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internal Medicine

Do you follow the recommendations you give to your patients? 

  • I try as much as possible... but not always easy... Keep a balance and think about evening...?!?

  • Not always.... 

  • I would tend to say yes to most, or at least the most important ones like not smoking, not taking drugs, taking your medications, etc. We can always exercise more but I'm doing my 10,000 steps a day, we can always be abstinent for alcohol but the important thing is not to overdo it, so I would answer yes to this question

What do you think is the most difficult medical practice? The easiest ?

  • Most surgical specialties seem more difficult to me, but with a big bias, since I wasn't at all fond of the operating room. The easiest... before COVID, I would have said public health, but now, harder to say... I tend to think that practices that do not involve patient follow-ups are a tad easier .

  • The most difficult: bad news announcements.  The easiest: talking with patients and getting to know them

  • It's hard to answer because we don't know the details of all the specialties, and the devil is in the details. For example, from the outside, ENT seems very simple to me (ears, nose and mouth ???, when an internist takes care of the heart, lungs, intestines, kidneys, brain, thyroid, pancreas, infections, arteries, veins, skin, etc…). It remains that the important thing is probably not the difficulty of a specialty but rather the fact of being comfortable with uncertainty and the desire to learn new things. Especially since in medicine, we work more and more in collaboration with other professionals (nurse-clinician, physiotherapist, etc.) who help greatly with certain tasks.

Would you be friends with your colleagues if you had met them outside of work? 

  • I think so... for several colleagues

  • It depends on the colleagues

  • Probably, even thinking about it, my best friend from high school whom I knew before medicine became an internist like me and we are still in contact at internal medicine conferences. But it's sure that currently our friends in our circle are often doctors, especially when our spouse is also a doctor in the same specialty...


What do you think is the most important factor for a successful residency in your specialty? 

  • The desire to learn, be ready to work hard, but have the recognition that comes with it. 

  • Perseverance 

  • I think it's curiosity and the desire to learn. Even if after 20 years of practice, we still see situations that we have never seen and which surprise us!  


What is your favorite alcoholic drink?

  • Only one possible answer Scotch, If you have taste, Edradour. Rather useful for surviving a marriage of convenience!

  • A good glass of Sauvignon blanc on Friday evening!

  • Wrong question.  It depends so much on the situation.  A Labatt 50 on the golf course or after a hockey game will be perfect, while a Côte Rôtie will be perfect in front of a chop of lamb…  A great all-rounder remains a Carlsberg, which, as she says, is “probably the best beer in the world”…  just for his humility, we have to love him!


What specialty would you never do? Why?

  • Ortho. But very complementary


During your medical studies, what did you do on a Friday evening? 

  • Guard (1/2), otherwise see below (but given the limited funds, not always Edradour)

  • Friday was the only day of the week (unless on call of course) that I never worked or studied. It's a blessed day! We were going to dance at the now defunct bar Les Marches du Palais…

  • Pick up from Thursday evening.  Until a certain time.  Then do a Thursday night variation.  

What personality traits are typical of your profession?

  • Detailed oriented... but not only. Living with uncertainty. To be synthetic

  • Curiosity, attention to detail, patience...

  • The ability to live with some uncertainty.  We make decisions to the best of what we know, sometimes urgently, and we have to live with them.  And a nice dose of curiosity with that…!

What do you think is the most important factor for a successful career in your specialty? 

  • To want to seek answers, to get to the bottom of things.

  • Love your practice/specialty

  • I think it's curiosity and the desire to learn. Even if after 20 years of practice, we still see situations that we have never seen and which surprise us!  

What is the best advice you have received? 

  • Good question...internists have the same brain as everyone else, it's just the way we use our knowledge that is sometimes different

  • In pre-doc, an old professor told me that learning medicine was like eating an elephant, and that you had to take it one bite at a time to succeed. And I think it's true, because it's impossible to know everything in medicine, there are always new things that challenge what we thought we knew, and especially new treatments (and sometimes even new diseases! ) which mean that we must constantly be on the lookout!

What does the practice of a general internist look like? 

  • Very varied...depends a lot on where you work. Focused more on therapy if practical in a secondary center and focused more on the practical diagnostic aspect in a university centre.

  • Varied, motivating, interesting practice which consists in helping complex patients with multiple pathologies

  • It mostly depends on where the internist works. The practice in a secondary, tertiary or quaternary center is as different as 2 different specialties can be. An internist in a secondary center (as in Shawinigan or Drummondville) has a much more versatile and diversified practice than an internist in a university center, but sometimes the cases are too complex or require a technical platform that is not available at home and must transfer the patient. On the other hand, he has to deal with many more problems because he does not have a superspecialist at hand (eg inflammatory bowel disease, rheumatoid arthritis, etc.). He must also often provide part of the technical platform such as cardiac ultrasounds or bronchoscopies because he does not have the subspecialties that do this work in his hospital. On the other hand, the internist in a university center has the possibility of being more specialized in a specific field (hypertension, obstetric medicine, etc.). He can also do more teaching or research than a colleague in a secondary school. In addition, the internist must most often work in a hospital, because that is where the most interesting practice takes place. Nevertheless, there are probably around 10-15% who only do outpatient clinics or who have developed expertise that can be done outside the hospital (pre-op, dermatology, etc.), but that's really the minority of internists in Quebec.


How does the practice of an internist in the region differ from that in a university centre?

  • Significant or less presence of learners, research, flexibility, variety

  • Mainly the constant presence of learners, who are a great source of motivation, and who help us keep up to date through presentations, journal clubs, questions, discussions, etc. Also, easy access to all specialists and technical platforms to solve the most serious and complex cases.

  • The internist in the regions must generally devote more time to a sub-specialty, just as the groups of internists in the regions must generally provide all of the specialized care.  


Is the clientele varied or are they just old people?

  • Surprisingly varied, especially in the region. Also depends on the preferred subdomain (eg rheumato vs gastro say)

  • Very varied clientele, of all ages, especially externally, where the elderly in great shape will surprise you. Very sick elderly people are mainly in hospital. Everything also depends on the orientation of the practice: I do obstetric medicine, so many young women!

  • Really varied!  Mainly an elderly clientele, but the chronological age being often misleading, we see everything, in people with and without comorbidities, which makes each situation, even similar, unique!  Well, we see young people from time to time too…!

Do you have to work in a hospital?

  • Not mandatory, but intuitively, I would have said that more than 90% of internists in Quebec work at least partly in a hospital setting.

  • No


What does an internist actually do, considering that there are specialties that cover the different systems (cardio, nephro, etc.)? 

  • What distinguishes an internist: a global approach, ability to precisely integrate the recommendations of cardio/endocrion/nephro/pneumo societies etc... In several centers, emphasis is placed on the diagnostic aspect: e.g., a cardiologist will write : "Non-coronary DRS"; an internist will try to find "the" diagnosis...

  • In the regions, it replaces certain absent specialties.  In large centres, the internist takes care of complex patients, keeping a global vision of the various problems

  • Answering this question in less than an hour is difficult! As I said above, it really depends on where the internist works (secondary or tertiary center) and, if there are other subspecialties in his center, how the task is divided. Since the internist deals mainly with difficult diagnoses and the treatment of patients with multiple pathologies, in centers where there are internists and subspecialists, for example cardiologists, internists will often take care of cardiology cases in diabetic patients with CRF, which is quite a bit more complex than a patient with only stable MCAS. In general, since there is no shortage of sick people in medicine, especially with increasingly older patients, the division of labor is done quite easily.  

What are the difficulties, the least pleasant aspects that you encounter in your specialty?

  • Alright, that's cheezy, but besides the point above, frankly, I have a dream job. What also makes the difference is the group and its complementarity with our interests, which is the case with us. Even further, I see very badly how the group could support me more than it currently does :-) 

  • Hospitalizations for loss of autonomy without an acute diagnosis explaining it because there is no other specialty to take care of these poor patients.

  • We often have to manage purely social aspects, without medical problems.

Why did you choose to stay general instead of specializing? 

  • When a cardiologist asked me as resident 3 to request endocrinology for a TSH of 4.6 (marginally elevated). I couldn't believe that I was going to lose what I had learned in all the other "specialties"... But, more seriously, it was the aspect of caring for a whole patient and not just an organ that made me interested and who continues to motivate me

  • Internal medicine is a specialty in itself not centered on one organ only.

  • It is above all the intellectual challenge of internal medicine that motivated me to choose this specialty. I knew that family medicine had aspects that I found less interesting for me (paediatrics, gynecology, psychiatry) and that all internal medicine subspecialties interested me. The choice was therefore obvious during my residency because after each subspecialty internship, I wanted to become a cardiologist, nephrologist, oncologist, etc. !!


How many hours of work per week on average does the average doctor have? 

  • Hard to say, probably 50 hours...

  • In my opinion, 50 hours/week

  • It really depends on the weeks, we have the advantage of having very different weeks from one to another (sometimes in hospital, but sometimes just in outpatient clinics which close at 4 p.m.). I would say roughly 45 hours, but sometimes less because we can take half days off if we worked harder on a weekend or on call. And at home, we are on call about one weekend out of 4, but it really depends on the environment (sometimes one weekend out of 8-12).

  • 60 (but clearly not typical, clinician-scientist).

  • 50 hours in the day hospital, 8-10 hours in the evening for research work, organization of conferences, participation in learned societies, preparation of presentations, etc.

  • Hmm…  It depends on the dean, the clinic, and other factors.  But let's say it's not an 8 to 5 job... J


What do you dislike most about your practice?

  • Contact with patients and their families. We are recognized in internal medicine, for thinking a lot... sometimes too much... we have, I think, less pressure to solve problems quickly.

  • The weekend guards

  • Of course, the work is sometimes demanding. We sometimes think that the internist can answer all the questions of all the patients, but the 90-year-old patient who has cognitive impairment and who does not know why he is in the hospital, who is deaf, English-speaking, in a chair wheelchair and who has a non-specific symptom such as fatigue can require a lot of work for a sometimes disappointing result. In fact, patients hospitalized in internal medicine have often far exceeded their life expectancy and represent a lot of work for often limited prognoses. But hey, 1- we have to take good care of these patients and do our best, and 2- the majority of an internist's work is probably in the outpatient clinic where the patients are younger and for whom our interventions have an impact important.

  • The obligation sometimes for social or administrative reasons to have to get involved, see to take charge of cases outside my expertise.

  • Always being expected somewhere, always being late everywhere.

  • Not being able to do all the techniques necessary for diagnosis and treatment.  But hey, we have to leave some for the others…


If your specialty had to have a romantic relationship with another which one would it choose? 

  • Marriage of convenience: ortho; Marriage of heart: cardio; mistress: pneumo; 

  • All surgical specialties. It is with these patients that we make the biggest difference. I call the neurosurgery/ortho floor at the CHUS “our house” when I'm in consultation. We love each other a lot, even if we argue sometimes and we don't always understand each other!

  • The entire surgery department...  we are like an old couple, with its ups and downs, but we are inseparable!!!


Was there an aspect of the residency program that was unexpected and required adaptation on your part? 

  • Autonomy (surprisingly but so pleasant), but above all the care in an outpatient clinic (which we see shortly before, but it is true for several specialties)

  • It was rather the beginning of practice that surprised me: we always think that the residency is a lot of work, but...

  • Multidisciplinarity.  We really need others even if we do everything, and the reverse is also very true...  we can't think of doing everything alone even if we do everything!

What is the most common criticism you receive? 

  • It's too complicated... Stretching a differential diagnosis... Tel dx less likely 😉

  • With the residents/students, I am sometimes too present.  I don't give them enough autonomy

  • We receive very little criticism, in general patients and families are satisfied with the care we provide. Of course we always need to do things as quickly as possible, so one comment I would give myself would be to spend more time with patients, but the problem is that there are plenty of others who are waiting in the room, and that we must maintain a balance between quality and quantity. It's all very well to see 2 patients in a very complete way in a day, but the demand is so great that we also have to see as many as possible! (I imagine that question excluded my wife's criticism?!?!).

How would your colleagues describe you? 

  • Effective for the chosen specialty. 

  • Patient, calm, respectful, hardworking

  • They have to say that I work a lot in all sorts of other projects besides patient care. And that's true ! But I do it because I find it interesting and complementary to my practice.

If you had to specialize in something else, what would it be and why? 

  • Cardiology.. I hesitated a little... but honestly, my role models in internal medicine "spoke" to me more... and see above the answer on why to remain general

  • Critical care medicine because of the challenge and acute care

  • Probably not in ENT… No kidding, hard to say. Of course, sometimes I would like to spend an afternoon not breaking my head and looking at x-ray images, or doing cardiac ultrasounds or colonoscopies. But on the other hand, since it's often the routine that makes a job boring, I would be afraid of getting bored quite quickly. And the problem in medicine is that our career lasts 30 years, so it can be long if you have a boring job!

Does your specialty take jokes well at work?

  • I would have said yes... residents are generally surprised by the atmosphere at AMSIQ parties

  • Absoutely

  • I'm not sure that internists have the reputation of being the clowns in the place, but yes the working atmosphere is very friendly here. And since there are often a lot of internists in a work group, we have the advantage of having all sorts of people rub shoulders with all sorts of personalities!  

How do you plan your vacation?

  • When it's possible. There is a big rush on the research side at the beginning of the fall, so it's a bit limited to the second half of the summer and I often do my weeks in July. Except that research is time-consuming but relatively flexible. So I take fewer full weeks, but more opportunistic moments with the family.

  • Six months in advance when we schedule the service. As a family, with my spouse and my four children. Traveling, often in Africa where I opened a primary school, just to occupy my free time...

  • Never during the hockey playoffs.  For the rest…


Why choose general internal medicine instead of the sub-branches of the specialty?

  • For the variability, the flexibility, the ability to work anywhere, the possibility of changing our practice drastically during the career, the involvement in teaching in the region, the excellent match with research and perhaps above all the curiosity about challenges diagnostics.

  • Clearly for the diversity of the cases encountered and for the omnipotent detective work: if the edema of the lower limb referred from Asbestos with macro hematuria on Friday pm looked like a neo of the bladder with deep paraneoplastic thrombophlebitis on the telephone, when it happens, it's clearly rheumatoid arthritis and its hematuria, IgA nephropathy. And the most extraordinary, I can diagnose all that!!!

  • Because we're not bad everywhere, so we can do anything.  And we're not super good anywhere, so we're always on the lookout and never jaded.  Best position to have an interesting practice!


What stresses you the most in your practice?

  • Frankly, I'm not really a stressed person in general. Making schedules so that everything happens on both sides?

  • The endless stream of lab results, messages from patients, pager calls. Always late, never early

  • Missing something simple while looking for something too complicated.

What specialty would you never do? Why?

  • Any form of surgery. No manual interest. What goes on in my head excites me more!

  • Any.  I think I would be able to love just about anything...  and get out of it not too badly!

What car do you drive?

  • Outback. It's a car. 

  • A small electric Chevrolet Bolt!

  • An Infiniti sport utility.  Enough room for mosses, bikes, hockey stocks, skis, …

Do students/residents sometimes make you feel overwhelmed? 

  • I would have seen it from the side that it allows me to stay up to date! I find that it is super stimulating to work in a university center for the aspect of maintaining skills, staying up to date, being reflective about your practice and having a historical aspect when it has been more than 10 years of practice.

  • This can happen on occasion, and it's totally normal!

  • Continuously! And it's perfect like that, it proves that they have good knowledge! In fact, at the start of practice, we often have the impostor syndrome, we can't believe that we're going to be able to treat all the patients, we have the impression that we weren't that good at pass this medical course. Conversely, when you gain experience, you have the impression of forgetting some and not being as good as before, and you also have the disadvantage of being able to imagine everything that could go wrong. with a patient or imagine all the potential mistakes one can make with diagnosis and treatment. But I think that no matter where we are in our journey, the important thing is to do our best as often as possible!

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