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General Internal Medicine

MGR featuring Chief Residents Dr. Natasha Ovtcharenko and Dr. Vincent Poon

Reem Alzafiri, MSc Candidate, Translational Medicine

At the medical ground rounds on November 28, the Department of Medicine had the pleasure of welcoming chief residents Dr. Ovtcharenko and Dr. Poon from the Internal Medicine program. The role of a chief resident focusses on leadership, advocating for fellow residents, and has a large administrative obligation within the program. The path that led the two doctors in becoming chief residents were very different. Dr. Ovtcharenko has a Bachelor of Science in political science and a concentration in human biology; global health. As a physician, her work in critical care is inspired from her passion of being able to experience different specialties. 

 

Dr. Poon’s background in basic science led to a career in medicine, specializing in oncology. His interest focusses on communicating bench-side science with clinical practice within the field of oncology as he believes it’s an exciting field that continues to grow and change through translational research. 

 

Dr. Ovtcharenko began the medical ground rounds with her talk introducing a very important and under-recognized historical event that continues to have repercussions today. She brought awareness to the Canadian tuberculosis epidemic where the segregation within the healthcare system, between Indigenous people and Caucasians, caused harmful treatment of indigenous people that lead to an increase in their mortality rates. The mistreatment of indigenous people was centered around racial bias and the development of Indian hospitals. 

 

Canada has a long history of colonialism that is rooted in the cultural genocide of Indigenous people, as stated by the Truth and Reconciliation Commission Report of 2015. Further marginalizing the community, from the 1930s to 1970s, the Indian Hospital system was formed in order to racially segregate federal healthcare institutions for Indigenous peoples. These hospitals were strategically selective when taking in indigenous patients. They only took in patients who had a high probability of being cured from tuberculosis, leaving the fatally ill to spread their disease in their home communities. This led to the public concern of “Indian diseases” creating the ‘racially careless’ stereotype of Indigenous people. This stereotype affected the way Indigenous people are seen in the medical community, how they are treated by physicians, and ultimately being isolated and feeling alone. Dr. Ovtcharenko touched on how the medical community can reconciliate with the indigenous community and how physicians today should continue to learn and expand their knowledge on these issues, as they are in the business of patient care. 

 

Following Dr. Ovtcharenko, Dr. Poon’s talk introduced a very interesting topic that focused on ordering tests for patients using a systemic approach where the implementation of care and its outcome is based on a feedback mechanism. When examining a patient, figuring out their diagnosis is based on the amount of testing done for the patient, whether it is standard tests or going the extra mile when the symptoms presented are complex. Dr. Poon brought to our attention that, as a resident, the amount of testing a physician conducts can have repercussions when facing the board if tests are not supported. This can cause a lot of stress as one must keep in mind whether the benefits outweigh the harm when considering different tests. 

 

Dr. Poon also introduced a new method of screening for colorectal cancer. Transitioning from the old test, the guaiac fecal occult blood test (gFOBT), the fecal immunochemical test (FIT) is a safer and painless stool-based test that checks for early signs of colorectal cancer or pre-cancerous lesions via the presence of occult blood within the stool. Research has shown that the FIT test is better at detecting colorectal cancer without having to worry about it mistaking other substances for human blood, making it a more valid screening approach.

 

In our post-round discussion, Dr. Ovtcharenko and Dr. Poon touched on their experience going through residency. They mentioned that there is a level of comfort in practicing independently that builds over time but sometimes imposter syndrome can kick in and you fear about making mistakes and having bad outcomes. However, in this specialty, you are always learning and there are always people who will help you. The most important thing to keep in mind is to be confident in yourself and your expertise among accepting that bad outcomes are inevitable. It’s how you act in the face of adversity that will steer your success in the future. 

 

On behalf of Queen’s University and the Translational Medicine graduate program, thank you Dr. Ovtcharenko and Dr. Poon for bringing awareness to important issues and sharing your academic experiences.  

 

Comments

Name
Spencer Finn

Tue, 12/03/2019 - 21:01

Great post Reem! You did a great job summarizing both talks. While listening to both Dr. Ovtcharenko's grand round and what she had to say during our discussion it got me thinking about the need of doctors on indigenous reserves. I was wondering if anyone has ever considered going down the path of going to a school like NOSM, which focuses on getting more doctors in remote areas, like some of the reserves in Northern Canada. Some would say that it is a big commitment to move out into those remote areas, but there definitely seems to be an extreme need for these doctors based on what we learned from Dr. Ovtcharenko.

Name
Spencer Finn

I was thinking something similar, Spencer! As you said, NOSM focuses on getting more doctors to remote areas, I am curious if others think that other medical training programs should focus on this area too? Perhaps making it mandatory during residency or medical school that one elective or placement be on a reserve, so every trainee has at least some experience in those areas.

Name
Madison MacKinnon

You bring up a great point about attracting more physicians to rural areas and Indigenous reserves to help improve the access and quality of health care in areas that may not receive it! I think a possible direction forward would be for medical schools to offer a return of service agreement (much like the one that the Canadian Forces offer) to allow future physicians to have a direction in which they can shape their career during their training years.

Name
Quentin Tsang

Name
Sophia Linton

Fri, 12/06/2019 - 12:02

Well summarized Reem!

I would be curious to hear the opinions of physicians. Do you tend to order more tests and cover all the bases, or do you selectively order fewer tests?

Name
Sophia Linton

Great summary Reem. We had a good post-round discussion with Drs. Ovtcharenko and Poon. One of the things that I believe is emphasized at various levels of training of physicians is the need to obtain a good history and perform a thorough physical examination. This critically informs the likely diagnosis, testing and subsequent management of patients. The level of training and experience of a physician plays a key role in informing the number and type of tests requested. As we heard from grand rounds ordering many tests does not necessarily mean one has covered all the bases, neither does ordering fewer tests show how prudent one is or vice versa. The main message I believe was that one should be able to give a plausible reason for requesting a test based on a patient's presentation. I would be curious to hear the opinions of physicians at various levels of training and experience as well, on the many factors that influence their decision making about tests.

Name
Edwin Ocran

Name
Daniel Rivera

Mon, 12/09/2019 - 09:49

I think both Dr. Ovtcharenko's and Dr. Poon's talks were very interesting, particularly that they challenges some of the day-day thinking that is regular/routine.

I think Dr. Ovtcharenko's did a wonderful job in having the audience reflect on the very important, but not-so-often thought of, roots of health disparities present in the indigenous population in Canada. I think she was able to convince others that when a patient presents with an illness at hospital practicing western medicine, it is beneficial to consider the unique needs of indigenous patients and in doing so and accommodating these requests, in rejection of paternalistic treatment, indigenous patient ownership of their healthcare and better experiences are supported.

Dr. Poon was also able to challenge the thinking amongst the audience and touch upon the roots of why physicians, particularly residents, may over-order tests. From wanting to avoid malpractice to trying to demonstrate thoroughness, various expensive tests may be ordered - but do these lead to better outcomes? I think Dr. Poon was also able to advocate for physicians to critically evaluate the decision process they are using in order to determine which tests are necessary.

Overall, two great talks that I think challenges regular routines and prompted some great reflection!

Name
Daniel Rivera

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