‘In Dialogue’ Episode 6: Dr. Chase Everett McMurren
In episode six of “In Dialogue,” CPSO EDI Lead and Medical Advisor Dr. Saroo Sharda speaks to Dr. Chase Everett McMurren, a family physician, psychotherapist, nâtawihôwêw (medicine man) and Indigenous Health Theme Lead for UofT’s MD program, about non-traditional approaches to medical education and patient care, specifically Indigenous health and methods of healing; cultural humility in medicine; and the role creativity can play in physicians’ own well-being as well as patients’ health.
Dr. McMurren’s spirit name is “Water Song Medicine Keeper” and his ancestors are Michif/Métis, Celtic, French and Ukrainian. He’s an Assistant Professor and the Indigenous Practitioner Liaison within the Office of Indigenous Health at the Temerty Faculty of Medicine at the University of Toronto, and the physician lead for the home visiting program at Taddle Creek Family Health Team, where he provides care-at-home for long-living people with advanced illness. Dr. McMurren also provides medical psychotherapy, primarily to physicians and artists struggling with grief and overwhelm.
Related eDialogue Articles
- Treating Root Causes, Not Symptoms
- Implicit Bias in Health Care
- CPSO’s Commitment to Learning, Unlearning
- Being a True Ally
- Complementary and Alternative Medicine Policy
- Understanding Representation in Research and Medicine
- Interconnected and nuanced ways of understanding healing with Chase McMurren
- Indigenous Health in Ontario Introductory Guide for Medical Students
- Royal College’s Indigenous Health Resources
CPSO presents In Dialogue podcast series, where we speak to health system experts on issues related to medical regulation with delivery, quality care, physician wellness, and initiatives to address bias and discrimination in health care.
Dr. Saroo Sharda (CPSO Medical Advisor / EDI Lead) (SS):
Hi, and thanks for joining us In Dialogue. My name is Dr. Saroo Sharda. I’m a practicing anesthesiologist in addition to my roles as a medical advisor and Equity Diversity Inclusion leader at the CPSO. I hope you enjoy this episode. We are really pleased to have Dr. Chase McMurren joining us today, and I’d like to give you a warm welcome Chase and maybe just invite you to tell us a little bit about you and your work. I know that you’re involved in many different things and wear many different hats, and we’re going to hear about them in a bit more detail. But could you just introduce yourself for everybody listening?
Dr. Chase Everett McMurren (CM):
Well, thank you so much for having me. I’m honoured to be here and to get to share in conversation with you. I am speaking to you today from Tkarón:to or GichiKiiwenging, also known as Toronto these days. I go by Chase, though my spirit or ceremonial name is “Water Song Medicine Keeper.” I get to practice medicine. I’m trained as a family physician and my focus these days is a mix and match of psychotherapy — generally one-to-one, sometimes grouped with professional artists and fellow physicians — I also get to practice home-based end-of-life care. And so, I have a small micro-practice of long-living people nearing their end-of-life, who hope to die in their own homes. And then academically, I am privileged to work in medical education at the University of Toronto in the Temerty Faculty of Medicine. So, these days, I’m the theme lead for Indigenous health in the MD program, and more recently have added a day per week as an Indigenous practitioner liaison, hoping to create more welcoming, trustworthy spaces for Indigenous learners, staff and faculty across the whole of Temerty medicine. I’m learning more and more that there’s much more to a faculty of medicine than the MD and post-grad training programs. There are all sorts of very wise and wonderful people outside of the confines of clinical training programs. So, that’s a little bit about me. I guess I can also say that I’m Michif or Métis on my mom’s side, also French and Ukrainian and Celtic, and I come from Blackfoot Confederacy territory, Treaty 7, southern Alberta, though now call Toronto home.
SS: Wow, you are busy, and it sounds really interesting and fulfilling. I wonder if we could maybe dig into that a bit more and ask you what have been your greatest joys — and perhaps some of your greatest challenges — in all of this work that you do as a physician, as an academic, as a therapist, as someone who works with homebound, long-living people? We’d love to hear what some of those high points and joys have been, and also what has been challenging.
CM: So, I love the reality that joy and grief are inseparable, that they go hand-in-hand and part of being well as, in my humble opinion today anyways, riding the waves of all of it — of delight and dread and joy and sorrow, I think it all goes together quite beautifully. Colonial biomedicine sometimes gets distracted or focuses its attention on certain pieces, like prolonging life or treating symptoms or not missing something, though, I think that at the end of the day, finding ways to really respect the reality of suffering and to find ways to accompany people in their suffering without feeling like we need to fix it or avoid getting blamed for it is, I would say, a wish of mine. And so, in the work that I do, I think I’ve kind of found a way to reconcile some of that existential difficulty within practicing medicine by focusing more on end-of-life care and on supporting or serving people and helping them understand their relationship to their experiences. And I say that in the context of my work as a psychotherapist. I prefer thinking of psychotherapy as assisted self-discovery, really thinking about myself as an assistant and a witness to help someone by being there rather than telling them what they ought to do or how to do it. And I often think of that work as really beautiful midwifery in a way that the sense of respecting a natural process without thinking like I know best; and thinking about teachers I’ve had along the way and very skilled midwives and physicians — I’ll say generally with family physicians and obstetricians who are quite non-interventional and non-violent in their approach to the birthing process and respecting how it’s not a pathology. And I think that can be relevant to medicine across the board, that when we think of ourselves really as supporters and respecters — I don’t know that that’s a word — but I think the more that we can really appreciate and uplift people’s current and therefore best efforts, I think that can be much more therapeutic than offering any sort of advice, or prescription for fancy medicines.
SS: I love how you’re talking about so many things here, Chase, about sort of being witnesses and assisting in self-discovery is so resonant for me. And I think often, as you say, these colonial underpinnings that we have in medical education — and I’d love to hear more from you about what some of the challenges have been with that in a moment — but they really have moved us, I think, to a place where we do feel that we have to know and that somehow not knowing as a physician is a failure. And I think sort of what you’re talking about or the way you’re conceptualizing and describing this is really, I’m here to witness, I’m here to support, I’m here to guide, I’m here to accompany people in the suffering — I love that — is sort of trying to reframe what some of that really ingrained narrative is for us in medical education as physicians. And I wonder if maybe you could speak more about that, because you did say that one of your joys and privileges is being involved in medical education. And now, not just with medical students and residents — obviously, that’s been a great joy and a privilege for you — but what has been challenging, particularly in trying to unpack and unravel some of those colonial underpinnings and those things that, as I said, are so embedded for us as physicians. Can you speak a little bit about what your approach has been to that? Because I imagine that has not been easy.
CM: I think the reality is that slower is faster, right? And that sometimes, if we want to, I’m paraphrasing the psychologist and Mohawk elder Ed Connors here, but he says something about that, if we want to go far, we need to slow down or if it matters, then everybody benefits when we slow down. And I think that that is very out of fashion, both in the world of medicine, where we sort of think critically and we need to act fast on anything that looks red in the lab work, and we need to get things moving. So, both within medicine and then more broadly within the context of very important change right now with regard to social justice, I think there’s a sense of urgency about making change and things needing to be different. And so, it feels kind of unpopular to say, whoa, hold your horses, let’s slow this down. I think the reality is that slowing down is quite uncomfortable and often feels like it’s not right to slow down, that people will die or get hurt, or we’re not doing our part. And that idea that it’s sometimes okay to tune out, which feels blasphemous when I say that out loud; it’s like, how selfish?!
And so to get to your question, I have to say that I’m starting to get the hang of it several years into the role. And at the same time, I’m beginning to grieve more and more. And I think the grieving is important, where I’m so mindful that as I say, whatever I say here, of course, it’s not everybody, I don’t want to generalize, though many people almost sell their soul or give up an organ to get into medical school and, and generally, luckily, sort of figuratively and not literally, though there’s a hardening of hearts, I think, and the gain of getting into medical school comes with lots of loss, whether we’d like to admit it or not. And what I’m noticing now, in having the great responsibility and honour of being involved in curriculum development, and also getting to teach sort of areas within the program, like clinical skills, it’s that there isn’t really time in the curriculum at the moment to undo what’s been done in the process of people getting into medical school. And I mean, I’m speaking with judgment, this is my opinion, so people might disagree with me, but the competitiveness, the intensity, the investment in being smart and being seen as smart, the investment in being seen as kind — there are strings attached to all of that. And I see that playing out in the med school curriculum or journey a little bit. And I see that most in the way that even though they’re not called tests, the evaluative exercises that are peppered throughout at least the Toronto MD curriculum, they really steal the show and they take a lot of battery power, and they come at a cost where when I show up to tutor or teach clinical skills on Thursday, if learners have a test on Friday — other kinds of tests and mastery exercise — it means that they probably won’t have done the reading or the readying work for clinical skills, and will be distracted and afraid of their exam or their exercise the next day. And for me, I just find it irritating because I’m sacrificing clinical time when I could be seeing patients and getting my work done, so to speak, to spend time with learners who aren’t really there because they’re afraid of how well they’ll do on the exercise relative to their friends or their classmates and fellow learners. But it’s just I find it really challenging in a way that — the world of medical school is way better than I think it ever has been, so I’d like to name that; that like, no longer are the learners being ranked on paper on a bulletin board, which I think was a thing and is still a thing in some places, where there’s basically, I don’t even know what to call it, but a rank list of who’s smartest, who did best on the test. We don’t have that now. And yet the learners come from undergrad programs where that may still be a part of the culture and so that doesn’t disappear once they come to medical school, so that’s a factor. And then the other thing that I just want to name is that — and I imagine if there are any physicians listening to this podcast, they might relate in some ways — that coming to medical school can be traumatizing.
And so, one of my favourite teachers right now is a person named Sarah Peyton, whose focus is on neurobiology and understanding the way that the brain works from what we currently know neurobiologically based on all the fancy imaging, etc. And she defines trauma as an experience where we feel helpless and alone. And so, it says nothing about the actual content, or what actually happened, it’s all about the quality of the experience. And when I think back to my medical school days — I mean, I’m not going to slow down to conjure them up right now — but moments of feeling helpless, check, particularly as a learner at the bottom of the hierarchy, feeling helpless, especially when there’s moral distress and seeing most responsible physicians conduct themselves or practice in a way that doesn’t feel at all all right. And then the aloneness, right? So let alone if someone comes from a marginalized community or community that’s historically not been welcomed into the medical school setting or a university setting, even the aloneness can come throughout the day for any and all of us, where we feel kind of like we have to do it ourselves or that nobody understands or we’re not keeping up. So, I just think, and specifically for those skeptics, understanding the idea that trauma is a thing and our bodies don’t pretend it’s not.
So, we might have been conditioned through the hidden and non-hidden curriculum within medical school to be strong and straightforward and stand up for ourselves and be excited to be busy and stay up all night. But at the end of the day, those times that we feel helpless and alone create wounds that eventually need to be healed, and so — or they don’t, I guess, but I tend to believe that they do or they’ll catch up with us somewhere along the way. And the point I was hoping to make was this big risk, even life threatening risk of loss for some learners who have maybe been stars wherever they were before, top of their class or lauded, raised up by their family potentially as the future, the first to go to med school or following in someone’s footsteps or whatever it may be, going from being celebrated to being kind of one of the rest of them, so to speak, as med school classes are filled with very bright, very impressive people. And I think that that can be very alone and helpless; I think it can be quite traumatizing for some learners where it just feels so horrifying to feel not very smart anymore and to feel like you’re not so special, especially if performance in traditionally defined tools has been a way of measuring worth. Med school can be a rather terrifying place to be.
SS: I was just gonna say this has a lot of resonance for me, and even into training and post-training as an anesthesiologist and somebody who works in the perioperative realm where efficiency is everything. You know, gotta keep going, gotta keep going. And it really is — you kind of feel that you’re sometimes sacrificing yourself on the altar of efficiency and other things, which are really important, like connection and creating welcoming, trusting spaces; and really seeing multiple sides and nuances is really hard to do when everything is about how quickly can we get through this list, because at 3:30 we’re going to start to have to pay the nurses overtime or whatever it may be. But I wanted to just elaborate on something you said, Chase, and bring in the fact that you are now the Indigenous Theme Lead and now have a new role in terms of the Indigenous Practitioner Liaison, you mentioned elder Ed Connors, who actually came and did a beautiful session for us at CPSO for our board, and I learned so much from him, and sort of asking you to elaborate on the fact that we know now — and maybe we’ve always known, but it’s becoming more accepted — that incorporating different kinds of knowledge — and I’m thinking specifically with your background, traditional Indigenous practices, methods, ways of knowing, traditional healing, which, actually, we now specifically name in CPSO’s Complementary and Alternative Medicine policy, we know that that is so helpful and healing for so many people. And so, from your experience and your work, for people out there who maybe haven’t been exposed to this and are nervous as physicians to say, how do I approach my patient about other things that may be helpful to them, whether those are spiritual or traditional medicines or people? Because you are so embedded in this journey of accompanying people, how could you advise physicians who want to do that and just aren’t sure, they don’t feel they have the language — how can they incorporate that in a safe, sensitive and respectful way?
CM: Thank you for that question. It is so valuable to simply be curious about how we feel about something, even before we consider talking about it or bringing it up to somebody clinically. I think checking in with ourselves about what we notice shows up when we think about it is a very, very wise and respectful practice. So even in this moment, if anyone who’s listening, which I mentioned you are if you hear me talking, but just noticing what comes up for you when you hear the idea of traditional healing, or using plants in the healing process, and just noticing what happens inside yourself in terms of whether there’s a body response, or an expansion or contraction, like a warming or cooling, whatever it may be — this noticing where you’re at, because I think for some of us it might even feel obvious in a way of like, “Well, of course, I would bring that up;” whereas for others, it might be like, “Oh, my goodness, I’ll have trouble with the College, I’ll get accused of negligence.” And people can go in many directions based on their life so far, and what they’ve seen and heard, back to what they learned in their training, back to what they heard at home.
So, I think that I’m reminded right now of a wonderful, wonderful medical student who did an elective in Indigenous health with me a few years back now, who was very sheepish about letting me know that she sees a naturopath. And it was a humbling and heartening experience for me because I don’t think twice about naturopathy these days. I still have very strong opinions about certain practices and ideas and how it’s done; and I don’t like things costing money because of my own upbringing, and I like it when the government will pay. But besides that, it was just so interesting that she was so afraid. And yet, she also knew me from lectures, etc., where I’ve been pretty straightforward about the idea of be curious about judgments, but try not to act on them until you know what they’re about. And so that was sort of a pulse check in a way, for me, of realizing that I am way over, somewhere else, maybe past the threshold in terms of my openness to being as humble as possible and acknowledging that colonial biomedicine is very limited. It is life saving, it is wonderful — please, oh, please, if I fall off my bike on my way to the hospital this afternoon and, like, fall apart, please see if you can put me back together with contemporary, present, evidence-informed medicine; though, at the end of the day, it is so troublesome. And the idea of epistemic racism isn’t an important concept.
And I realize I haven’t answered your question, yet. So, I will get there so soon. Of the part two — so part one is check with ourselves and notice what we notice, and part two would be language. But in between, sort of as a pause, is seen awareness of epistemic racism, epistemic or epistemology theory of knowing, a system of knowing that within colonial biomedicine, especially these days, the idea is, is it evidence-based? Are we practicing evidence-based medicine? Are we practicing according to the guideline? Which is lovely and feels very comforting. So, back to the tests or the exercises that the learners sacrifice other beautiful learning opportunities to or for — it is so much easier to study for a multiple choice test than it is to practice quote, I’m air quoting here, soft skills, which, paradoxically, are much harder than hard skills, because they’re nuanced and there’s no right answer necessarily, and even if we do it exactly the way that the acronym tells us to, the person may be more upset than relieved or feel less heard than the mnemonic said we might achieve, quote. So, I just want to highlight that the guidelines are really easy and comforting for us because they’re organized or sometimes beautifully tabled, and people have said they’re good.
The reality, though, is when we pull back the curtain in a way and acknowledge the fact that that guideline came from somewhere, there’s a specific epistemological foundation informed by — and again, this is where I don’t want to be too intense with my language because I don’t want to sound like I am an extremist in this way — but the reality is that so often, there’s so much funding that informs what ends up in those guidelines, whether directly or indirectly, there is an entire system of medicine that historically has marginalized particular populations, that will affect the way that the research is conducted and how the results are implemented or not. The reality is that much of the research done doesn’t show up in the guidelines, although maybe it ought to some of the time. And so just that alone, the reality that many people won’t be involved in the research because they’re skeptical of it, or they weren’t invited, or their literacy levels might not have made it possible for them to know that they were being recruited. So, I just think that again, there’s grief and there’s a bit of terror sometimes that medical students aren’t necessarily invited to consider that critically — I don’t think, but I hope they are and, again, maybe I’m wrong and that would be a good thing. But there’s such a feverish need to learn and to master the knowledge, that the slowing down just sort of cultivated, the wisdom can go missing.
And so, all that to say that a lot of very, very old indigenous medicine has stood the test of time and there aren’t evidence-based studies to confirm that because nobody’s going to fund them and many people aren’t willing to participate, or perhaps someone well-meaning decides that they want to do it, they probably don’t have the necessary cultural savoir faire or awareness or the funds to do it appropriately, or the backing of big companies who probably won’t benefit from learning about how to use dandelion or plantain — I don’t think they’re big money-makers. So, it’s complicated that way and I think I am really delighted by James Makokis’ comment in a chapter he co-wrote with his mom in the textbook on Indigenous social determinants of health that I think he says, Western medicine — but I would say contemporary colonial biomedicine — is actually alternative medicine to Indigenous medicine on Turtle Island. And for those who aren’t aware, Turtle Island is sort of what we now call contemporary North America. But the reality is that that medicine is far from alternative. It’s original medicine that was intentionally stifled and suppressed, and made illegal for quite a time. So, I think it’s complicated. And I will now answer the question if you want.
SS: Well, maybe before you do, Chase, because I love that you didn’t immediately answer the question, because there’s so much wisdom in a lot of what you’ve said, and actually a lot of resonance not just in medical education, but in medical regulation. So, I wanted to just pick up on this idea of epistemic racism, and what we consider evidence and what we consider not evidence, and really this idea that we’ve become very narrow, not just in medical education, but in regulation and policy around what is considered valuable information, and whose information is considered valuable or whose information is even sought out. So, one of the things we did last year for one of our important policy renewals, sought out the voices that are not normally the ones who are going to respond to our policy call out because maybe the policy caller is always in English, it’s always on the internet — that excludes a significant number of people already — and really try to be much more proactive in our outreach. Because again, I think we make a lot of assumptions around neutrality of process and neutrality of curriculum, and this idea that somehow in medicine we’re inherently neutral and objective, when, of course we’re not, nothing is neutral and objective — and so why would we be any different?
But I think my time many years ago at the Wilson Centre at the University of Toronto really opened up this idea for me of what are different epistemologies? And how do we think about different types of knowledge? I think as physicians, we get very narrowed into a very particular way of knowing and a very particular way of doing, and just being able to hear and be, as you said, curious about what we feel about something is so important, and I think it ties back into what you were saying about slowing down. Because when we don’t have the opportunity to slow down, how are we going to get curious about how we’re feeling? We don’t think about how we’re feeling, we don’t have time or the opportunities and so I really love that actually as practical advice. And also that it’s not an either, or — you keep coming back to this idea that this is not about colonial biomedicine being bad; this is just about it being limited in certain ways. And so how do we open that up? And how do we think about this in a more holistic way, where we can bring in different types of knowledge and ways of knowing? And I think that it’s not a subtraction, right? It’s an addition and it doesn’t mean that we don’t have a lot of really important things that we do in that Western model, but it is limited. And I think that’s a really important point that you brought up, so thank you for all of that and the resonance in our work in medical regulation, which I think is really important lessons for us.
And then maybe now we can get you to offer people some practical language around — because there are physicians who really don’t feel comfortable with this and really feel that maybe they’re going to offend their patient, or that they’re, as you said, gonna get in trouble with the College — so what can you maybe offer to them?
CM: Yes. Oh, this is so nourishing to talk about all this with you. I’ve been playing a lot with the idea lately of being more of a both-and-ist, kind of like a specialist. Family physicians don’t get to call themselves an “ist” in a way, we’re an “ician,” like a geriatrician or orthopedist. And so, I’ve been playing with my own fancy new word and that’s a both-and-ist, which I think is playful and a bit silly. And ironic, because the alternative is being an either-or-ist, which brings us right back to a binary, so we run back into trouble. Though, pursuing both-and-ism, I think goes a long way. And I think the practical invitation that I would offer to those who are curious and open to trying it out is to use more “sometimes” statements, because I’ve been playing with it in my own practice and I find it very helpful — ideally, when it’s not too robotic, though this idea of offering a general statement goes a long way.
Sometimes I find that patients come in and they’ve already come up with the differential diagnosis. And what I mean by that — because that’s coded, fancy language — what I mean is they looked online and found a handful of possible explanations about what’s going on with their health. “And I’m curious if there was something that sort of made the top of the list for you and you’d be willing to share that with me?” So, that’s sort of a non like, “Are you an Indigenous person? And are you using Indigenous herbs?” example. Though, I think a very helpful one that sort of says, “Hello” to the elephant and respects the elephant as a being. And that Dr. Google is probably really good sometimes. And Dr. Google also probably causes a lot of harm and unnecessary suffering, while people think they’re dying of cancer until they see you for an assessment.
The second piece that I want — I think I’ll just say this in every conversation for the rest of my career, I hope anyway, because I don’t think I will tire of this — that before we offer any kind of reassurance, it is so important that we validate that we acknowledge that we’ve heard what someone is suffering with before we try to dismiss it as not a big deal or offer some sort of solution. And I would say that this is the case, even if they’ve asked for that, just because — the reason I’m saying this is if someone thinks they’re dying of cancer and they come see us, and we very quickly say “Oh no, it’s nothing,” unless they really trust us and we are somehow totally believable in a very remarkable way, that the likelihood is that they’re not going to believe us because they’ve been feeding this dying of cancer plant within themselves for days. And so, for us to come in and say, “Oh, it’s nothing,” it’s going to take a while for that plant to sprout. Or if the plant that is growing and doesn’t belong, to be uprooted. So, I just think that with all of this, acknowledging is very powerful and is a medicine in its own way. And I think we forget that or we think we don’t have time. I will say, it doesn’t take that much time to say, “Oh my gosh, that must be so itchy that rash. I’m sorry that you had to wait so long to get in today.” That alone and then just say, “I do have some good news to share. Can I share it with you? I think this is eczema. I don’t think you’re dying. I don’t think you have Kaposi sarcoma.” I think we have to slow down in those moments. So, acknowledging statements — and this is sometimes specific to non-allopathic or colonial biomedical practices — I think can be very easy.
I think people can’t see me on the podcast, though I look very white. I think I’m very white appearing or white coded would be the term used in academic writing. So, people generally won’t think that I’m Indigenous and so it would be very odd if someone asked me outright, “I’m wondering if you’re considering, or if you’ve connected with a traditional healer about this” because they probably won’t know that I’m Indigenous unless I felt safe enough or feel like I can trust the person enough to disclose that I identify as Indigenous. And so, this is one of those challenging traps in EDI-land, where many people may identify in many ways and we have no idea unless they disclose it. And so, our work really is creating a space of welcome, I think, and ideally focusing less on creating safe spaces because there’s no such thing — I don’t believe there’s such a thing as a safe space — though creating more spaciousness for people to trust us. And thinking about how we communicate trustworthiness with the idea that it’ll be different all the time. We might think that we’re the most trustworthy person on the planet, and people may feel very different, right?
SS: So beautiful and so important, like, how do we communicate trustworthiness and that is not always going to look the same. And I find a lot in my EDI work, what people want from me, especially physicians, is give us a toolkit, tell us what to say. Something I always come back to is elder Ed Connors teaching, when I co-facilitated some stuff with him saying, “I’m not going to tell you what to say. But I do hope that I can encourage you to think about good questions.” And I love that. And I come back to it all the time. Because as you say, it’s not always going to look and sound the same. And one thing that you actually shared when you were interviewed for one of our eDialogue articles, Chase, when we did a piece on anti-indigenous racism is that you spoke about this term, “cultural humility,” which really acknowledges that we don’t know everything, but that we have a willingness to learn — and it’s different to competence. And I strongly agree with you that I don’t think we can ever be competent in somebody else’s culture because culture is this really nuanced, complicated thing. It’s not just about being indigenous or not, or being South Asian or not, or being gay or not. It’s really complicated. And so, can you tell us a bit more about this? And I think maybe what you’ve been talking about is cultural humility, but is there anything else you’d like to say about that? And again, how practitioners can embed that and how that might sound in addition to what you’ve already been talking about?
CM: Yeah, for sure. Not to say we need to get over ourselves as physicians at all, I think we need to be very mindful that we aren’t ourselves when we’re practicing as a physician. So yes, we’re us. I’m Chase when I’m playing doctor, but the reality is that I’m not me in the eyes of the people who meet me. I’m that version of me and that changes throughout the day. So, in a day of psychotherapy, I will be 13 different versions of myself or more, because people project all sorts of things onto me. And half the time my mind boggles when people reveal their thoughts about it, because they’re often not accurate. And then there’s a work of delicately updating their awareness. But sometimes I have patients who don’t realize that I’m a physician or people who think I’m a psychiatrist, like people will think that we’re doing psychoanalysis when we’re doing something different. And this is after doing very careful, College stamp-approved consent processes, like intakes, etc. And so, it’s a reminder for me that it’s so nuanced and complicated, and people will be affected by us.
If we think about ourselves as quite chimeric and made of many parts, every age we’ve ever been, most people have had challenging encounters with, if not physicians than the health system. And all of that gets stirred up like the bottom of a riverbed whenever someone comes into a health context. And we don’t have control over that and to think we do is hubris, not humility. What we do have power to do is really about how we show up and I think, along with being a both-and-ist, I think when in doubt, slow down to notice the how more than the what. And I think the how of relating to people, whether it’s team members like the ward clerk or the scrub nurse or the family member or whomever it might be, that the how matters so much. And I think undoing the idea, which is both hidden and transparent in medicine, that we know so much and we should know so much, is I would say uplifting the idea that people are experts in their own lives and we’re mere consultants.
And if we go back to the beginning, ideally, we’re mere assistants, where we’re there to assist them in their — I think for some physicians, this might sound a little too hokey — but in their healing journey or in their process of moving toward wellness or their experience of navigating through suffering, however we want to put it. But even if someone wants us to fix them, that’s part of their journey. And that’s not ours to take on, necessarily. We can honour that or hold it, but we certainly don’t need to take that on, because it’s not really our job to fix anybody. It might be our job to address a health issue and to maybe set the bone or sew up the belly once it’s been opened. But that’s different than fixing someone as a being, I think.
SS: Yeah, I love your focus on, how do we show up? You’re talking about power, and how do we use our power and share our power in that interaction as well, because there’s always going to be a power differential. As physicians, we have a certain kind of positional power in society, and what does that look like at any given moment in whomever we’re interacting with? And I wonder if that transitions into the next question, but I sense that you are going to say something before we get into that next question.
CM: I promise to be quick about it. Simply a quick reference to Atul Gawande and his book, Being Mortal. And the beautiful, tender sharing about his dad’s process of having a tumor in his spine resected, if I recall correctly… But the sense that they saw one surgeon who was so person-centred, basically that it was like, “Well, here’s the menu, pick what you want.” And then they saw another surgeon who was much more attuned to what Atul’s dad was needing. And I think that this is a beautiful conceptualization of what humility is and reminds me of how often in downtown Toronto — and it’s certainly in my home visiting practice in little Portugal and Little Italy, and at the hospital in the neighborhood — where culturally, there are some families where there’s a very, very concerned and considered effort to not disclose diagnoses, specifically cancer like diagnoses to parents, because of the fear that it will lead to a depression and then they’ll die. And I learned over the years watching that those conversations unfold in horrifying and really skillful ways. And I think just thinking back to Atul Gawande and his dad, this idea that being culturally humble means that I don’t know what’s best. So yes, we have like clinical bioethics that tells us one way, but that’s actually very violent and very selfish, in a way, for me to say the patient needs to know, so I’m going to get the interpreter and we’re going to let mom know that she has cancer — that would be horrifying and not in service of the well-being of that person, particularly because people are parts of families chosen or biological or however it’s defined, but that when we meet someone, clinically, it’s easy for us to imagine that they’re the patient. So, I’m thinking in the OR and the person on the table, the reality is that they are part of a complicated constellation.
SS: I wanted to move into a little bit about something that’s very close to my heart, which is creativity and artistry in medicine. I’m a creative writer and a creative writing coach, and I know that you’re an artist and musician and a generally a creative person. You engage in poetry and harp playing, and you use this, I think, with your patients as well, if I’m not mistaken. And we would love to hear a little bit about — I think this is a two-pronged question. So first of all, just generally how your creativity and creative expression influence your work as a physician, as a medicine man. And also maybe about how you have found those things to be helpful in your psychotherapy practice, especially during the pandemic. And physician burnout has been a huge issue, I mean, pre-pandemic as well. So yeah, maybe a two-prong question around your creativity and artistry, and how it informs you personally, and then how you have found it helpful in treating your colleagues in your psychotherapy practice.
CM: I am so grateful that I ended up in medicine. I applied with the idea that if I was meant to be a doctor, I would get into medical school, but I really planned on being a school teacher. And so, I feel really grateful that I wasn’t coming into medicine because I felt like I had to be a doctor. It was more like I kind of followed the breadcrumbs. And so that’s made it easy for me to be like, “Okay, well maybe I’ll learn a new instrument,” or, “How about I write a poem about this.” And I think that’s been a fun way to actually keep my undergrad in English lit, and my teaching degree in music and English alive. I also just think that for me, trickster medicine is what I’d call it — even though tricksters are dangerous and they can be very helpful, but they can also lead us astray — I think trickster medicine has been really important for me along the way. And I think integrating creative play into my practice has been kind of a trickster move. So, the idea of getting to learn the harp and getting to bring it on home visits with me was kind of a trickster move. Especially because it felt too good to be true to be, to be like, I can actually play the harp and be a doctor at the same time? And it was really wonderful in that way of like, look, I can still play doctor and get my job done and perform a complete assessment per the schedule. And I can also sit down and play the harp for a bit, help the patient play the harp too if they want. And so it’s just been kind of fun. And so, I think that that can be very helpful. The two things — one is like gardening outside of the medicine patch or planter, and then also finding ways to subvert and be playful about it. So, by that I don’t mean cheat the system, but to find ways to make it energizing and delightful.
SS: Thank you, Chase. I love that it doesn’t have to be about picking up a pencil or picking up a musical instrument, but these micro-moments of creativity and thinking about how we can kind of stray away a little bit from that non-linear path that I think, again, is so embedded in medical culture. And so, hearing your journey and hearing some of your background, and how you’ve brought in the teaching part of you and the musician part of you and the writer part of you and the medicine man part of you has been just really, really an honour to listen to.
CM: Thank you so much. Can I share one quick quotation before we go? It’s a Rumi translation and it goes, “Be a lamp, or a lifeboat, or a ladder. Help someone’s soul heal. Walk out of your house like a shepherd.”
SS: Thank you so much for your time and your wisdom and sharing all of this with us. It’s been a pleasure. Thanks for listening, everybody.
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