Of all the problems we face in clinical medicine, few are more vexing than patient interactions that don’t go well. Dealing with a “difficult patient,” as they’re commonly referred to, can ruin your day and set off a spiraling cascade of thoughts and emotions. Those patient encounters frustrate us and drain us as clinicians. They can leave us feeling at once helpless and self-righteous, empathetic and disdainful. Often, they make us want to run away. Other times, they suck us in, to an...

A little over two years ago, two good friends of mine, whose daughter Fera was born just a few weeks before my daughter, came to me with concerns about their baby. Fera was about 9 months old and at a routine check-up her doctor had found that her weight gain had slowed.  When her mother, Vanessa, reached out to me about this, I wasn’t too worried – so often in pediatrics health concerns turn out to be nothing, or small hiccups that get better on their own. Not to mention the fact that I...

The phrase “evidence-based medicine” is uttered so often in the medical world that it can lose its meaning. So what does it mean? We use the phrase to highlight the ways that medical knowledge and practice are based on scientific data, systematic studies that allow us to determine what really works, to distinguish cause and effect from random associations. And modern medicine has been built around that notion of scientific objectivity.  But I also like to think of the many gaps in that...

When I first started reading Lisa Rosenbaum’s work in the New England Journal of Medicine a few years ago, I felt I had discovered the voice I’d been searching for since starting my medical career. At once evidence-based and deeply human, Lisa’s reportage on topics such as vaccine hesitancy, the war on science, or the Covid pandemic provided something I craved, which was to see the medical world explained and exposed in a way that questioned and transcended the assumptions and dogma that so...

In the clinical work I do in urgent care pediatrics, most of the kids I see come in with an injury or an infection – a fever, cough, runny nose, GI symptoms. That means that – as is the case for many pediatricians – so much of what I do revolves around diagnosing infections and counseling families about them. It’s often routine work, but it has its challenges. The most difficult thing, I think, is seeing parents who are desperate for relief, exhausted from a few sleepless nights with a sick,...

“I’m twenty-nine years old, writing in my journal in a sloppy felt-tip pen (no ballpoints are allowed), trying to understand how I went from being a newly minted physician in a psychiatry residency program at Columbia University to a psychiatric patient at Bellevue, the city’s notorious public hospital.” That’s a quote from the first page of Carl Erik Fisher’s The Urge: Our History of Addiction (Penguin Random House, 2022). As he reckons with what has brought him to that point and enters...

The summer I turned thirteen my family moved to Berlin from Canada. Although we were an essentially secular Jewish family, I had a basic Jewish education and quite a developed awareness of the history of World War II and the Holocaust. Like many young readers, I had been captivated by “The Diary of Anne Frank”. I’d also been to museums and seen plays, movies, and read many stories about the period and the plight of Europe’s Jews under the Nazis. So although I was well aware of Germany’s...

One of the reasons I never tire of making this podcast is that each conversation brings with it a sense of surprise, an encounter with the unexpected. When I heard about Q Hammouri and the advocacy group they founded, Pride Ortho, I was eager to hear about their efforts to break the taboo of queerness in the straight, male-dominated field of orthopedics and to hear Q’s own story. Although we were able to speak at length about that advocacy work and the field of orthopedics, our conversation...

So many forces that seem to be about other aspects of human life – economics, geography, identity, politics – are in fact also intimately connected to health. That connection isn’t just incidental, it’s fundamental: once you begin to see it, it’s everywhere, and it comes through in concrete, important ways, ways that impact human wellbeing.   Transportation - how we choose to get around - is one such aspect of daily life. We usually talk about it as traffic patterns, transit fares, bus...

Mental health as a phrase is so broad and far-reaching as to drift into cliché, or elude meaning altogether.  The many facets and complexities that “mental health” encompasses each merit their own conversation: the role of diagnosis and medication; our approaches to care; addiction and substance abuse; the apparent increase in struggles among our youth; the impacts of the Covid pandemic; the changing workplace; the effect of technology; the role of economic inequality, systemic racism,...

In this third pandemic summer, it’s difficult to say anything about Covid that hasn’t been said before. More than two years into this transformative event, we’ve pretty much heard it all. But that doesn’t mean we’ve reached a state of peaceful coexistence with the virus, or an acceptance of pandemic life.  In spite of all that’s unfolded since news of a novel respiratory virus emerged out of Wuhan, China in late 2019, the infection has continued to surprise us and catch us off guard. Even at...

While many physicians are called to the profession from a young age or commit to it early in life because of onerous pre-requisites and medical school admission requirements, others find their way to the bedside through more meandering routes. When the leap into medicine spans such a great distance, when the change of direction from a person’s past pursuits into the profession is so abrupt, I automatically become curious. What happened in this person’s life, or in their mind, to send them...

I never would have guessed that I’d think this about a book on sex, but Peggy Kleinplatz and Dana Ménard’s “Magnificent Sex” is a revelatory book. I was intrigued about Peggy, a clinical psychologist, sex therapist and researcher, when I saw her work mentioned in a fascinating New York Times article, “The Joys (and Challenges) of Sex After 70”. That article opened my eyes to the importance of intimacy and sexual relationships beyond the so-called prime years of adolescence and early...

Although some have known it for decades, the Covid pandemic and the Black Lives Matter movement have brought the fact that systemic racism pervades our healthcare system into mainstream conversation. And just as racism influences healthcare outcomes and service delivery, it impacts the experiences and opportunities of healthcare workers.  Yet where I sit in Quebec, our Premier, François Legault, has never acknowledged the existence of systemic racism, even after Joyce Echaquan, a First...

Sam speaks to pediatric hematologist-oncologist and palliative care physician Erica Kaye about her writing on infertility and misogyny in medicine. Erica talks about her own experience with infertility, how she came to write about it, and her ideas on how storytelling and dialogue can transform medical culture.  Erica's New England Journal of Medicine essays; -One in Four -- The Importance of Comprehensive Fertility Benefits for the Medical Workforce -Misogyny in Medicine Erica's bio As...

Sam speaks to psychiatrist Wendy Dean about her pioneering work on moral injury and the crisis in the healthcare workforce.  ***  Show notes: 2018 Stat News article on moral injury: https://www.statnews.com/2018/07/26/physicians-not-burning-out-they-are-suffering-moral-injury/ Follow-up Stat News article: https://www.statnews.com/2019/07/26/moral-injury-burnout-medicine-lessons-learned/ Moral Injury of Healthcare: fixmoralinjury.org Moral Matters podcast:...

Sam speaks to his friend, KC Bolton, about his career of service, from his impulsive move to enlist in the US Coast Guard, where he became a decorated hero during Hurricane Katrina, to his time as a volunteer EMT in rural Vermont, and his medical training and new career as a community internist.  *** Show notes: Distinguished Flying Cross Citation for KC Bolton: https://aoptero.org/medals/citation_bolton_kenyon_c_dfc.pdf Richmond Rescue: https://www.richmondrescue.org/ Central Vermont...

Sam speaks to pediatric palliative care physician and medical educator Stephen Liben about his work with sick and dying children and their families,  how mindfulness changed his life and career, and more.    *** Show notes: www.stephenliben.com "MD Aware" course guide: https://link.springer.com/book/10.1007/978-3-030-22430-1 McGill Programs in Whole Person Care: https://www.mcgill.ca/wholepersoncare/ Article on course in Mindful Medical Practice at McGill:...

Sam talks to pediatrician and writer Bindu Suresh about her medical and literary careers.  They explore themes of work, creativity, and selfhood.  Bindu's novel is "26 Knots" (Invisible Publishing, 2019).  *** Show notes: Bindu's website: https://www.bindusuresh.com/ "No Visitors" by Bindu Suresh: https://www.cbc.ca/books/transmission/a-woman-must-make-a-life-changing-decision-for-her-covid-19-infected-ex-husband-in-this-story-by-bindu-suresh-1.5581050 Montreal Gazette profile:...

Sam talks to Pediatric Emergency physician Samir Shaheen-Hussain about medical colonialism, physician-enabled violence against Indigenous children, and his journey as an activist.  Samir is the author of “Fighting for a Hand to Hold: Confronting Medical Colonialism Against Indigenous Children in Canada” (McGill-Queen’s University Press, 2020).  *** Show Notes: CLARIFICATION: Samir mentions working in Oji-Cree communities during his experience in Sioux Lookout as a medical trainee. The...

Practicing is a new interview podcast by physician and host Sam Freeman, who asks the question: "What can medicine tell us about our world, our culture and our society?"