Tales of a Persecuted Physician - Part 1

Grieving the immeasurable losses

Today marks 12 weeks since my medical licence was suspended for accusations (the college still has no proof) that I wrote covid-19 vaccine exemptions and this somehow justified displacing 1600 patients, many elderly or terminally ill.

• 12 weeks of worrying about my patients’ well being and medical issues

• 12 weeks of putting out countless ‘fires’ realizing the various harms being done to my 1600 patients

• 12 weeks of loss of income and continuing to pay for my office and skeleton staff so my patients are still supported during this catastrophe

• 12 weeks of preparing legal submissions and collecting 70 patient affidavits of the harms to my patients

• 12 weeks of gut-wrenching losses and external judgements

• 12 weeks of feeling lost and hoping each day will be when we hear about our court date for an injunction. this list is no where close to exhaustive, but you get the picture.

I lawyered up early on (thankful for JCCF and Mr. Michael Alexander) and tried to avoid this; but, to no avail, and have been trying as hard as possible to get back to my office community and patients. But, the roadblocks and barriers at every level, including the courts, is proving to be far more difficult than anyone could have anticipated. Twelve weeks my patients have not had appropriate access to medical care, their medications, counselling or various supportive programs as these were all removed the moment my licence was suspended.

Today is also the day my nurse, S., informed me that she has had to take another position somewhere else. If anyone knows S, her quality of being is top shelf. She is a bright light in this world and I value her greatly. The weight of all of these enormous losses are so heavy on my heart. It is almost too much to bear.

When I took over a retiring family physician’s practice in 2019, I chose this option for many reasons. My office is located in a Christian elderly independent living community, in my home town, and was about half way between my home and my parents’ for logistical planning and support for my children. Care of the elderly became a passion of mine. Patients and residents are well enough to be living independently in small homes or apartments on the grounds and remain fairly active. There is a church on site and many other recreational amenities. I became part of the community.

Fortunately, prior to this decision, I took a few years to locum (a covering doctor) to really sort out what processes work well in a family office and how I would implement my other interests, such as small procedures and palliative care. Along this part of my journey, I met and worked with S and realized her uniqueness immediately. S is an experienced nurse, but it is her way with patients and families that stood out the most. She treats everyone with the utmost care and compassion. S is professionally diverse, and can explain labs, tests results, and provide information to educate patients. S knew me, my character, and how I practiced medicine - my approach - and would prepare patients ahead of my even seeing them. She knew what the most likely tests or management I would reach for and did so with precision. Her work ethic and willingness to go above and beyond for patients, staff, and myself were a gift from God. S has the kindest, most thoughtful heart and always makes everyone smile and feel at ease. Her sincerity and genuine interest in each of our families, our children, my patients’ children, told the story of her values and priorities.

We had a truly incredible relationship and she stood by me every step of this difficult road. But, 3 months and not even able to get into a courtroom to have our voices heard about our urgent grievances, she has to make decisions that support her family’s needs, understandably.

When the pandemic response began in March 2020, we closed our office to in person visits but we shared deep concerns regarding the impact of such fear, isolation, and removal of human contact for our patients, particularly the elderly ones. Telephone or virtual visits with patients were not sustainable in any health care model, from my perspective. My instincts directed me to maintain the utmost benevolence and in person connection to best help my patients. We all learned how to manage and cope together. Our office opened up after the first lockdown, and largely remained so, providing a mix for patients to come in or continue virtual care depending on their preference. We reduced the number of patients seen each day to accommodate for distancing in my waiting room and cleaning in between patients. Right around June 2020 we began seeing the manifested ramifications in my elderly patients from the isolation and desolation. Many became confused and cognitively impaired, many lost weight due to the many social losses, and many began to fall, and even more were so afraid to go for any tests and had tragic delayed diagnoses. S would always be tender and delicate when caring for our patients’ wounds. Elderly skin is extremely thin and challenging to suture or adhere for healing. She was booking elderlies in weekly for weight checks and providing the basic human need of connection for so many who had lost this completely. S helped these patients and their very concerned families tremendously. She will be greatly missed and is irreplaceable. My heart hurts thinking that my patients will miss out on her loving skillful care when we return. I already miss S and all that she brought to my life and the dynamics of our office. We were more than just colleagues; my staff and I became family. Reconciliation for this loss will be challenging, hence the writing. It is therapeutic in these excruciatingly difficult times.

Now, the college is fully abusing their authority, which hopefully the courts will help us fix this mess. But, the wheels of justice turn quite slowly, especially for an urgent request, as mine is, advocating for mitigating patient harm. And, effectively everything I have worked so hard to build and maintain is being dismantled. I have never known such deep grief in all my life. My staff, including S, are incredible people. Had a different response been allowed, none of this would be happening to any of us. Needless and impossible systemic top down homogenization of health care leads to patient harm and human suffering.

Each morning I wake up, I think of my patients who I should be seeing today. I think of my palliative patient, who I was not able to care for at her end of life and she died in a way completely inconsistent with her wishes, ones that I would have organized for her with a moment’s notice. I care for my patients deeply and have incredibly strong relationships with almost all of them. Why should my patients be punished and used as pawns in the college’s authoritarian takedown of any concerned autonomous physician? Why should I have to lose what I have earned and intentionally selectively built for my patients and self? Is it really the price necessary to pay for standing firmly rooted in the first principles of medicine, namely informed consent and bodily autonomy? How can this be justified or necessary when patients are actively being harmed by the reckless decisions of the regulatory body who is tasked with protecting them?

At no point during the past two years has a cost/benefit analysis been completed by any authority to unpack the actual (emphasis added) benefits of each measure imposed on human lives from the perceived and propagated ones, vs the cost of the impacts of the consequences from these measures. Completely uprooting the way we live, interact, and treat others has broad sweeping ramifications. Where did we go wrong?What did we get right? Why aren’t we talking about this until someone in leadership starts to actually LEAD?

We cannot compare human suffering and loss. We cannot remove our unique humanness and understanding when dealing with any crisis. We cannot determine what or who is “essential” for someone else. Yet, this is exactly what the ‘authorities’ have imposed and expect, while sitting in their ivory tower, far away from the distressed, suffering eyes of patients. ‘Do as I say, not as I do; and, do not DARE to question what we are doing; we will tell you when it is over’ is the messaging from the bureaucrats, not the”front lines”. What we need to have is the sense that willfully imposed iatrogenic suffering of most to spare some is atrocious human behaviour. And, this process is now deeply rooted and threatens to become the canadian cultural norm. In palliative care discussions with patients, I often reviewed the well known fact that the longer a process continues, the more permanent these new changes become in life. The same applies to cultural, societal, or behavioural changes.

One of my quips I used a lot when discussing end of life processes with patients and families, is

just because we can do something (ie. give fluids iv to hydrate dying patients), doesn’t mean we should.

Just because we can force people to give up all of their basic human needs and die alone doesn’t mean we should. I will leave readers to consider all other scenarios over the pandemic response that perhaps could or should be reframed and understood more deeply from a humanistic lens.

Currently, no definition is provided by regulatory bodies or authorities on what they claim is “misinformation or disinformation”. No scientific debate between conflicting experts and qualified voices has occurred to settle a series of serious and unsettling public statements and claims that have shaped these disastrous policies for our communities. Clearly, no scientific consensus exists. Yet, they forge on in their path of destruction rather than working toward the common goal of public best interest. Medical colleges across Canada and the world are removing highly qualified doctors from their professions (during a pandemic!) without even answering questions or engaging in conflict resolution. Patients are being stripped of their trusted medical advisors and care teams and face punishing wait times for access to any medical attention or care now. No one will care for my patients better than I will as I know them and sincerely care to help them. I had a patient track down my husband’s phone number recently to try to speak to me. He wanted to get an update on my legal status, see how I was doing, and to inform me he is not going to find another doctor, he only wants me. He is a complex elderly patient with many chronic issues who really needs regular follow up. So many of my patients feel this way, and for that, I am truly humbled and grateful. Over the past 8 years of my independent medical career, I have chosen to hone specific inter-relational qualities and skills. I have created my own unique approach and service to provide both the science and the art to my patients. I love what I do and feel honoured to have such strong bonds with my patients. It is through intentional choices in how I interact and treat each one of them for the valuable individual being that they are. I have shaped my practice from the roots of ethics, compassion and patient-centred care. Just as a tree with deep solid roots will not topple over during the gravest storms, nor will any of us who are rooted in ethics and humanism.

I fear the homogenous syphoning of everyone into one tunnel (one response option) will collapse and the collateral damage, which we are only beginning to see, will far outpace any damage from an infectious pathogen alone. Much of the collateral damage is qualitative and cannot be measured along side data and numbers. The human condition and experience is far more than that; they cannot be reduced to constructs or symbols. Treating human beings in their most vulnerable state, while sick, injured or grieving, it is essential to treat the whole individual person, rather than the algorithm or policy. There is no one-size-fits-all when sincerely caring for the betterment of infinitely diverse human lives.

Some may believe that I deserve the “consequences of my actions” as a colleague so poignantly stated in an email to me. However, I am well aware that decisions have consequences. Every day I know how my chronic pain and mental health patients are struggling and how they are being treated by other doctors because I know their stories. Every day I worry about my elderlies who were barely keeping it together and likely need more help now. I consider deeply and broadly what others are going through as I firmly plant my feet on the side of medical ethics and compassionate care. Likely far more aware than most people and colleagues could imagine. My husband knows since he is the one who hugs me and wipes my tears, reminds me to eat because the pain and stress of losing my patients and persistent character assassinations has nearly destroyed me. Choosing to maintain my values and patient approach caused no harm to anyone in over two years. No cases of covid went through my office, only 1 of my 1600+ patients passed away from covid in hospital and he had multiple other significant comorbidities. I am trained, knowledgeable, reasonable and balanced but must be stripped of my earned professional autonomy and authority to provide care the best way I see fit with my patients? It is crystal clear, these investigations and suspensions are not consequences. They are not legitimate either. Natural consequences of providing exemptions, had I done so, would have surfaced some evidence of harm if there was any. Patients who received an exemption plausibly would be dead or disabled from covid. Many more of my patients or even my staff would have gotten covid. Yet, none of these happened. I have caused no harm. I have done nothing wrong. I have discerned the most appropriate truthful information, data, and applied that to my humanistic model of care. My relationships with most patients improved as I spent as much time as needed discussing and explaining current literature and risks/benefits of covid responses and mandates. My patients benefited in so many ways from the style and type of care my team and I provided throughout the pandemic.

My office became a sanctuary for patients, my nurse S, staff, and myself. I am desperately trying to get back to my patients. I should not have to fight this hard to be a doctor. I should not have to lose all that is important to me to practice medicine the way I always have. I should not have to rebuild my practice or hire a new nurse. I had a beautiful practice with the nurse I knew was the best for my patients and team. My patients loved S just as much as they loved me. Our profession should be not be governed under an iron fist that, at first question, goes for the jugular.

Our system is now creating infinitely worse issues for our people, families, communities, and province to have to face. There is an unprecedented number of family doctors leaving their practices, likely due to the massive rise in physician burnout.

https://www.iheartradio.ca/newstalk-1010/instagram/ottawa-family-doctors-say-burnout-is-real-and-some-are-leaving-their-practices-1.17950070

But, also the moral fatigue is obviously a factor; whether or not people will honestly admit it or not. Long lasting MD shortages will devastate our already fragile infrastructure leaving even more patients without access to essential medical care and treatment. Removing good, ethical, strong physicians who WANT to remain caring for their patients is not ever a productive solution, nor is it for any ‘greater good’.

No matter what happens, I will be able to tell my children that I stood up for what is right, fair, just, and necessary during this historical period in our human existence. And, I have the scars from each abusive sling and arrow figuratively thrown at me by so called ‘leaders and authorities’ to prove it. If there ever is a time to be brave and morally centered, it is now.