Leading by Example
Dr. Christopher Smith’s dedication to patient care engages trainees and colleagues alike
It was as a patient that Dr. Christopher Smith began to think seriously about the kind of physician he wanted to be.
He was in his final year of medical school in London, England and he just finished a three-month elective in India. Upon his return, he became feverish. Worried he may have malaria, he had tests performed at the London School of Tropical Medicine. When the results came back, he was admitted with giardia and post-streptococcal glomerulonephritis.
“It was fascinating — mostly younger patients with exotic illnesses and wild travel stories,” Dr. Smith remembers of his week-long stay. “However, what left a lasting impression was how little time as a patient you spend with the doctors, and how important the nursing and allied health staff are to your experience and recovery. The lack of communication from senior doctors that I experienced was striking. I had to get most of the information about my condition from the nurses. Since then, I have always tried to provide clear explanations to patients on diagnostic plans and treatments. I’ve also made communicating clearly and often with nursing staff a top priority.”
At the most recent meeting of Council in December, Dr. Smith was presented with a Council Award that recognized his talents as a communicator, and his expert leadership in medical practice and medical education.
Dr. Smith has been described as one of the most influential and respected clinicians and educators at Queen’s University. In fact, his colleagues describe his contributions as nothing less than transformational.
Prior to his arrival in 2008, the school’s Core Internal Medicine Residency Training Program had just received a notice of “Intent to Withdraw” during an accreditation visit by the Royal College of Physicians and Surgeons of Canada. Residents were overburdened, faculty members were fatigued and morale was at an all time low.
When Dr. Smith was brought on board as program director, he unified the faculty and re-engaged trainees. He developed a clear and organized curriculum. He advocated for resident wellness long before it was a term in common parlance. He engaged medical educators to improve the delivery of academic half days. The change was astounding and within three years of his arrival, the program was given full accreditation status and has become one of the most well-respected Internal Medicine residency training programs in the country.
As a testament to his hard work, passionate teaching and dedication, Dr. Smith received the PARO Clinical Teaching Award in 2010, and was nominated for the PARO Program Director of the Year Award and PARO Residency Program Excellence Award in 2011.
“His love for the practice of medicine and the rewards of great patient care allowed him to lead by example, and excite and engage trainees and senior colleagues alike,” said Dr. Stephen Archer, Department Head of Medicine at Queen’s University, and Program Medical Director for Kingston Health Sciences Centre.
Dr. Smith’s introduction to medicine was through Britain’s National Health Service. He received his medical degree in 1990 from University College & Middlesex School of Medicine in London. He stayed in that city to complete his rotations as House Officer and Senior House Officer. He was attracted, however, to the structure of North American training programs and he left shortly afterwards to complete his Internal Medicine Residency Training at the University of Illinois in Chicago.
His first faculty job was at Cook County Hospital, where he cut his teeth on complex patient care. If the name of that hospital sounds familiar, it’s because it is the inner-city hospital on which the television series ER was loosely based.
He worked at Cook County — now called Stroger Hospital — for 10 years. The vast majority of patients he saw were Black and Hispanic, and it was here that Dr. Smith was struck by the extent of racial and ethnic health disparities, and how health systems can fall desperately short in caring for their poorest patients.
While in Chicago, he met and married a fellow physician — a Canadian. In 2008, they made the decision to move their young family to southeastern Ontario to be closer to her parents.
At Queen’s University and Kingston Health Sciences Centre, Dr. Smith has built a solid reputation as a medical expert and is highly sought after as a diagnostician. His knowledge is both broad and deep. Since his arrival, he has assumed different leadership roles. Currently, he is the Deputy Head of the Department of Medicine (DOM) and chair of the Division of General Internal Medicine (GIM).
“Because he stands for excellence in clinical care and medical education, people want him at the table to help ensure that, whatever the problem, they benefit from Chris’ equanimous and principled wise counsel,” said Dr. Archer.
Dr. Smith has a unique ability to ensure more light than heat is generated as health care professionals debate and discuss the many complex and controversial clinical issues that arise at a busy hospital, said Dr. Archer. “It also helps that Dr. Smith has that rarest of communication skills — he is a good listener,” he added.
Dr. Lysa Boissé Lomax says she has been privileged to work with Dr. Smith at various stages of her career, including as his resident, junior attending staff and now as a colleague. She is now an associate professor at Queen’s University, jointly appointed to the Divisions of Neurology and Respirology.
“Dr. Smith is the first to get his hands dirty and commit to the hard work that is required to improve patient care and resident education,” she said. “He is the general who leads the charge, whether that is on the front-lines of COVID-19 care, teaching residents and medical students, or challenging the status quo to improve equity in health care and education.”
Dr. Smith’s leadership skills were never more in evidence than when the pandemic struck, said Dr. Boissé Lomax. He immediately established specific patient care units, and organized a safe pattern of patient flow within the Emergency Department and on Clinical Teaching Units. Moreover, he established alternative inpatient care areas in previously outpatient care hospitals. This allowed less critically ill patients to be safely moved off-site, making space for higher acuity patients with COVID-19 within the ICU and step-down units. And typical of his lead by example style, Dr. Smith was the first attending for the hospital’s dedicated COVID-19 unit. His achievements earned him a 2020 COVID-19 Outstanding Service Award from the Queen’s University Department of Medicine.
Below we talk to Dr. Smith. We also have a video of his remarks 🎥 when he accepted the award at the December meeting of Council at the end of the article.
Can you describe how your unique perspective — shaped by working inside three different health systems — informs your view of the state of medical practice today?
I grew up under the NHS in the UK and so health care as a universal right has always resonated with me. In the U.S., after residency training, I worked at Cook County Hospital in Chicago. It is a ‘safety net’ hospital, meaning we took care of poor and uninsured patients regardless of their ability to pay. This opened my eyes to health disparities in the U.S., but also exposed me to an amazing group of dedicated physicians. It also taught me how to advocate for patients in a system that does not have limitless resources. Coming to Canada was a positive move for me and our family. The provincial nature of Canadian health care still strikes me as an unusual and complex way to deliver healthcare. There are many things that are done well here, but, as we all know, the system is struggling now.
What does that struggle feel like to you?
It is getting harder to feel you are providing a good experience for people — patients, trainees, nursing and allied health. However, it is the people you work with that keeps you going and provides a reason to feel optimistic. Personnel is our most precious resource and we need to look out for each other.
Can you elaborate on your experience working at the Chicago hospital?
It was enlightening. As a white, European male, for the first and only time in my professional career, I was a minority in many situations — on the wards or in clinics, in meetings. I realized that casual words and statements can be hurtful to others if you fail to understand a person’s history or background. I came to understand that I had been given advantages in life that others had not. I learned that you had to work hard and be non-judgmental to earn someone’s trust and respect. It is not automatically given.
How have you changed as a doctor over the years?
I know that I try and listen more, and ‘do’ less as I have got older. That is hard for young attendings and residents. The urge is to act, but sometimes it is better to watch and think.
What kind of space do you want to cultivate for your learners?
A space where they feel comfortable asking questions, learning from each other and realizing they will never get everything right all the time. A sense of humour helps too. We need to have some fun when working because otherwise what we do and see is too hard.
What is your particular strength as a teacher?
A mentor of mine who was an outstanding clinical teacher told me he always tried to do four things teaching trainees. One was to ‘keep it simple’ — so trying to explain complex things in a way that’s easily understandable. Next was to ‘think out loud’ — explain your clinical reasoning to others by talking things through. A third was to listen — to patients, to learners, to the bedside nurse, etc. And finally, to be kind. I have never forgotten those things and I still remind myself every time before I start on inpatient service.
What would be your number one rule for reducing clinical errors?
Be prepared to change your mind.
You are noted for your calm and reasoned demeanour. With the emergence of COVID, that kind of leadership must have been deeply appreciated.
I may appear calm and reasoned on the outside, even if I do not feel that way on the inside. With COVID, I don’t know why, but I wasn’t frightened. I just felt this is what we are trained to do — respond in a crisis, not walk away or hide. I volunteered at the beginning to be on the COVID unit and I think if your leaders are prepared to do that work, then others will follow. I am very proud of how our institution and the Department of Medicine at Queen’s responded to the crisis. We continue to staff very busy wards and large numbers of admissions. My colleagues in the GIM Division and the DOM have voluntarily staffed a backup schedule for almost three years. When needed, residents and staff have consistently provided emergency coverage.
If there was one lesson from the experience of COVID that you hope is never forgotten, what would that be?
How we looked out for each other. That is certainly true in my Division (GIM), where we regard each other as our ‘work family.’ We could not have got through this without mutual support for our colleagues. This has to be a priority for all of us in health care going forward.
How do you like to spend your time away from work?
In Kingston, we are lucky to be close to nature. The lake and great trails and parks are all close. Spending time outside has always been relaxing for me. I also like to cook, and watch football (soccer to Canadians) and television shows that are not set in a hospital.
Not even ER reruns?
(Laughs). I watched ER obsessively when it first aired. But no, I see enough medical drama during the day. No need to watch it when I am trying to relax.
Video from Council
CPSO Council presented the Council Award to Dr. Christopher Smith, a Kingston-based general internist, at its meeting on December 9, 2022.
Wow, thank you very much. I was really not expecting all of that, and it’s always a little humbling to hear other people talk about you, but thank you very much to the CPSO and obviously to the people who nominated me.
So, you know, you heard quite a lot about me. I really think the recognition for this award probably came out of the time COVID, when everything was turned upside down at the hospital, and for all of us working in health care. It’s been a very challenging and transformative time. But the biggest thing I’ve learned, I think, from that time is that we have to be flexible, and we have to be adaptable, and I think it’s been one of the privileges of my professional life to be able to lead a group of physicians, and nurses, and allied healthcare people, working with administration, to be able to enact change when it was really need it. And when I look back at that time, and how we coordinated with the emergency department, the ICUs and the medicine wards to make things work, it does make me very proud. And, you know, we all know you can’t make changes like that in isolation. You have to work with a team of people. And so, I just want to thank all my colleagues who’ve been able to make that work during that time.
I’d particularly like to highlight the work of people in the Department of Medicine and in my division of General Internal Medicine, because they’ve worked tirelessly over the last few years with increasing workloads during the pandemic, and continuing workloads and continuing backup schedules, and being able to do that with good grace, good humour, and dedication and passion for health care has been — It’s been wonderful to lead a group like that. And as we heard earlier, morale is challenging at the moment, but the morale with that group of people has been good, and it’s because we help each other, and that’s been the most important thing. I’d like to thank my colleagues who nominated me. You heard from Dr. Lomax, who was one of my residence years ago, and it’s lovely to see people you’ve taught become leaders themselves and gifted educators. And also from Dr. Archer, who’s the Chair of the Department of Medicine at Queen’s [University], who himself has been a transformative leader, and built a vibrant and collegial department, and been a mentor and friend to me during that time.
I’ve loved being part of medical education and one of my mentors many years ago told me four things that I still think about every time I teach residents and students, and one is to listen — it’s really important to listen carefully to what people want to say. The other was to try and keep things simple. We deal in complex systems all the time, but trying to make things understandable and simple for people to think out loud with your clinical reasoning has always been an important thing for me to transmit to others. And finally, which I think is probably the most important, was be kind — be kind to each other, be kind to your colleagues, be kind to your students — it’s really important.
I’ve been fortunate to live and work in three different countries as you heard. I’m very grateful to Canada because this is a great place to work, despite the challenges in the system at the moment. It’s a wonderful country to live and work in. And the most important person here that’s allowed that to happen really is my wife, Elaine, who herself is a physician, and we were jointly recruited to Kingston in 2008. They really wanted her, I think, rather than me. [audience laughter] So, I was lucky to — I got the job of trying to fix a training program that was in trouble at the time, but it’s been a good move for both of us. Thank you, Elaine, for your support throughout my professional career, and, of course, raising our children and family here together. And finally, I’d just like to thank the CPSO again for everything. This means a lot to me, but it really is on behalf of all my colleagues back home. So, thanks very much. [applause]