician. But it doesn't matter what we call people because you know, the name's different in different countries because healthcare has evolved differently in different countries and there's different cultures of how our healthcare is delivered and the expectations of communities in different countries. That doesn't matter. But what is it, you know - it's my family doctor. It's the doctor that I trust for my medical care and advice, the doctor that my family trusts for their medical care and advice.
Dr. RezmovitzAnd so how do you see family medicine evolving in Toronto, in Ontario and Canada right now?
Dr. KiddWell, I think that firstly, family medicine is very strong in Canada. Family medicine is the base of our healthcare system, if you like. Most people can relate to family medicine. Hopefully most of the people listening have their own family doctor - if they don't, they should have because there's really good evidence that shows that having a ongoing relationship with your own family doctor is actually very good for your own health and improves your life expectancy and the outcomes and life expectancy of your family. So it's a really important component of our healthcare system. It's a really important way of helping to keep the members of our community as well as possible for as long as possible. Because of course we integrate preventive care, health promotion into the work that we do. It's a good way of keeping people away from our hospitals here in Ontario. We have a challenge at the moment with too many people being cared for in our emergency departments , wards and corridors, which are overfull of people. If we invest in strong family medicine in strong primary care, we prevent a lot of those emergency admissions and attendances. You know, what do we do in family medicine? We're really good at understanding the health of the population that we serve. We're really good at the early detection and diagnosis of chronic disease. We're really good at preventing chronic diseases from developing to the point where people get serious morbidity or early mortality. As a consequence, we're really good at integrating mental health with physical health. We're really good at providing care throughout the spectrum of life, including the members of our community who are elderly, who are frail, who have significant disability. What we need to be doing more of though - and this is, I think is very exciting - is better integration of the care we provide in family medicine and primary care with other providers, with the other community providers, with hospital care and also with social care - the home based care services, which many of our patients need and which integrating that well actually prevents people from needing to be admitted to hospitals and may actually help keep a lot of people in their own homes rather than having to move into long-term care settings as well.
Dr. RezmovitzSo I've recently read your book every doctor - it's great title and honestly I think everyone should read it. It's filled with small changes and suggestions. One of the suggestions in the book actually is get your own family doctor. As a doctor yourself, as a physician, you need your own doctor, right ? A physician heal - a physician who has himself as a patient - a physician who treats himself has a fool for a patient, I believe is the quote.
Dr. KiddFrom Sir William Osler. Great Canadian.
Dr. RezmovitzYeah, he's a great Canadian. As an aside, I need a family doctor - mine just retired. It's a tragedy that there's only - a lifespan. I think I figured out you need a minimum of two, usually average of three family doctors in your lifetime. And it always amazes me that patients come in and say, "I didn't think I'd ever need another family doctor," but no one's doing family doctor math, which is your career is only about 40 to 50 years. That's not the span of most people these days. So if you know anybody, let me know. But as an aside , something else you said is we need better integration of care. And so in the Global and Mail on the weekend - I don't know if you had a chance to see the article on the state of psychiatry and mental health and the fact that we are not providing enough mental health care for our patients as a population, as a whole. And also for, I think doctors as a whole. There's a ton of burnout that's going on and it's not just this profession, but it's a lot of professionals. And the question is how can we do better? I know you mentioned better integration, but like let's have a chat. Let's try and figure out and maybe generate some ideas and come up with some challenge for maybe our listeners that we can improve the state of mental health, especially here at the small station in Toronto and when you think bigger globally. What do you think?
Dr. KiddWell, first off, I think that there are some excellent services providing mental health in Toronto and in Canada. The challenge is access and the challenge is equitable access for everybody in the community. So some people are getting access to really good mental health care and many aren't. The reality is most mental health care services, - medical, mental health care services in Canada are delivered through family medicine. They're not delivered by psychiatrists. They delivered by family doctors - family doctors are specialists in mental health, in the diagnosis and management of depression, the diagnosis and management of anxiety, supporting our patients with chronic mental health conditions in supporting our patients who may have addiction challenges for themselves and their families. Much of this doesn't need to be treated by a psychiatrist or other specialists . Most of this should be managed and managed well in primary care by family doctors. And part of that also is, it's hard for family doctors to be doing a lot of this work all on their own. So if you're working as a solo doctor in your practice, all on your own, people do get burned out. And there is some risk. And one of the models of care that I really like here in Ontario is the family health team approach where family doctors are working in a group with other family doctors so they can provide some peer support to each other. But also in the team are other healthcare providers, nurses, allied health professionals , psychologists , social workers , pharmacists helping with medication review and others. And I think that this is a model of care which can actually provide sort of a one stop shop for many of our patients who are seeking health care advice. You mentioned that I've been president of the World Organization of Family Doctors. And in that role - I did that role for three years - I had the opportunity to visit 72 countries and look at what sort of reforms were happening in primary care in many countries around the world. And one of the countries I found most interesting was Brazil. And in Brazil - a country of 220 million people - the previous government has set up a system of family health teams. But they're different to Canadian family health teams, family health teams in Brazil, look after a defined geographic population. They're responsible for knowing everybody who lives in their catchment area. And the family doctors work with nurses and with community health workers who are people from that local community. And the community health workers go door to door - they knock on every door and they document who lives in every dwelling in that geographic area and what is their health status. And then they bring that together with the family doctors and the nurses so they truly understand who are the people who have frail and elderly in our community. Who are the people who are young parents? Who are the people who are children who need to be followed up for immunization and healthy child checks? Who are the people with diabetes, with heart disease, with cancer in the community, who are the people with mental health challenges? And they can target the services they're providing. One of the challenges we have in Canada is as family doctors, we know the people we know. We don't know the people we don't know. And you may look out your window and see all these homes and we don't know who's behind all those doors. Who's behind all those windows? Are there frail elderly people who can't come and access us, who can't get to our clinics, who we should be providing outreach services to? Are there new arrivals to Canada? People who've come here as refugees or come here to work who don't understand the Canadian healthcare system and don't know what a family doctor is. And if something happens to someone in their family, immediately take them to the emergency department thinking this is how you get access for care. These people - we need be integrating our services in the community. The other thing with the Brazilian model - each of these family doctors looks after about 3000 people, but they also integrate specialist consultant services into those services as well. So what you will have is a psychiatrist who looks after 10 of these family health teams and they'll visit half a day a week to each of these 10 family health teams. And so patients can be rostered to come and see the psychiatrist if the family doctor feels that they need to get some consultant advice. And what this does is it provides an equitable model of care because all of a sudden there is a psychiatrist visiting every community across the country. So instead of being concentrated in high income areas or in urban areas , they're providing care in low income areas as well, and in rural and remote areas across the country. And so, as well as providing a referral service, also the psychiatrist is providing some peer support to the family doctors who they visit every week. And the family doctors can talk to them about patients they're seeing without the patients actually needing to necessarily come in. Family doctors can talk about how they're managing the work that they're doing and the psychiatrists learn from the family doctor and the members of their team about the community that they serving and about the challenges. So I think that looking around the world, you can often find new ideas about how we might do things a little bit differently and then bring those ideas home and then talk about, well, what would work here in downtown Toronto? What would work in Northern Ontario, in a remote community? What would work in other parts of this country and elsewhere? And also what can we share about the successes that we have? And you know, one of the things which I'm very keen on building is the primary care research base here at the University of Toronto, but also across Canada. So when we do have a new innovation, we do some evaluation of it and then we report on it so we can share those ideas with our colleagues right across the country. So we don't just have a good idea that occurs in one little area in Toronto. We have a good idea which occurs and works that we can share with everybody else and then other people can take what may work for their communities.
Dr. RezmovitzI mean, it's fascinating. I love it. I think you're an amazing resource that you have this breadth of experience that can pull from 72 different countries and say, "Hey, what do we need to do here?" And so, I think we have a role as the Department of Family Community Medicine to start educating our caregivers, our providers , in how we can start integrating those ideas into everyday life. But the problem is as somebody who's on the front lines in the community, as a solo practitioner, I haven't heard of the conference, I haven't seen the resource website, I haven't seen yet how can we get to actually operationalize these things? Because you've identified - it's the same thing when you're doing research on scholarship. You don't know what you don't know. You know when you're in residency, they say that the most dangerous are those who don't know what they don't know, and sometimes that pot is huge. And so how do we get to access? How do we get those individuals who are at risk - the marginalized, frail individuals, who don't have the capital investment available to them - whether it's knowledge or money - how do we get them into a system and use the system that's already available to get these people healthier? I don't have the answer for that.
Dr. KiddWell, I think there are a number of answers. So, you know, it's a very complex question. So -
Dr. RezmovitzYeah of course. We're here for complex -
Dr. KiddIt has complex solutions. But there are a few which work . The first thing is I believe that part of our role as a family doctor is to be an advocate. An advocate for our individual patients, an advocate for the community that we serve. Ian McWhinney - one of the great leaders in Canadian family medicine , had a set of principles for family doctors, which are worth looking at. And one of the principles which I really loved was he said, a good family doctor should occupy the same habitat as their patients, which means that it's a good idea to actually live in the community where you work as a family doctor. Because if you do that, then you will understand the social challenges affecting the community that you're looking after. You'll understand the healthcare needs of that community, perhaps better than if you're driving into that community or commuting into that community from somewhere else. So I think we have a job to be an advocate, and you see this - you know, I'm so impressed by so many of the family doctors that I've met in Canada who have stood up to be a voice for people who don't have a voice in their local community, who stand up and work with their local government, work with their local organizations, work with their local hospital to improve the healthcare services and access to services and improve equity of outcomes of health care for the people that they look after. And it is one of the things that we are specialists in, in family medicine. We are specialists in population health. Specialists in the population that we serve. How do you find out about ideas though? You find out about ideas by talking to your peers? You find out - so as a solo doctor, having some way that you can meet with other family doctors in your local area and come together. And the college provides us opportunities, the Canadian Medical Association provides those opportunities , continuing education activities provide those opportunities to come together. I think also it can be really helpful for people to have a link to their local academic department of family medicine. Our department, we invite every family doctor in the world who is interested to join our online community. To subscribe to our monthly electronic newsletters where a lot of these ideas are being shared. To engage in the conferences and the CME events that we run. So, you know, I think there are lots of different ways of finding out about new ideas. Now at the global level, if you have a particular interest, the World Organization of Family Doctors, WONCA, has a number of working parties in rural health, in mental health, in management of chronic disease, in the care of refugees, in the care of people who are homeless - in all sorts of different areas. And as a family doctor in Canada, you're welcome to join the online communities. And what a brilliant way of finding out how people manage different challenges around the world. I've used these working parties to send an email to the whole group saying, "we're working on this area. Do you have any ideas from your country?" And then I'll go to bed, and during the night, as time zones change and people wake up, people will answer the questions. And by the time I wake up the next morning, there's half a dozen amazing ideas from great family doctors around the world. You know, using the technology to share ideas and to learn from each other. And you know, we're very generous in family medicine, and many of our colleagues very generous with the advice that they'll share the resources that they'll share if you just reach out and ask.
Dr. RezmovitzYeah. I've noticed that actually in being in the department for almost 10 years now that there are a lot of mentors available if you're willing to be mentored , if you will. And so we have a ton of opportunity then , in this department to start sparking leadership , providing voice and support to people to create these networks if you will. They almost exist, right? I mean you have the family health organizations , family health networks, family health groups that are already set up. And I guess we have an opportunity as the Department of Family and Community Medicine to reach out to them to see, maybe each of these groups who take care of the special populations - because they're probably a very homogeneous population - and following McKinney's principle , maybe we can find a way to reach out to these groups because there are thousands of foes set up in all over Ontario of how can we improve the population of these foes and start at that level and splintered down to each individual doctor. Food for thought. I apologize that I'm here interviewing you and here I am waxing on ideas of what we can - we can change the world.
Dr. KiddWell, I think some of that is happening as well. You know, one of the innovations in healthcare in the province of Ontario that I find really exciting at the moment is the establishment of what are called Ontario health teams. And these groupings of people in the community, healthcare providers, healthcare organizations , for serving a population about 300,000 people and try to look at how we better integrate family medicine and primary care with the local hospital and services provided by the hospital and how we better integrate with social services being provided, especially to the frail, elderly, and people with disability in our communities. And by doing so, how do we get economies with less usage of very expensive hospital services and hopefully greater investment in community based services. We know that it's far more cost efficient for our government to be investing in health services at the community level where people are based rather than building more and more shiny hospitals, which only provide care to small numbers of people. Yes, we need hospitals when people have certain health requirements, but so many of the services provided currently through hospitals could be provided and perhaps provide provided better through community by services at a much lower cost. So, I find this initiative really interesting. I think - it's only in its early stages and I think that it will bring forward a whole lot of new ideas about how to do things differently. But what works for one community of 300,000 people might not work for another community of 300,000 people. And I find that exciting too , that we actually have a government that is willing to allow things to develop differently based on different community needs, rather than expecting we have a cookie cutter approach, which we just provide to every community across the province or across the country. And the other thing which I find really important is that these models require not just input from funders and hospital managers and clinicians and other healthcare providers. They also require input from the community - the community that is being served. And there is a global revolution underway at the moment called people-centered healthcare , which is trying to get healthcare services to do 180 degree flip if you like. From developing services which meet the needs of funders and managers and healthcare providers, to delivering health care services which truly meet the needs of the communities we're supposed to serve and getting that input. And if we had healthcare services which really met our community needs, then we wouldn't have - harking back to your comment earlier - we wouldn't have most of our psychiatrists working in downtown locations. We'd have it distributed services where people are based in the communities where they're most needed. We would be not just relying on psychiatry to deliver health care services, but we'd be investing more in training, more people working in family medicine and community services to deliver that care. We'd be investing more in placing psychologists and other mental health professionals and therapists within the healthcare settings where our patients are based . So that's more people centered care. And I think that we're going to see - Ontario health teams are sort of helping to flip things a little bit, but they need to go all the way over. And in order for us to provide the care that communities generally need and frankly deserve.
Dr. RezmovitzSo I think you touched on the point earlier with McWhinney's principles of family medicine. I mean, you have - good leaders meet people where they are. I mean, that's how you take the followers with you, right? Otherwise you're out for a walk by yourself, you're a lone nut . And so I think that's what we need. We need to start meeting people where they are in order to have them come along and get engaged in the system. So this is where I ask you then - the podcast is called Small Changes, Big Impact. And so I'm curious to know , what small changes have you made - or more importantly, what big impact are you most proud of that you've been a part of that you think stemmed from either a change that you made with a patient or change that you made yourself in your role as a physician that helped stem a big impact - and I want to hear a story. I think our listeners want to hear a great story.
Dr. KiddYeah. So, you know, the first thing is, a lot of what I know about family medicine and what might work in different settings has not come out of my head, has not come from academic literature, has not necessarily come from family medicine peers - it's come from my patients. So, you know, we have this great gift as family doctors that people come to see us and we help them, but they also help us. They help us to understand the challenges that our communities face in accessing the healthcare services they need. They help us to understand what it's like to live with medical conditions that we may not have experienced ourselves. They help us to understand how life can be challenging for people who live in different ways or have different beliefs or have had different opportunities in life than we may have had. So, you know, my greatest teachers are my patients. And many of the ideas that my patients have brought forward - and many of the ways that my patients have challenged me as a family doctor - you know , I'll say, "here's what's happening. Here's what I think we should do. Is that gonna work for you?" And they'll say, "no, that's not gonna work for me because it doesn't work for my life, my lifestyle. I can't afford it. I can't get to where ever you want to send me. We need to come up with something else." And so my way of working as a family doctor has changed throughout my career in response to the patients I've seen. But also I've been able to take those lessons and apply them in the leadership roles that I've had at a national level and at a global level. And perhaps the story I want to share with you is how we worked in the World Organization of Family Doctors to try and change the world. So how we took some of these principles to try and change the world. So when I became president of the World Organization of Family Doctors, I looked at this organization which represents 600,000 family doctors in 160 countries all around the world, and I thought, how is this organization actually going to change things and change things for the better? And we came up with three targets. The first target was to assist all these 180 countries - 160, 180 countries to develop their own college of family doctors. Their own grouping with family doctors could come together and set standards for healthcare in their country and set up extraordinary training programs to train family doctors to meet community needs . Now, we're very lucky in Canada - we have the College of Family Physicians of Canada. It's been around for a very long time. It does these things, but those colleges don't exist in every other country. So one of my challenges was how do we set up these colleges in all these countries - especially in low and middle income countries. And family doctors from Canada and elsewhere have been working with our global organization to help their peers in many low income countries to set up their own college and set up their own groupings to bring family doctors together. So that was number one. And then the colleges of course can work with their governments to be advocates on how to change and improve healthcare for their populations. And one of the big global health movements is about how do we ensure everyone has access to healthcare services in the communities where they live. That was number one. The second one was looking at the next generation of family doctors coming through and how do we support the next generation of family doctors to become leaders and advocates in their own communities. And one of the ways which we've done that is by establishing young family doctor groups in each of the continents of the world. So we set up these groupings led by young family doctors for young family doctors in every continent. And again, here in Canada, our college has had this for a long time. It's encouraged the voice of the medical students and the residents and the recent new certified family doctors in all of college activities. And again, we bringing that lesson to the rest of the world. So we've set up the young family doctor group in Africa. We've set up the young family doctor group in South America. We've set up the young family doctor group in the Asia Pacific region and in South Asia, and in the Middle East, where family doctors can start to work together, and all the family doctors acting as mentors and supports. The third way that we want to change the world was by looking at the most influential global health group, which is the World Health Organization, and looking at how we as family doctors can inform the work that the WHO does. The WHO sets global healthcare policy, and then it rolls out policy and programs, especially in low and middle income countries around the world to improve healthcare services for everybody, but especially for the most vulnerable, marginalized , populations on our planet. And so what did we do? We started working really closely with the WHO. We set up regular meetings - WONCA now has a memorandum of understanding with the WHO about how we'll work together. But more importantly, we set up working with the WHO in each of the regions of the world and then at the country level. So our colleagues developing up a new college in their country, not only work with their government, they also work with the WHO office on how to roll out programs and how family medicine can have a voice and be involved and be a vehicle for rolling out new programs in different parts of the world. So it sort of starts at a very high level, the global level and it rolls right down to how things are happening between us as individual clinicians with our individual patients and the communities that we serve. And these ideas about how to do things differently, they come from the work we do each day. As family doctors, the interactions we have with the peers, the experiences we have working with our colleges and our other medical organizations and with our universities. And you know, a lot of the basis of these ideas for new policies comes from the research that we're carrying out in family medicine, the research that's been carried out by so many of the academic members of our grant department.
Dr. RezmovitzSo then obviously there are going to be barriers to implementation. So what do you think the biggest barrier has been so far? Let's pick the last one - in getting people on the frontline to make a change. How do we get people to follow that - working with the WHO? Because if you said to a family doctor up in Sudbury, "Hey, by the way, I want you to follow this guideline." They may say, "ah, I don't think so."
Dr. KiddYeah. No, I think that's, that's very fair. And I think that guidelines in themselves are very important, but often they sit on a shelf, or nowadays they sit in a computer somewhere and not necessarily read , not necessarily actioned. And we've actually got to look at ways that we practically put what's in the guidelines into practice and change it in healthcare policy and changes in healthcare practice. And that happens through our education programs, through our continuing professional development through the work of our college, through the work of our universities on how do we actually translate what's in the guidelines into practical things. It's very challenging working as a family doctor. People work very hard, they're very busy, and it can be very challenging to get people to stop and think about: is there a different way of doing some of the things that we do on a day to day basis? But family doctors are very resilient , very flexible and are willing to look at community needs . And I think that it's a responsibility of our college and our medical association and our government ministry and our university departments to share these ideas in ways that are actually bite size, so that people can actually pick them up and incorporate them step by step and help people to look at ways we might do things differently. At the same time, respecting the great work that people are already doing and not saying, "we don't like what you're doing. It's got to change." It's more like, "here's what you're doing. We really respect it. You're doing great work for your patients and your community. Here's some ideas, which have worked in other places that you might like to consider adding into what you're doing." What added resources can we provide to you and your practice to help you to do things differently? How can we move resources that are currently being spent in overinflated hospital settings perhaps, and provide some of those resources to you? Do we need all those nurses? If we're actually doing a really good job in keeping people out of hospitals or can some of those nurses be funded to come and work in your setting and help you to deliver even better preventive care, health promotion, chronic disease management programs , and so forth in your practice, in the community where you're working? Can we take some of the other health professionals who are now no longer needed in the hospitals and move them out and base them in your practice to work with you? Can we get psychologists working with you , physiotherapists and others? Can we employ a pharmacist to come and work with your patients on many medications to see if we can rationalize some of those medications or reduce some of the side effects that occur from people taking multiple medications and other treatments. How can we work with you to make things work better?
Dr. RezmovitzAnd I think that's what the Ontario health teams are trying to do. I saw it when I was in a family health team. We're trying to do this stuff. It just - change takes time.
Dr. KiddIt does. And as you've said, a lot of change is incremental. So it's the changes that we make and then sharing what actually has worked with our population and importantly, what hasn't worked and why hasn't it worked? Because what works brilliantly in a downtown practice in Toronto may be absolutely hopeless in a rural practice elsewhere in the country.
Dr. RezmovitzYou know, there's an equation to explain that. It's called a C + M = O. Have you heard of this? It's a realist design, the underpinning theory of Pawson and Tilly that talks about how context plus the mechanism will equal the outcome. So if you continually provide the same mechanism and change the context, do you really expect the same outcome every time? And so it really behooves us to start implementing different mechanisms. And I think family doctors do that. I think we know - I don't know if it's trained, if it's instinctual , if it's genetic - maybe there's a genetic component in every family doctor, and that's why we're family doctors that says, you know what, I just want better for my patients. And so you find the way to make it work for your patient for that context, even though the mechanism may not be exactly the same. And you hear this from every family doctor who says "guidelines? Yeah. Are 6,000 guidelines, but my patient isn't in the guideline unfortunately." And so that's why we know we just have to find a way to make it work. On that note , this has been quite lovely. Thank you so much for coming in. Let's leave readers - readers, listeners - sorry, I've got your book in front of me - wanting more. How about if they only knew? Give some advice to some - either learners trying to get into the system or learners early in their system - if they only knew: some advice from Dr. Kidd.
Dr. KiddWell, my advice to listeners who are medical students who are early in their career and are thinking about how am I going to spend my life and what am I going to do and what contributions that I'm going to make, is to get some experience working with a great family doctor. So actually get out there, maybe part of your formal medical program curriculum, or maybe something you organize yourself. Just contact one of the family doctors that you may know of and say, "can I come and visit you? Can I come and have a talk to you about the career that you have? Can I come and talk to you about the challenges that you're encountering? Can I come and see your practice - see how it works? Sit in with you if your patients consent to watch some of the ways that you're doing what you do?" Family medicine is a fantastic career. It's really exciting. The thing that I love most is it's about people, it's about relationships, and it's about trust. And I think if there is a genetic component to being a family doctor, it's you need to be someone who likes people. Who likes working with other people, who likes making a contribution, who likes listening to other people, listening to their stories , learning about the human condition. You know, I know I've had a good day in my practice as a family doctor, if I've learned something new about humanity, about what it is to be a human being from one of my patients. I know I've had a good day if I've seen something new that I've never seen before. We see patients with different conditions, with different presentations, with different complications , every day. Things which are not in the textbooks, things which have not yet been fully understood and researched. And it's a fascinating career. I've had a good day in my practice if at least one person has cried in my consulting room each day . Not because I'm mean to my patients, but because I know many of my patients have undiagnosed depression, but they don't come in saying I'm feeling depressed. They come in saying "I'm not sleeping well. I'm not eating well. I've lost interest. I'm distressed in other ways." And I also know I've had a good day in my practice if at least one person has laughed in my consulting room and we've shared some of the joy of human existence. I've told someone who's desperately trying to have a baby that yes, they're pregnant. I've told someone coming with a good news story about their care and about the health and wellbeing.
Dr. RezmovitzWell, I've thoroughly enjoyed this, so you put a smile on my face. Probably I'll go home later and cry. So you'll have two of those today. I'm just kidding. Thank you so much. It's been really lovely. Thanks.
Dr. KiddThanks Jeremy.
Dr. RezmovitzThis 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.