Sometimes when I am stressed out about my long to-do list, I take a step back and realize that most of these things I worry about actually are not all that important in the grand scheme of things. Ultimately, our health and our loved ones are what’s really important.
Mathieu Walker, Montreal, 49-year-old, block C leader since 2006 when he started as both a staff cardiologist and teacher in the McGill Faculty of Medicine
Describe yourself in one sentence
The way I thought about it is “what are my roles?”. I am a father; I have four children. I am a husband and I wouldn’t be who I am today without my wife. Obviously, I’m a cardiologist and a physician. I’m a teacher, as you know - at least part-time but, in fact, most of the time, there is someone that we are teaching, whether that would be our students, our patients and my children. I like to think of myself as a good friend to some of my buddies and I have kept friendships from high school that are still around today.
Tell us about your journey from medical school to block leader at McGill.
Back then I didn't know what I was going to do - I had no idea. I ended up doing a Bachelor of Arts (BA) in Psychology at McGill. The thought was maybe law school, but honestly, I wasn’t too sure. During that time, I had the opportunity to work with cool researchers in neuroendocrinology at the Douglas Hospital. That’s where I got the bug for medicine and health sciences.
I ended up going to McGill medical school from 1995 to 1999. I sat in the same amphitheatres and same small group rooms that you [the students] did, even went to the same labs and had a very similar experience. Back then, it was a different set up where you learned all the normal [portions of medicine] for many months, and only at the last unit, you did pathology and learned about disease from pathologists - and not clinicians. I always remembered Unit 2, which was heart, lung and kidneys, as a block that obviously interested me.
It was clear that internal medicine was what interested me the most. I wasn’t sure which field [of internal medicine] I was interested in - it was not like I was gung-ho about cardiology at that time. Honestly, I was just thrilled to be a medical resident, and was thrilled to have gotten into internal medicine. I just always loved what I was doing and was very enthusiastic.
In Internal medicine, I had the opportunity for some leadership roles as a chief resident. As part of that role, we had to do a lot of teaching, and I just really enjoyed it. I wasn’t the recipient of any medals of academic valour during med school but I did find some success with teaching others. I have always been somewhat of a linear thinker and for me to truly understand a concept, I really need to bring it down to its basic level and then build it up. This has served me well over the years. Sometimes when you have these crazy talented researchers as profs, they are working at another level that is beyond that of us mere mortals. Sometimes their genius doesn’t translate well to teaching novice learners.. I discovered that I had success in teaching basic stuff, so while other people may have been better at memorizing the numbers needed to treat of the latest cardiology randomized controlled trial, numbers were never my game. I was more about, why don’t we just talk about the basic physiology, and people seemed to want to hear that.
I quickly learned during Internal Medicine that Cardiology was my place. As you do residency, you have different exposures, and ultimately discover where you belong. [...] I liked the patients, I liked the presenting problems, I liked the fact that we have solutions, I liked the fact that there were so many different aspects where you use all your senses - listening to murmurs is so cool, predicting what someone had just by touching their chest, palpating their precordium and listening to their heart, feeling their pulses, watching their neck veins - that really excited me. The fact that the patients tended to get better, and were smiling when they left the hospital, for me, was really good. And I had some really cool mentors and people that I looked up to when I was training.
So I went into Cardiology, and during it again I was offered more leadership roles. I got to be chief resident in Cardiology, and once again I had to teach. I was recruited to be a small group leader. I ended up being a tutor for small groups going over the same cases I had when I was a student. These small group problems were kind of totally out there, completely unrealistic, and in desperate need of an update. So I had an opportunity to rewrite some of the small groups and that was a key experience with what was to come later.
I went on to finish Cardiology, and went on to do some echo training at the Montreal Heart Institute just before starting at St. Mary’s Hospital as staff. Near the end of my fellowship, I got a call from the Associate Dean of Undergraduate Education, Dr. Joyce Pickering (the equivalent of Dr. Chalk now) who asked me if I would like to meet her to discuss a job opportunity. At the time, I was convinced that she was going to ask me to become involved as the Cardiology leader for the 3 weeks of [cardiology in] Unit 2. Unit 2 was a large (9 week) block that was run by Dr. Unikowsky at the time, and each block had 3 sub-leaders. When I went to meet her at the McIntyre for the interview, I gradually realized that she was asking me to take over the entire [Unit 2]. For me, it was a big thing since I hadn’t even started as a staff at that point, which was probably good because my schedule was fairly open. It was quite an honour, and a bit of a scary proposition for a new guy to be coming on as a block leader who had not even completed their training. But I went for it and it was a lot of fun and I haven’t looked back since. For a while, I ran the whole block (heart, lung and kidneys) until the reorganization of the curriculum and the unit was broken up into organ-specific blocks. And that was when Block C was born. That was a huge year, a lot of anxiety that year since we had to recreate a new course from scratch by deciding what was “in” and what was “out” from the old course.
When I am not teaching, I’m at St. Mary’s Hospital, a small academic community hospital. Why do I continue on as Block leader after 15 years? One of the major reasons has been because of feedback from the students. It seems to be making a difference, and the block stands out and people remember it. Although I might not get to meet a student in-person or have a conversation, I feel like I have a link with the students. When I am walking through the hospital and I meet a student wearing a short coat, and they all look at me a little weird and yell out “It’s Dr. Walker!”, I kind of get a kick out of that. But I always on the look out for the next block leader to come along who would take this job on. Not as a task or as them being forced to do so, but rather a person who sees it as an opportunity. Because it has given a lot back to me. Despite my non-aspirations, I have kind of moved up a little bit in the academic ladder - I’m an associate professor. You get an opportunity to get some teaching awards and it looks really great on your CV for those who really are interested in moving up the academic ladder.
What has been your most impactful or memorable experience since starting to teach in medical school?
I have had a lot of experiences and a lot of wonderful memories. I guess for me, the Osler Award that I got in 2011 came out of nowhere - I just wasn’t expecting that at all. Obviously, it was very very special to me. I have my little wall of certificates, and that particular certificate is in a special place. It carries a lot of importance in my heart, mostly because it was actually students themselves who nominated me for that. At the time, I actually got to go to the grad ceremony, the social part of it, and then be at the official ceremony with the hat and gown, and I got to address the class. Obviously, that was the most memorable in terms of special moments in my teaching career. I’ve had no other award that meant as much as that particular one.
Sometimes students - especially students that are more junior - they’re coming from a situation where a teacher does that [teaching role] 100% of the time. And when they’re not teaching you, they’re preparing their course, they’re reading up on things, etc. Whereas here, we are practicing clinicians. We have full-time jobs and we’re preparing our courses at night or after-hours. We don’t have all of this reserved time. It's a big sacrifice in terms of time and it's a lot of stress, and it’s a financial hit as well since you don’t get paid very much for teaching. Certainly, the positive feedback is what keeps us going, that’s worth its weight in gold. What was particularly special about that particular award was that it just came out of nowhere - I wasn't expecting it at all. I had been five years into it, all people who had won it before were people that I massively looked up to - great, great, great teachers - and I didn’t feel like I belonged there. But anyway I was really appreciative of it, and I guess it was the fact that I didn’t expect it that made it special.
What is something little known about you?
Well honestly I don’t even know what people know about me. I was trying to ask my wife, what is something little known about me… I was thinking when patients come and see me, they notice that I’m left-handed. For me it really means nothing, but for some people somehow that means something.
I love alternative and electronic music. I used to play electric bass in a band when I was at your level, but that’s old school stuff.
I took a trip around the world before medical school. I took 5 months off and travelled the world with my friends which was one of the most memorable experiences I ever had. I just had to come back for med school interviews. So that was an exciting trip through Africa through the Sahara desert, Trans-Siberian Express to Asia. 17 Countries in all – an unforgettable experience.
What is one experience that you have had that you feel others can learn from?
I thought of my world trip, although I feel bad because it’s a little bit difficult to tell people to do a world trip right now. In fact, many of the the places I went to, I would not recommend going to now in terms of security concerns.
We get all very focused on our career and the next step, and where we’re going next, and sometimes, especially in medicine, once you are on this train, it’s hard to think of getting off even for just a stop, and getting back on the train. You’re kind of discouraged to interrupt your training . For me, I had that opportunity to take a whole year off on purpose. Five months away is a long time to be traveling with a backpack. I was in parts of the world where you’re not caring so much about your device (we didn’t have cell phones back then!) or emails and all this data that’s continuously coming in, interrupting your stream of thought. It’s an exciting experience having nothing to think of except for your next meal or digging your truck out of a ditch, and just very basic stuff.
In Africa, the pace of life seemed slower. Here, we’re so driven, we’re always doing something, always having a to do list. I am in that now, I mean it's hard to get out of that. When you’ve lived that pace of life a little bit, you realize sometimes that maybe our priorities need to be adjusted. I think some people have learned this with the pandemic. They had a chance to be home, and work a little less hard, and I think there’s going to be a major societal change. People aren’t going to be working all these hours per week. And they may make a little less money, maybe their house won’t be quite as big or their car as fast, but they’ll be happier. Sometimes when I am stressed out about my long to do list, I take a step back and realize that most of these things I worry about actually are not all that important in the grand scheme of things. Ultimately, our health and our loved ones are what’s really important.
In terms of more practical advice, I mentioned training at the Heart Institute. And although that’s not very far away, it was a different world with people I didn't know. If you have an opportunity in your training to actually go somewhere else, it’s going to pay you dividends and it’s going to be a good investment moving forward. Yes, you are out of your comfort zone, but that’s the whole point. You’ll see that the same patient will be treated in a bit of a different way, and just seeing a different approach to things, it’s very useful. If you’re in the same place all the time and you see things done in the same way, you’ll just think that’s the only way. And you only realize that that's not the way things are done by seeing and working with others. And working in a different center, maybe in a different city, will bring you back a lot of learning and wisdom.
What is something you wish you knew before entering medical school that you would like to tell students?
When you’re a student, you kind of think you have 4 years to learn all of medicine, and then you have your exam, and then you are all set to be practicing medicine. But you’re going to learn a lot of stuff, and you are going to forget a lot of the stuff you learned in medical school. You’re going to retain those things that you really need to retain. Sometimes I meet some students and I ask them about the Wiggers diagram and they don’t remember and it’s okay, I’ve gotten over it. Things get displaced and we don't expect people to remember all this stuff.
The point is that you’re going to do most of the learning after you graduate, after medical school. You do a lot of learning in residency. You do a lot of learning when you’re put on the spot and put in an uncomfortable situations. More and more, students want to be supervised and supported, and that’s all great and I totally agree with that, I am not advocating for people to be just left to their own devices. But I think sometimes we may be over-supervising. We have to let our students have a chance to be in a situation to be actually making their own decisions.
I will give you a little anecdote. One of the reasons why I am here at St. Mary’s is, as a med student, I was assigned to St. Mary’s hospital as a pre-clerk in a course that was the equivalent of TCP, and I was assigned to this cardiologist called Dr. Ozen (turns out later, she hired me). I got to work there, had a wonderful time, and I really liked this place. Then, I came back for clerkship and I was assigned to St. Mary's and my staff was Dr. Ozen again and Dr. McConnell, who happened to be the chief of medicine. I finished my clerkship and they said: “Walker, we really liked you, you had a good rotation, and we would really like to have you back at St. Mary’s one day. If you ever need a job, you should come and look us up.” I really loved my experience, it was fantastic. I had the best clerkship ever. I had a really great group of students; we had a great time. I was like “you know what, I think I want to be at St. Mary’s”, and I think it’s because of those experiences.
What I was getting at was, during our clerkship, we had to do overnight calls. It no longer exists for a variety of reasons. I think it’s a little bit too bad that you don’t have it anymore. For me, it was during those calls that I really learned a lot about how to approach a sick patient. They would call and say: “we’ve got a patient here at 5 south, he’s satting at 85%” and you were woken up out of your sleep and you would be the one to have to see the patient and assess the patient who is desatting. You have to examine your patients, figure out what the diagnosis is, order some tests and the resident would sign and back you up. You were approaching that patient. You could call someone, but the expectation was you would start by assessing the patient, examine the patient, and provide your opinion about it. I learned and memorized how to approach a patient with pulmonary edema, but then when it actually came to it, I couldn’t necessarily apply that knowledge. So the next morning, I would tell my staff “what do I do? What do I do if I have this guy?” and it was LMNOP - morphine, Lasix, nitrates, oxygen, positioning the bed, and then get a chest x-ray, do a blood gas. And the next night I was on-call, I got it, and I reviewed with my staff and resident and it was like “yeah, that’s exactly it”. You learn a lot from being put on the spot. Sometimes, you have to be in a bit of an uncomfortable position for this stuff to actually enter your brain.
But the point was, don’t worry too much about trying to learn everything. Obviously, you have to pass your exams, but most of the learning you’re going to have is later and I’m still learning a lot today. My patients teach me, I learn a lot from my patients and it’s a lifelong experience. 4 years is just a drop in the bucket. You’ve got many many years to learn, forget, relearn, forget, relearn, and maybe not forget some stuff and teach it to others.
How can medical students now pursue more independence?
I think [not having night calls] is too bad. Right now, you can't say “I'm gonna do a night call”. You’re not allowed, you’re not insured for that. You can't have that same experience. So, you have to recreate that experience within the structure of our current curriculum. Try not to look up all the answers that people have provided. Try to go see the patient and not necessarily look at all the notes beforehand. Try to do the history for yourself, try to gather the information for yourself and try to come up with a diagnosis yourself. Sometimes, students take a side paper and write impressions and commit to "this is what I would recommend". You might be wrong and your staff might say “no, you got it wrong, number 3 is actually number 1, doing that test is actually dangerous”, but if you don’t commit, if you don’t put yourself out there, you’re not going to learn. And then when you become staff, you’re going to need to start from scratch, and you might not have that support or that backup available, and it’s just more uncomfortable.
Something that some students do is shadowing. Sometimes, that can be a nice experience to get a little of a taste of how things are. That’s not necessarily for learning an approach to problems, but it can sometimes at least guide you if you’re having doubts about where you fit in and which specialties to do.
More and more, we see students and residents not take ownership over their patients. It’s like “yes, this is my patient between 9am and 5pm and at 5pm, I’m gone because my contract says so.” Somehow, that patient is no longer your patient. That’s not the way medicine works. If you want to become the best doctor for your patients, you gotta make your patient feel like you’re their doctor. You can do that as a student. Sometimes, students feel like “oh I’m just a student and I’m there to do the scut work”. You have an opportunity as a student. You might have a little more time - you don’t have 20 patients. Get to know your patients, help them out, be caring, listen to them and be an advocate for them. That means a lot to patients and they will really appreciate you as a med student. You’re going to be the doctor. These patients are not just there to teach us, they’re people going through a hard time. They’ll really appreciate it if you listen to them and truly care for them as human beings.
One thing I’m known for and I’m proud of is that I explain things to patients just like how I explain things in class. This week, a student was like “you gave that patient a whole lecture on AFib'' and I’m like, “yeah, I did”. You'd be surprised how little patients know about their medical problems. You ask them, “what’s your medical problem”, and if you don’t look things up, they say, “oh maybe a blood pressure problem and maybe a heart problem”. And you look at their med list and it’s anticoagulants, statins, this and that. And often, what happens when people are not compliant is that they don't really trust you, they don’t necessarily believe what you’re saying. But if you take the time to explain things - it doesn’t have to be an hour long, just a few minutes - just to explain what you’re doing everyday for the patient in the hospital. They’re lost, people are continuously coming in, bells are ringing, they’re sleeping poorly, they're a little bit
confused, and they're scared. Take a few minutes just to say, “Mr Smith, you’re here for this, today’s plan is this, that and that. And what we’re looking for is this, and as soon as we reach that, you’re gonna be going home.” It really helps anchor them, they breathe a sigh of relief and they just really appreciate that. So, take the time to explain things, you’d be surprised how little your patients understand. Even sometimes after explaining, they still don’t understand and you have to reiterate. Sometimes, I’ll ask patients what is your understanding of what’s going on and sometimes you’d be surprised what the answer is.
If you had a superpower, what would it be?
I’d take any superpower. I’d love super hearing so I could hear every murmur, even the 0.5/6. That’d be awesome. I would love super speed so I could get through my day and not get home so late. Anything that would improve my senses would be fantastic. Unfortunately, that’s not possible and I’m stuck with what I’ve got. I’m not one to always wish for something that is not possible, and I’m more practical and say “that’s not gonna happen” and I have to live with what I’ve got. My hearing is not as good as it was when I was your age - I’m still working on listening to those 0.5/6 murmurs. Maybe I will hear them next year, but I’m 49 after all.
If you had a magic wand with one wish to change this world, what would you wish for?
Honestly right now, I could just wish for COVID-19 to go away. There are a lot of things we would want. If the wand was super powerful, obviously we would want world peace and cure world hunger, and do all these wonderful things. But just practically speaking, this whole COVID-19 thing has been a disaster and we’re having to learn to live with it, and it may be endemic and we may never get over it entirely. And that’s sad. We’ve seen what life was before and I guess we learned to appreciate certain things we took for granted. But I could’ve done without it. If my wand was looking for major world fixes, that one is a pretty big ask, but that would be wish #1. I wish to go back to what we were before. I’m being a bit selfish, but really it’s been tough with that for everybody: my kids, my family, my parents, all of us, every one of us. It’s just been negative throughout and crappy. It seems possible to make this thing go away, so that’s why I’m adding my little magic wand into the mix to help a little bit.
Thank you again to Dr Walker for this great interview and we hope you have learned more about your Block C leader.
Note: The above is a direct transcript from a live interview with Dr Mathieu Walker conducted by the Resonance Humans team.