Following a modestly successful career in training young physicians in family Medicine in an era when superspecialization was the solution to all the world's problems, I was offered the Headship of the Department of Family Medicine at University Hospital in Saskatoon, the site of the College of Medicine at the University of Saskatchewan. Generalists In a territory the size of Texas, with a population of 1000000 were desperately needed. The opportunity was too good to turn down and eventually led to becoming the Chair of the Department of Family Medicine and a full Professorship. When I was forty I had taken an academic position as Assistant Professor of Family Medicine which involved teaching undergraduate and postgraduate students and developing a residency training program in the newly built teaching hospital, The Plains Health Centre. It was with mixed feelings that I left the community based partnership that I had enjoyed for fourteen years. My partners were of a caliber I don’t seem to encounter very often nowadays. Hardworking, caring and rugged individualists. We all took our own night calls, did our own deliveries and made house calls. All without whining about how hard we were working and what facilities we could access for burnout!! (What was that, anyway?) We kept our post-partum patients in hospital for five days, because we knew that new mothers needed the rest and weren’t likely to get it at home. When a patient pressed for early release we would reluctantly let her go home on the fourth day and feel we were exposing her to stress.
In those days our heart attack patients stayed in hospital for several weeks and weren’t even allowed to get up to go to the bathroom for the first week. We would look after the elderly at home, making house calls as necessary to monitor their progress. Those were the days before the ‘Health Care Industry’, when being a physician was naively thought to be a noble profession.
I had only been in my new position a few days when my nurse knocked on my office door,.
“Dr. Smith, there are two Mounties here to see you, they say it’s personal,” she said apologetically.
“Oh, they’ve finally caught up with me,” I said laughingly, “show them in.”
Two young RCMP officers came into my office, looking a little uncomfortable.
“We’ve come to pick up your RCMP special constable pass, doctor,” the shorter of the two said, awkwardly.
“Oh, you mean you’re firing me?” I asked gravely.
“Oh, nothing like that, sir. It’s just that our headquarters are in Regina. I’m sure that if we have any medical needs in Saskatoon you’d be the first person we’d be contacting.”
I reluctantly handed over my RCMP Special Constable pass thinking of all the story-telling mileage I’d gotten out of it over the years. Little was I to know, however, that before long I was to be offered another position with the Justice System that would be more interesting, more lucrative and more dangerous than the one I had just given up.
Soon after we had moved to Saskatoon where the Medical School was, I was approached by an old friend of mine from my Regina days. Dr David Williams was a graduate of Cambridge University, who had come to Canada, possibly to escape two ex wives and two sets of kids who’s maintenance kept him permanently impoverished, to the extent that he found it difficult to maintain the lifestyle he preferred. That included wining, dining, skiing and travel. Fortunately his current lady was also a physician, who was well able to support herself. He was a very competent and busy family physician whose itinerant lifestyle was prompted more by personal preference than by any professional shortcomings. In any event, he ended up in Saskatoon as the Medical Director of a maximum security Corrections Canada Psychiatric Institution. (Prison!)
He sat in my office, “So how are you enjoying being the big boss at the Regional Psychiatric Centre?” I asked him.
“The job is actually quite interesting and pays well too!” he responded.
I interrupted, “How the heck did you get did you get a high level administrative job like that, you hadn’t had much administrative experience, had you?
“No, not formally, at any rate. As you know, I did a term as President of the Provincial Medical Association and did interact quite a bit with Health Care Politicians and bureaucrats, regarding various issues. Being fluent in French didn’t hurt either.”
“I wanted to talk to you about a couple of things, Stan. As you know, I’m the medical director of the Regional Psychiatric Centre. I’m quite enjoying the job but I have a couple of concerns. The first is that I don’t want to get so far out of medical practice that I can’t get back into it. I don’t want be an administrator for the rest of my life. I know that you have some community based physicians come in to the clinic and do some teaching, as well as farming out residents and students to community based practice. So, I’d like to offer my services to your department one day a week, doing anything that you feel would be useful in the department as long as it involves patient care. I have done some teaching in the past and had students do a month rotation in my office when i was in private practice. Actually, I got some pretty good evaluations from the students. So do you think there may be something I can contribute that will allow me to continue to have some exposure to patients on a weekly basis. Of course I don’t want any remuneration and any fees that I generate can go into the departmental slush fund or whatever.”
“I have no doubt that you would be a valuable asset to the department. If you can firmly commit to coming on a Monday, which is our problem day to get teachers to come into the unit, I can definitely facilitate you. You say you had a couple of issues you wanted to discuss, what else do you want to talk about?”
“We have a whole phalanx of psychiatrists at the Psych Centre, but we have as yet, no clear-cut mechanism for providing general medical care for the inmates. We wondered if the department of Family Medicine would provide that care.”
“That’s going to provide a considerable time commitment, Dave. There’s no way we could do it on a fee for service basis.” I said.
“We don’t expect you to do it on a fee for service basis.” He mentioned a figure that quickly removed any doubt in my mind as head of a university department with an unhealthy deficit. The Department needed the funds.
I looked impassively at Dave for a moment and wondered what all the wives and mistresses saw in him.
“I’ll have to discuss this with members of the department, but we’ll certainly give it serious consideration. I could see that it could have some very valuable advantages from a teaching point of view,” I said. I didn’t add that it would also have some very valuable advantages from a financial view for a teaching department that was having difficulty maintaining its mission while functioning in the black. Let me talk to the department and think about it for a day or two and I’ll get back to you.”
Experience had taught me never to say yes or no to any idea, no matter how good or bad it seemed at first blush, until one had a chance to think through all its implications.
My decision to follow such a policy had served me well over the years and avoided embarrassment on a number of occasions.
It didn’t take me long to convince Staff and Residents that providing the general medical care for the Regional Psychiatric Centre would be a valuable teaching service as well as providing the financial means to provide some much needed improvements within the Department.
And so it came to pass that Dave became a regular Monday afternoon teacher in the Department of Family Medicine and the Department of Family Medicine became the official care providers of the Regional Psychiatric Centre. We negotiated a start date a couple of months down the road and it took all of that time to get the necessary security clearance and complete the contract. Two of my departmental colleagues and I would alternate coming out to the centre on a weekly basis accompanied by a family medicine resident to hold a clinic and the physician or resident on call for the department would manage out of hours calls.
On January the second nineteen eighty-eight, I showed up at the RPC Saskatoon, federal maximum security institution of Corrections Canada and walked up to the perimeter fence.. This place was for males only - the really dangerous guys. The entire complex was protected by a double ten foot high fence broken only by a single entry point that served as a check point for anyone or anything entering or exiting the centre. Sensors secured the area between the two fences which were sufficiently sensitive to be triggered on occasion by birds or small animals.
The entrance was protected by a checkpoint that was an office with an outer and inner door between which was a security desk and a scanner of the variety which we have all become familiar with at every airport. The security doors were glass in their upper part so that any prospective entrant who rang the bell to gain entry could be observed and questioned as to the nature of their business. Once admission was considered appropriate the visitor was questioned regarding the nature of his business and prior to gaining admission to the institution proper was required to turn out his pockets and empty any briefcase or other baggage to avoid the possibility of anything being smuggled in or out or of being stolen by the inmates. After passing through the metal detector the metallic clunk of the lock being released on the inner door, allowed the visitor to begin the long walk across the courtyard to the building.