A healing profession and a service to humanity

A healing profession and a service to humanity
Sudbury cardiologist Dr. Zulfikar Juma has this advice for the members of the Northern Ontario School of Medicine’s (NOSM) second graduating class and all other young physicians. Medicine, he says, is a healing profession and a service to mankind, not a ticket to make a lot of money.

“Society has become very secularized and very materialistic,” said Juma, an assistant professor at NOSM, “The emphasis seems to be too much on material things, and I feel that influence is also creeping into medicine. The focus has shifted from looking after patients to generating income. It’s not true for everyone, but this seems to be the trend in society generally.”

Juma decries assembly-line medicine as impersonal, unsatisfying and an affront to the Hippocratic oath.

“The opportunity we have for spending time with patients is a unique opportunity,” he said. “They have a problem and they’re coming to you. They put their trust in you. Patients who come to you and tell you what’s wrong with them need to be respected, and that means you have to give them time.

“We need to bring back the passion for medicine. We have to talk to our patients, look deep in their eyes and make a spiritual connection.”

Too often, said Juma, we look for quick fixes. “I don’t have to spend a lot of time getting a patient to change his lifestyle if I can write a prescription for Lipitor or Crestor to lower his cholesterol.”

Technology is another quick fix that keeps doctors from connecting with their patients.

“Instead of spending time with patients to find out what’s wrong with them, we send them for a cardiogram, a stress test or a nuclear study. We rely too much on technology to make a diagnosis,” he complained.

A patient complaining of chest pains or shortness of breath may simply be stressed out because she’s going through a divorce or having financial problems.

A physician can “miss the boat” if he or she doesn’t talk to the patient to find out why he’s having these symptoms.
Besides, “technology may not give you the answer because there are so many false positives and false negatives.

“We have patients coming to us all the time complaining of chest pains, especially women,” he said. “In your mind, you’re convinced that there’s nothing wrong with their heart, but to reassure the patient that everything’s fine, you send them for a stress test or a nuclear test and it comes back abnormal. Now, you have to take the next step and order an angiogram. You know in your mind that it’s going to be normal, but you have to put them through this series of tests and it’s expensive. We see this very often. Too much reliance on technology can mislead you.”

Physician burnout is a direct result of a lack of fulfillment, said Juma.

“I have been in practice for more than 25 years and one of the things I notice is that a lot of physicians experience burnout after 10 or 15 years, but I also know physicians who do enjoy what they’re doing and I ask myself, ‘What’s the difference?’

“My own perception is that when you’re dealing with patients and you are really attending to their needs, medicine is interesting and exciting. There’s a sense of fulfillment. But if your focus is anything other than enjoying time with your patients, then it becomes a numbers game and you get burned out.”

Juma was born in Kenya, studied medicine in England and completed his residency in cardiology at St. Michael’s Hospital and at Sunnybrook Health Sciences Centre in Toronto. He spent two years doing research at the University of Miami and returned to Canada in 1981 with the intention of pursuing an academic career.

He rejected an offer from the Ottawa Heart Institute to do pure research, concerned that it would deprive him from also doing clinical work, and decided instead to accept a position in Sudbury “for one year.”

Twenty-nine years later, Juma, now 63, is still going strong though he has cut back on his work at Sudbury Regional Hospital and now devotes his time to his private practice and his work at NOSM.

In 1981, he achieved acclaim for using the clot-busting drug, streptokinase, on a 17-year-old Laurentian University student who had a heart attack, and in 1984, introduced coronary angioplasty to Sudbury.

Juma was delighted to see a medical school established in Sudbury and happy to take advantage of the opportunity to finally pursue the academic career he dreamed about as a young cardiologist.

While he’s concerned about the drift away from patient-centred care, he has nothing but praise for his students at NOSM.
“I’m really impressed,” he said. “They’re not just bright, but they have a lot of compassion and love. That’s what makes for a good physician. I learn a lot more from them than I can teach them. I love their positiveness, energy and laughter.

You know, as you get older, you can get a little crabby, but the students keep you on your toes. That’s the interaction I love.

“They are here to learn and you can’t bullshit them. You have to know what you’re talking about and that makes me want to learn more, read more, go to meetings and conferences and stay in the forefront.”

In His Own Words

“The clinical encounter that clinicians have with their patients is indeed one of great privilege and trust.  It is, in fact, a very unique and spiritual encounter, a bond that allows physicians to explore deep into the recesses of the minds and bodies of their patients.”

“Nothing can be more damaging to patients and their illness than to have a clinician spend the briefest of time in the interest of expediency. Clinicians are expected to bear witness and receive their patients with the utmost humility.

Denying that opportunity is a breach of the fundamental Hippocratic oath we take at the time of graduation.”

“A clinician’s role is to continue to pursue knowledge as well as to discover new frontiers in medicine. A robust research program that includes medical student participation and exposure at a tender age, needs to flourish.”

“It is also important to remind ourselves that education is a privilege and is only given to some. Therefore, education should not necessarily lead to intellectual arrogance. The clinician’s focus in this highly materialistic world seems to have changed from being caregivers to expediency and a preoccupation with income. Personally, I believe that if physicians were to remain passionate about their profession, dispensing their duty to their patients, success both personal and financial would follow. What is even more rewarding is a greater sense of personal fulfillment and joy.”

“Technologies are now being used to provide a quick diagnosis and results. The downside is that these technologies are having a dehumanizing effect on our relationship with our patients, creating yet again a disconnect and reducing physicians to being mere technophiles.”

“The foundation of medicine in my humble opinion should be built on a good clinical approach.  To an astute physician who has learned the art well, the clinical approach should provide the correct diagnosis in at least 80 per cent of illnesses.

Technology is meant to help us in decision-making, provide quantitative information and guide therapy. After all, technology is only as good as the human brain that designed it…We need to humanize medicine and recapture the passion, thereby keeping more doctors interested and involved with their patients.”

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