Guest Appearance on the Northern Exposure Podcast

Dec 15, 2020 | Blog, Communication Skills for Doctors, Medical Education

In July 2020, I had the pleasure of speaking with Anne and Hannah from the Northern Exposure podcast. These remarkable medical students from my alma mater McMaster University Niagara Campus are holding meaningful conversations with physicians across the spectrum to support medical students in their decision making around specialties selection. 

Their team did an excellent job of producing the episode, and it captures my day-to-day work and my approach to medicine quite well.

Hannah Levy

Welcome to Northern Exposure, the podcast that we hope will help Canadian medical students explore their potential future careers as Canadian physicians. We’re your hosts, I’m Hannah Levy.

Anne Keller

And I’m Anne Keller. Our guest today is Dr. Marcus Greatheart. Dr. Greatheart is a family physician providing team-based care to the 5% most complex patients in Vancouver and is a clinical instructor at the University of British Columbia. 

Prior to completing medical school at McMaster University and Family Medicine residency at St. Paul’s Hospital in Vancouver, Dr. Greatheart worked as an outreach worker with AIDS Vancouver Island, a research coordinator with the BC Center for Excellence in HIV/AIDS; and after completing his master’s degree in Social Work, as a social worker with Providence Healthcare. 

Dr. Greatheart’s clinical practice specializes in addictions, mental health, elder care, and LGBT health. He is the author of the book Transforming Practice: Life Stories of Transgender Men that Changed How Health Providers Work.Thank you so much for joining us today, Dr. Greatheart.

Marcus Greatheart

Thank you, call me Marcus, please.

HL

Okay, great. So, we have divided our interview into three sections. The first is about you and your specialty. We’ll then move on to a few questions about your journey and how you decided your specialty was right for you. We’ll then finish with the nitty gritty details of what the day to day looks like in your job.

MG

Okay. 

AK

One of the reasons that we wanted to start this podcast is we want to get a good feel for what specialties are really like after training when you’re in practice. And so to that end, can you give us a an elevator pitch or like a short sales pitch for your job as a family physician?

MG

Well, like many family doctors, I do a mix of clinical work, teaching and leadership. I work at a community health center, as you say we see the 5% most complex. So these are folks with medical, mental health, and addictions issues.

I think Family Medicine has, at its foundation, the relationships that we nurture with our patients. We build trust and connection over time, which helps maintain good health and it helps us to navigate the challenges that our patients experience. I’m often heard saying to my patients, that, for example, just because they have a substance use disorder doesn’t mean that they don’t get the same medical care as everyone else, which means that in addition to monitoring their mental health and prescribing methadone, that they get the same guideline-based screening as everybody else. They’re not excused from those things and I think that that’s an important equity issue. 

Historically, I think it’s interesting to know that addictions work was done by specialists. But over the past 10 years, especially in British Columbia, family doctors have taken the lead in addictions work, just because the rate of the opioid epidemic and the poisoning of the illicit opioid supply really required it. So, I think in many ways, the specialty work that I do is becoming more regular. And, you know, there are now new guidelines around treating opioid use disorder, which are considered national and standard practice for family physicians and, you know, physicians across the board in Canada.

HL

How do you think your personality complements your job?

MG

Well, before I came to medicine, I was a Social Worker. And I would say that I’m still that but I’m also a social worker, which means that I really enjoy working in a team environment. At my Community Health Center, we have a large back office area, and I have a little cubicle there: I’m surrounded by physicians beside me, nurses at one o’clock, social workers are at three o’clock, LPNs and other allied staff are behind me. And we’re all working collaboratively to support the patients that are part of our practice. 

Whether there’s an urgent issue there in the moment, or there’s someone on the phone in distress, or someone’s been admitted to hospital, we’re often working collaboratively, because I might not be the person who knows a patient best, or might not have seen the most recently, or I might not have all the historical context to them. So, we really rely on one another. 

For example, we have a Drop-In for methadone, suboxone and Kadian for Opioid Replacement Therapy every day at one o’clock. And so, it’s actually our nurses who are doing most of the engagement with our patients, they will come and see me if there’s an urgent medical issue going on. But they’re providing a lot of the context for the care that we’re doing and using their expertise and making recommendations. 

So really, I couldn’t imagine doing this work without working in a team environment and also, I couldn’t imagine doing the work without them, because we’re all working within our scope to maximize the impact and the health benefit for our patients.

AK

Switching a little bit to the maybe more negative perceptions of Family Medicine. We found a study published in 2017, that examined factors influencing medical students’ decision to pursue a career in primary care. In addition to positive factors, like perception of work life balance; negative factors included the perception that primary care physicians do not become experts, do not see immediate results from one’s actions, and the inability to have a focused scope of practice. So, I think you kind of addressed the focus scope of practice piece, but what are your thoughts on the other two sorts of negative perceptions?

MG

Well, when it comes to work life balance, I think that’s a key component that we should all be thinking about, in terms of the work that we do, and I think an important factor when medical students are considering what specialty to move into. 

I know for myself, when I considered where I might continue my training, and I thought about work-life balance, I realized, for example that I don’t like working overnight shifts I can. I demonstrated my ability to do that during med school and residency, but I’d rather not. So I took on work that doesn’t require much of that. I limit the amount of weekend on call work that I do because for me, having weekends means that I can recharge, spend time with my family and be more available for the really complex work that I do. 

I don’t work full-time at my primary care clinic, because I can’t do it full time. It is so complex, that on the weeks where I have worked five days because we needed the coverage (when we’ve been short staffed, sometimes that happens in the summer) it is exhausting. So really, the two and a half days a week that I do work is all that I can. It’s kind of all that I can muster. I don’t want to get to a weekend and feel like I’m drained. I want to get to the end of the week and feel like I’ve delivered as much as I could. But, you know, I’m still thriving, right? I don’t need to completely replenish the battery over the weekend. 

In terms of expertise, we talked a little bit about that, in terms of the addictions work, but I think in terms of, I have expertise in lots of different areas in terms of providing the management of patients with complex medical, mental health, and addictions issues. I teach our trainees how to effectively communicate with patients from a trauma informed and social justice perspective. 

Recently, I’ve been talking at conferences about the complexity of providing treatment for opioid use disorders in long term care settings. I think family medicine is so broad that every family doctor that I know has areas of specialization. While we cover a broad scope, I think we all just sort of naturally find particular areas. I run into one colleague and I know they’re catching babies, right? And they specialize in catching babies from mums who have substance use disorders, right? So, they’re sort of naturally finding those areas.

I think just sort of broadly speaking, this dichotomy of specialty versus primary care is problematic. I think they’re all specialties. And people are going to have gifts and strengths in each of those. It’s problematic that the study that you’re referring to is perpetuating that idea. I think family medicine is just one of many specialties, and it’s an honorable choice to go into any of the specialties.

HL

I think our stereotype question is one of my favorites because it’s so interesting to get insight from someone who works in the field. And to stop perpetuating what may not actually be accurate. So, thank you for your take on that. 

I’m going to transition us into our second part. So, we really want to know the story of how you landed where you are. So, choices you might have had to make, decisions between different paths, and ultimately how you made the decisions that landed where you are today.

MG

So, I started med school at the age of 40. After almost 20 years as a community health educator and social worker. My story is not typical for the usual medical student. Also, I applied to one medical school, one time, and I got in. And to me that speaks to… I recognize that I have a lot of privilege that helped me along that path, but I also see it as an opportunity created for me by, you know, Creator, Spirit—the Universe, to say, ‘Here’s an opportunity for you to do more than you’re doing right now.’ 

At the time, I was working as a hospital social worker with an amazing team of Geriatricians and colleagues at Mount St. Joseph Hospital, here in Vancouver, and really thriving. And one of the Geriatricians turned to me and said, “You know, I went to McMaster,” She was a physiotherapist before med school and she said, “McMaster is looking for the kind of people who would make good physicians, not necessarily just folks with high scores in science, and you should think about that,” and I did. I didn’t tell anyone except for my thesis supervisor from grad school and an epidemiologist I worked with at the BC Center for Excellence in HIV/AIDS, who wrote my reference letters. 

I applied, I got an interview, I flew to Hamilton and stayed with my brother and told him I was going to a “conference”. On the way to “the conference”, we hit traffic on the highway into Hamilton. And I started sweating and my brother turned to me and he’s like, “Why are you so nervous? You’re going to be a little bit late,” And I confessed. I said, “I’ve applied to medical school and I have an interview.” And my brother drove about a quarter of a kilometer along the shoulder [of the highway], and then up and across the back roads to get me to McMaster campus. 

For my interview, I showed up at the interview. Nobody—nobody shared the memo that said, you have to show up in a black or navy-blue suit. So, I was wearing gray slacks and a really lovely sweater. So I figured, well, at least…actually there was myself, and there was also a young woman. She had this stunningly beautiful, long platinum blonde hair. An ivory suit, like full suit, and so the two of us really stuck out against everybody else. And I figured, well, they’re gonna be like, ‘There’s the salt and pepper guy in the sweater, he was gonna be memorable’ either way. 

But anyways, I got a spot at the Niagara Campus. And I had a real heart-to-heart with some of [the] closest people in my life and decided to take that opportunity, because I really thought it was an opportunity to do more for the communities that I’m invested in. And so, I showed up on the first day with a bachelor’s degree in art history and a master’s in social work. I didn’t need a science degree to get in, but I realized I sure needed it on that first day. So yeah, what’s an allele? Hmm, I didn’t know. 

So it was tough, right? And I took an extra year in med school, right? Three years was not enough. So it took extra time to really solidify my knowledge and then landed in my first choice of residency programs at St. Paul’s Hospital in downtown Vancouver, where I’m now the site faculty lead for Behavioral Medicine. And now I help with the training of all of our residents, as well as the fourth year medical students coming from UBC. 

I’m doing exactly what I thought that I would. I remember sitting in Pro Comp (Professional Competencies), do they still have Pro Comp at McMaster? 

AK & HL

(Laughing) They do, they do! 

MG

Yeah. So I remember sitting in Pro Comp and saying to my Pro Comp group, I said, “The patients that you’re, you know, many of you, are not going to want to see the folks with psychosocial complexity and medical issues and addictions and mental health issues. You can just send them all to me.” And that’s exactly what I do. And I teach our trainees how to support and walk beside these patients who have experienced a lot of trauma in their lives and a lot of trauma from health providers along the way.

AK

Well, we are definitely going to ask you some more questions in that vein in a moment. But, while you’re in med school, was there anything else you considered beside family medicine or was it family all the way and you knew your path from day one?

MG

I was pretty sure Family Medicine was the path that I wanted. I did consider Psychiatry quite seriously. And I did a number of electives in psychiatry, I just realized that all of the things that I really wanted to do in terms of working with patients with mental illness I could do as a family physician. And now I actually have some specialty in that area as well. So, I manage, together with our team, folks with more complex mental illness than the average family physician would likely feel comfortable managing just because I’ve had extra training. And I work collaboratively with a number of psychiatrists. So, I’m just much more comfortable in terms of the medications and the diagnosis and I have resources that I can work with. My knowledge has just grown in that realm.

HL

So moving into the third part where we dig into the nitty gritty details of what your day to day looks like in your job. I know you previously mentioned the two and a half days in your clinic per week. Could you walk us through what a typical week looks like?

MG

Sure. So, I do 4 days of clinical work per week. And I work 5 days per week. I’m fully invested in the idea of not working the insane hours that I demonstrated I could do in residency and every once and while I need to do. 

So, Mondays, today’s Monday, I work from home on Mondays. I’ve got meetings and administrative work that I do. I’m meeting with my research team later on today. I’m speaking with you lovely folks, and catching up on some paperwork, some billing, that sort of stuff. So it’s my admin work-from-home day. My husband’s home today as well because it’s hot here and it’s too hot to go out and do beekeeping so he’s here. And the dog we’re trying to convince to get into the kiddie pool to cool off, but he’s terrified of water. He’ll drink from the kiddie pool, but when he drinks the ripples from his drinking make the kiddie pool move and then he jumps away in fear.

AK & HL

[Laughing]So cute. 

MG

Adorable. Tuesdays, I have a leadership role at one of the long term care facilities in Vancouver. It’s just a few minutes away from our house, which is great. So I walk over there. I meet with the team there—the leadership team, I do some education sessions periodically with the nurses and care aides and allied staff. 

Most recently, we did some work around HIV education, around COVID because one of our sister sites has had an outbreak. And so, we’re talking about the importance of that and the practical work that they do. And then I have a panel of about 40 residents under my care. So I round on them every Tuesday afternoon, in person, currently, we’re doing in person and alternating with telehealth just to limit the exposure, my exposure, and potentially being a vector for infection as I’m out in the community and they’re pretty locked in.

And then, for about half the year I have a resident working with me, a second year Family Medicine resident from St. Paul’s doing their Care of the Elderly rotation so they do 20 sessions—20 half days of care for the elderly. Yeah, so do some teaching and training. And they’re pretty independent at that point, right? Because they’re in the last year of their training, so we’re doing education and fine tuning around providing Family Medicine in the context of frailty and dementia, that sort of thing. So that’s Tuesday. 

Wednesday, Thursday, Friday: I’m in my clinic downtown Vancouver seeing patients. I have 14 half-hour spots in my schedule to see patients. I have lots of no shows, but a no show doesn’t mean no work, because we’re often having to follow up. Somebody asks when was the last time they saw their case manager with the mental health team? What’s the status of their methadone prescription? How do we connect with them? That sort of thing. And then there’s the folks who just sort of drop-in and just need to be seen in the moment. So we do that work. 

Thursday mornings I often teach the residents. So as I mentioned before, I’m the site lead for Behavioral Medicine, so I meet with them for about 12 sessions over the course of the two years of residency. And that includes a combination of issues around professionalism and boundaries, communication skills, Breaking Bad News…we just covered SPIKES  again (which I remembered from Pro Comp), code status. 

And so I’ve just, just for this year—this is my first full year in that role, we’re doing to four social justice seminars. So, with the R1s we just did a session on anti-racism. And then we’re going to be doing a session on anti-oppression and medical violence, based on some work by a Toronto doctor named Nanky Rai. She wrote an article called “Uprooting Medical Violence” that’s available as a Google Doc—one of the most important articles. If someone’s inspired to do the kind of work that I do with folks who are marginalized and oppressed, read that article by Nanky Rai. She wrote it as part of her residency research project. And it is, frankly: brilliant. One of the most important things I ever read in my training, so we’re going to spend a three-hour session talking about that with the residents. And then next year, we’re gonna create two more seminars. So that’s pretty exciting stuff. So that’s 12 Thursdays a year that I do that and then I’m teaching a communication skills with the 1st year med students at UBC starting in September –  interviewing skills and that sort of thing. So, I’m super excited. First year med students are amazing.

AK

Can you just elaborate a little bit on what your patient population looks like, and the types of cases you see on in your in your private clinic?

MG

So again, it’s not a private clinic. It’s a community health center operated by Vancouver Coastal Health. (The province of British Columbia is organized into five regional health authorities.) But it’s effectively an Inner-city clinic. So, in order to get care there, you need to meet the mandate and our mandate is the 5% most complex, so they have ways of assessing that. You need to have complexity in terms of your medical needs. And that’s often folks whose medical complexity is more than the average family physician could organize, or people who developed a significant medical prognosis in hospital and, you know, there’s a lack of family doctors available and so they didn’t have attachment. So they come to us. 

Folks with mental illness, they might be attached to the one of the mental health teams either voluntarily or under a long term certificate of being managed under the Mental Health Act. And so, if they don’t have a primary care provider then they come to us. And then, if they live in the downtown area, and they require treatment for substance use disorder, and don’t have a provider, then they come to us. Whether it’s opioids or stimulants or what have you. Usually folks whose lives are a little bit less organized. There’s plenty of folks who have substance use disorders and they’re still working and functioning well in the community, maybe they’re struggling. We’re a pretty heavily resourced site so it’s usually for folks who require more than just a family doctor, they need access to social work and nursing and that sort of thing

AK

What is an aspect of your job that makes you excited to go to work most days?

MG

I love to go to work pretty much every day because I love the teams that I work with, whether it’s at the clinic or at the nursing home, we have just like really amazing colleagues that we work with, and we work well, working through challenging cases. We work hard and the work can be tough. And we always seem to find some humour in it. On Fridays, especially we have our team at our clinic where we’re Fridays are a little bit quieter. And there’s fewer of us working. Friday is work hard, play hard and snack hard day. And so we, we just, yeah, we have a good time because they can be challenging. And so, we’re looking for the humor in all things. And we deal with some really traumatic issues related to our patients so we need to we need the laughter and the connection to be able to process through that together. And that’s what brings us together as a team. 

HL

Is there a specific clinical encounter or experience that was particularly poignant for you? 

MG

I would say generally speaking in our clinic, we have a specialty clinic providing Transgender Health and I cover there periodically (for example, tomorrow). And starting a patient on hormone therapy for gender dysphoria is a glorious thing. I think in part because when patients come in, there’s an anticipation that there’s going to be barriers in health care, that it’s going to be difficult. And realistically, it’s pretty straightforward. So after seeing them a couple of times, and we hand over a prescription, there’s often a little bit of excitement and disbelief. You mean, ‘it was this easy.’ So that’s always good. And it makes me think about the sort of research that I did that led to my book. In my grad research, a lot of the trans folks that I talked with spoke about what they called the “negative transition story”, that it’s perpetuated out in the world that if you’re trans, you’re not going to be able to access health care. And your family’s going to disown you and you’re going to lose your friends and your job and like this big, horrible, ugly monster of a narrative. And many of those horrible things do happen to folks just for their identity as being trans. But it’s the monstrosity of that, that has people when they’re thinking about transition, or trans identity, that has them reluctant to come in to access healthcare. So when they come in, and it’s relatively straightforward, and I’m, you know, handing them the prescription, that somehow there’s a little bit of like disbelief, and their eyes sparkle, and then they come back in a few months later, and I see them again and for trans guys, sometimes it’s their voice has deepened, and and it’s that scratchy, adolescent sound, and they’re just so thrilled with that gendered experience. Yeah, it’s delightful. 

HL

I mean, just describing it…you put such a goofy grin on my face? I can’t imagine experiencing it.

MG

Mm hmm. Oh yeah. There is no reason that any family doctor isn’t doing trans care because it is now so straightforward. You’re both about to start your second year of med school, if you came in sat with me in clinic tomorrow, and listen to the gender journey of the new folks coming in, 99.9% of those folks, you’d be like, ‘Yep, sounds like trans to me, like meet the criteria.’ There’s no magic to it. The complexity is around assessing each individual for: A) what are their health care goals? But B) Are there any medical contraindications for it? 

So, you know, you’re a 45-year-old trans woman who’s a smoker, right? Okay, I need to think about providing feminizing hormones because of the increased risk for cardiovascular disease. So, the complexity is in that: what [happens] when I add hormones to this individual? So, it’s not about not providing them. It’s like thinking through the case, and what concerns might we have? And how are we going to go about doing that? [But] in terms of the diagnosis part, that’s really straightforward. 

So, you all could help us with that, and in that 0.5%, where I’d be like, “Hmm, I think this needs further conversation,” you would say the same thing. You’d be like, “I’m not so sure here,” right? But oftentimes, that’s with folks where there is a comorbidity that’s related to mental health. And yet, even for those folks, we provide hormone therapy, right? We need to get more information, but just because you have a mental illness doesn’t mean that you aren’t also trans and that you don’t get hormone therapy.

AK

We’ve had so many moments, I’m sitting here with goofy grin on my face too, Hannah; but has there been a specific moments during your career when you thought like, “Aha, this is exactly what I’m supposed to be doing?” Or has it just been a combination of many moments and a general sense of satisfaction over your time working.

MG

I have a general sense of satisfaction with the work that I do. There are “Aha-moments” along the way. And those manifest in encounters with patients and with my colleagues. Teaching moments, even, you know, collecting my thoughts for our conversation today was one of those. And I would say it’s probably the most notable on the mornings, you know, you’re having a bad morning because, I don’t know, you slipped in the shower, you burnt breakfast, whatever else and you’re grumpy and you’re like, ‘I just don’t want to go to work today.’ And getting there and just realizing that that the work that I do is just so meaningful for me, that after a short period of time, I kind of forget. And, you know, I’m just back in. 

HL

Given that clinical exposure is currently limited for us medical students, what is something about your job that we wouldn’t know, just reading about it on paper?

MG

I think what’s not on paper is that family medicine will adapt, and it will thrive. And I know this because it’s a specialty that allows us to shift and change our work. You can work in one role for a few years, and then pick up and move to another community or shift into a different work setting. You can work in a facility or a clinic or out in the community. There’s enormous need for family physicians. And so, there’s a lot of opportunity for us as family physicians to do the kinds of work that we want to do. You can put up your shingle and do traditional, full practice family medicine, if that’s what you want. And there are so many other opportunities, family medicine isn’t just one thing, it is many things and an opportunity to try those things out and change your mind. And it has a flexibility that many of the other specialties don’t have right.

AK

Want to jump back a little bit to your clinical experience? And as I’m sitting here listening to you talk about your work, it sounds incredibly rewarding, but also quite intense. And so, do you find that burnout is a challenge in your sort of realm within family medicine?

MG

I see burnout among some of my colleagues. I think we are all in our collaborative care of one another, trying to support each other around that. And as I said, I think one of the blessings of this work that I do is that it naturally requires folks who have better communication skills around attending to psychological needs and emotional needs. And so, I think we end up doing some of that for one another as well. And just being mindful of, for example, a patient shares with me a pretty significant trauma they experienced, I’m very mindful that I’m holding that story. I can turn to one of my colleagues and say, ‘Hey, I just heard a really challenging story.’ I’m not going to necessarily recount the details because I don’t want to vicariously traumatize them. But I [find] an opportunity just to say, ‘Listening to that was really tough,’ that sort of thing. 

I’m also a big supporter of getting your own mental health support. I have a counselor that I see every once in a while just for a bit of debriefing and preventative health around my mental health, just so that I can keep clear. And sometimes it’s a call up to say, ‘Hey, can we chat because I’m dealing with a difficult situation and need some additional outside support.’ And then turning to my husband and my family and my people. 

AK

Thank you for sharing that and for sharing your sort of personal coping techniques. I think it’s, it’s really important to hear that everybody has struggles at times, and that there are ways to, to cope with it and to handle it and that it’s always nice to hear those experiences from others. 

MG

And I think part of you like, what’s happening in training is you’re starting to meet people. So my sense is that the two of you are working on this project because you two have connected, and so that might be a relationship that continues on through your training, right? And you need to have your people, right? The person, it’s three o’clock in the morning, and you’re an off service resident on some rotation that you don’t particularly enjoy, and you’re slammed [and tired and filled with self-doubt]. Who do you call, right? And so you have this pact, ‘You can always call me at 3am, if you’re in a bind, and you just need a rational person to talk to because you’re in tears, or you’re freaked out or whatever else,’ Right? You need those people that you can call. I have people in my phone that I know that I could call at any hour. Many of them are people that I met during my training.

HL

Before we wrap up, we mentioned at the beginning of the podcast, that you have a book called Transforming Practice: Life Stories Of Transgender Men That Changed How Health Providers Work. And we want to give you a moment to just tell us a little bit a little bit about that.

MG

I spoke to sort of the primary message of that in terms of the negative transition story, that monstrous story that there that narrative in the community that really impacts the ability for folks to access care. And there’s lots of research out there, a lot of it done in Toronto, Ontario through Trans Pulse around the fact that trans folks because of their fears around what it’s like to access health care will avoid health care sites, delay getting treatment, those sorts of things. So creating ways to improve access for folks. And so, there are a number of great stories in that from the interviews around folks experiences, things that worked and things that didn’t work quite so well, that I think are really helpful. And it was the first book that focused specifically on the experience of trans masculine folks. 

It’s been 10 years since I did that, so the publisher was actually asking about doing a second edition. So that looks like that’s in the works probably for next year. Because I think the story really resonated with folks. Things have changed in trans care in those 10 years; we’ve learned a lot, and as I said before, we’ve simplified a lot, because a lot of it is quite straightforward. And the evidence is quite good around the benefits. You know, I’ve followed all of the literature around mental health with trans folks. And we know that just starting on hormone therapy improves mental health of trans folks in and of itself. So, you know, why wouldn’t we? Why wouldn’t we do that? 

And then some of the simple things that providers can do to demonstrate their support of trans patients, doesn’t mean that you have to be a specialist. I mean, I’ll still argue that any family doctor can do hormone therapy; but even if you don’t, like find the person who does do that, right? liaise, write the letter, fill out the ID change form, like do all of those things. There is no rule that says that you have to address a patient by the name that’s on their ID or birth certificate, you can address them by the name that they live with, right? And by the gender pronouns that they use. And you can teach your office staff to do that and your colleagues to do that and stand up, right?

We have a lot of power and status as physicians and if we use that to amplify the voices of communities who are oppressed, we are listened to. So if we’re the particularly if we are not trans, and we speak up around trans issues, we’re not heard of as “the shrill.” When trans people speak up, they’re often discounted because they’re “the shrill”. Just as people of color are discounted as “the shrill” talking about racism issues, right? So, when we are a member of the majority and the privileged group, when we speak up, we’re often heard, right? But our job is to amplify the voices of that marginalized group. So that their needs get met. So, if we’re doing that, then we’re doing good. And if we have an issue, or whatever, around providing trans care or care to a particular group, we need to work out our own crap around that. But also, we need to have people then that we can that we can refer folks to, and we can still be kind.

AK

Our last question, do you have any final words of wisdom or just advice you’d like to share with students who are considering a career like yours?<

MG

As you’re going through your training, I think it’s important to consider the experiences that you had that were really meaningful. Preceptors that you’ve worked with, that really stood out to you. The locations that you worked at that you enjoyed. The procedures that you did that you liked, or didn’t like. Doing the pathophysiology that you find fascinating, or not. I think those are the pieces to be thinking about because there is lot of overlap between specialties. So rather than trying to fit your interests into the specialty box, I think it’s more important to build a profile of ‘what are the things that I love and that I find compelling and that I could see myself doing for the rest of my life. The things that I like that I enjoy, the things that I don’t mind, and the things that I’m just not interested in.’ And then looking at it, ‘What do I want my life to be?’ Because being a doctor is just a job, right? It’s not special, it’s not better. And really, if your life fulfillment comes from being a doctor, that’s a bit problematic as well. I think you know, life fulfillment comes from feeling like you’re giving back through your job and into your community and your family and you know, the love you leave behind when you’re gone—to quote a song that I can’t name right now, but I think that’s what’s important. So, I think thinking about putting together a profile for yourself I think that makes much more sense.

HL

Thank you so much for for your answer for your honesty, for telling us about your journey and bring us into your world for a little bit. It was a pleasure having you. 

MG

Happy to be here with you both. Thank you so much for creating this opportunity. And I love teaching and working with working with our med students and residents because I know how tough it is. I might look salt and pepper. But you know, I was just there, it seems. And so it’s really been an honor to spend some time with you today.

[ Photo credit: Shane on Unsplash ]

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