Going to Med School interviewed Jessica Otte, MD. Dr. Otte received her Doctor of Medicine from the University of British Columbia (UBC) in Vancouver, British Columbia, Canada. She did her residency in Family Medicine at UBC’s Nanaimo site.
Dr. Otte writes a very interesting blog that she updates regularly. You can read it at http://drottematic.wordpress.com/. Currently she is in Rankin Inlet, Nunavut, Canada where she will be serving for one month as locum tenens, filling a void.
GTMS: After your electives in Cambodia and Vietnam, would you ever consider practicing abroad in developing areas for a long-term period?
Dr. Otte: Well, fortunately Cambodia and Vietnam weren’t my only electives abroad. I was able to spend time in Northern India and Nepal also. Having seen healthcare projects in a few different places, my confidence in first-world citizens delivering medicine in third-world countries is not strong. It did take trying it firsthand to discover that. I’ve learned a lot about sustainable delivery of global health and believe that it has to come from within the country. The best project was the one in Nepal. It was totally Nepali run and although most of the funding came from Europe, their operation involved micro-insurance plans, in which members of the community paid a small fee to buy into the clinic – giving them a sense of ownership. They used other techniques to build capacity, for example, they would bring a malnourished child and its mother to stay at the clinic. Then, they’d teach the mom how to manufacture a balanced meal on a tight budget and re-feed the child under medical supervision. Once the child was well, mom and baby would return to their home and be tasked with finding one or two more malnourished kids to send for care in the clinic. Going overseas as a foreigner and doing brigade style medicine – handing out bandaids from town to town for 2 weeks – simply doesn’t change the health of the population. It’s tourism.
Take the parable of teaching a man to fish – and you’ll see what I mean. All that said, I would be happy to teach clinically and mentor in a public health capacity should there be a determined need for it. If an agency asked me to share my knowledge so that they could grow, I would be honoured to participate. I don’t think the warnings I’ve raised apply to disaster relief. Red Cross and MSF have no choice but to practice reactionary medicine and it’s something they do well. If and when I have the skills for this, I’ll be happy to contribute. I am also able to use the knowledge that I have to treat underserviced and marginalized populations within my own country (Canada). When third-world conditions exist in your own backyard (places like the Downtown Eastside of Vancouver, Nunavut, Northern BC), you don’t have to go far to feel like you are in a developing world!
GTMS: You blog, you tweet, you reference medical apps…do you feel that these technologies would be less or completely unavailable in the rural regions in which you may practice? If so, do you think you will need to adapt your practice in any way?
Dr. Otte: Well, the Internet revolution started a long time ago. I was the kid whose mom worked for the university, so I had my first website in 1995. Reading online medical references is probably the most common way that I employ technology in practice – but there are always a few ways to solve any problem. There is Internet access in most parts of the world. It might involve hiking to find a dial-up Internet cafe in Chapaguan, Nepal or convincing the Bell sales rep to sell you an expired no-longer-on-the-market Turbostick, but it’s really easy to get online. Most of my Nepali friends – a few of them doctors from Kathmandu – stay in touch via Facebook. I’m not sure the value of Social Media in remote places – except maybe to help combat feelings of isolation. In my first locum tenens in Nunavut, I’ll be counting on some standalone Apps on my iPhone (which won’t get internet service that far North) as well as a hefty pile of books in the clinic’s library and stowed in my backpack.
The medical technology can be quite different too. In Vietnam there was no machine to measure Central Venous Pressure. So, to get this information, we hooked up some IV tubing with saline in it and measured the height of the water column instead.
GTMS: For students considering Family Practice as a specialty, what are some downsides to Family Practice that might dissuade them, or that they should keep in mind when making their decision?
Dr. Otte: Wow, talking about the downsides without benefit of hearing the advantages? Ok, you asked for it! It’s a great specialty, but it is not always respected as well as other specialties. For some reason, subspecialists feel that generalists (like Family Physicians) are not smart or as skilled somehow. I think we may not know everything there is to know about the anatomy of an eyeball, but we can offer fertility advice, deliver a baby, assist at the C-section if it is required, sew up the patient, resuscitate the baby, and check up on the kid for the rest of their life, treating their colds and rashes and eventual diabetes. The downside to this prolonged relationship – which is seen by many as the heart of Family Medicine – is that you probably don’t want to have a lifelong relationship with a patient you don’t like! Fortunately, patients tend to select physicians that they get along with. What else? Well, there’s a lot of crappy paperwork, namely medico-legal reports and insurance papers, and you are responsible for your patients’ charts for 7+ years after you last see them. It doesn’t pay as well as any other specialty, but really, if you were in it for the money you would have gone to business, not medical, school.
I don’t know if it is the same in the US, but in Canada, Family Physicians emerge from their residency training as largely undifferentiated doctors who can work anywhere, with anyone, doing just about anything. If you decide to do straight up clinic for 10 years and get tired of it, you can start developing an interest in Global Health or Sports Medicine or Emergency or Rural Care. The options are endless, and that’s why I think it’s the most interesting and the most challenging field.
GTMS: Were there any opportunities of which you wished you had taken advantage during your time in medical school that you were unable to? (or opportunities of which you did take advantage which you would recommend?)
Dr. Otte: Absolutely. I should have taken some time off to travel in a purely recreational capacity. As much as I tried to retain the balance in my life, it was very difficult to do all the things I wanted to outside of academia. I went to The University of British Columbia in Vancouver. At the time, one could choose to study with the University but at a different site. In retrospect, I would have thrived if I had taken the opportunity to study in one of those smaller communities.
GTMS: Do you have any advice for medical students applying to be matched with a residency program?
Dr. Otte: Oh probably nothing you haven’t already heard. Follow your heart. Even if you don’t get your top pick, you will make it work and find a way to enjoy it. Do what you think you want to and do it somewhere you are willing to live.
GTMS: Your father is a nurse; did his career choice influence you in any way to pursue medicine?
Dr. Otte: For sure it was one of many factors. He became a nurse later in life, when I was 10 maybe. My mom was a computer scientist and mathematician, and my undergraduate course selection was heavy on programming probably in large part because of her unintended influence. I always loved our family’s discussions about biology and space and why the world works the way it does. Vacations were not complete without a visit to the city’s science museum in addition to the sculpture garden or amusement park. My parents encouraged me to be inquisitive and really supported me to pursue anything I was interested in. I’m not sure how medicine happened, it just kind of did.
GTMS: What has been the biggest obstacle that you have faced so far during medical school, residency, or now, post-residency? How did you overcome it?
Dr. Otte: I’ve been very lucky not to face much adversity. Being a ‘little fish in a small sea’ was the challenge of medical school, I think I just kind of hung on until the clinical years where I had opportunity to rise to the challenges set before me. In residency, having Bell’s Palsy was a kind of physical obstacle. I gained a new appreciation for the fear and unease that patients feel, in addition to struggling to live a normal life with a body that wouldn’t cooperate. Again, I was extremely fortunate that the condition reversed with time and medication. I think that short period during which I felt ‘disabled’ reminded me to be humble.
GTMS: As a blogger, how do you manage to post about interesting topics whilst maintaining patient confidentiality? Do you have any tips for aspiring or current health care practitioner-bloggers?
Dr. Otte: That’s a constant challenge. As I said to the Canadian Medical Association for their New in Practice guide, there are times where something simply can’t be published without being revealing, and so it shouldn’t be published at all. The rest of the time I change demographics and details so that the final picture is basically an amalgam of characters. It becomes a sort of pseudofiction which is fine if you are writing to illustrate a profound, funny, or educational moment.
GTMS: What is your opinion on health professionals using social media? Do you think it helps or impedes their care giving? Do you feel the risk of law suits is outweighed by the benefits of using social media?
Dr. Otte: Take it or leave it. I don’t think anyone should feel obligated to use it but if you choose to, first set out clear goals for doing so. Why bother with twitter if it offers nothing to your practice or nothing to your personally? I don’t think clinicians are using social media to the extent they could with respect to patient care and empowerment, but there are significant barriers. Time and confidentiality being the foremost ones. Canada is not as litigious as the United States and so I’m not familiar with any lawsuits related to health care social media in this country.
GTMS: What drew you to be interested in rural medicine?
Dr. Otte: Maybe it was growing up on a hobby farm on the outskirts of a fairly under-developed city? Maybe because I’ve always enjoyed nature and having dirt under my nails? The kind of medicine that you get to practice in a tiny town is so much broader than what you’d get to do in the city. I find it hard to imagine myself in the heart of Vancouver, working in a walk-in, with patient after patient complaining of a cold. I really enjoy meeting the rough-and-tumble blue collar worker. I like sick patients more than healthy ones, and although I’m sure I’m guilty of acting this way at times, I really don’t get a lot out of working with people who have a strong sense of entitlement. People in small towns are friendly and have stories to tell; they also are more accepting of adverse outcomes. For the new practitioner, this is important as you feel comfortable practicing good medicine rather than defensive medicine (in fear of lawsuits). There are financial incentives to practicing rurally but really only those who enjoy the adventure will stick with it. I chose my first locum tenens location because a mentor regularly works there and he couldn’t stop telling me how much I’d like it.
GTMS: Do you have any advice for students considering a rural medicine program?
Dr. Otte: Rural medicine all the way! Rural residents are happy ones, at least in British Columbia. There are challenges – especially isolation – but the reward pays off. If you train rurally, you’ll still be capable of functioning in a big center if life should steer you that way. If you train in an urban center, you’ll get used to referring stuff rather than managing it yourself. In Canada, we apply, then we have interviews, then we rank our preferences. If you have the chance of interviewing and checking out the location [of the program] it would be well worth an application fee provided you are not forced to attend.
Don’t forget to check out Dr. Jessica Otte’s blog! She updates regularly at http://drottematic.wordpress.com/.