Episode Notes

Dr. Kevin Mailo welcomes Past President of the Canadian Medical Association (CMA), Dr. Katharine Smart, to the podcast. Dr. Smart shares how leadership roles can enhance the success of wellbeing within our careers. 

Dr. Smart details how the child health program she spearheaded in the Yukon came to be, and explains how wellbeing for patients and physicians alike is balanced in her program. She carries a lot of passion for the work and is a passionate person by nature. This passion helped Dr. Smart when she became the President of the CMA just as the pandemic was getting extremely difficult. Her authenticity is what she carried into that role, and as she advocated for colleagues she worked to state clear facts and distill where things were truly at.

In this episode, Dr. Kevin Mailo and guest Dr. Katharine Smart really dive into what wellness looks like for physicians in the dark time healthcare is currently experiencing. Dr. Smart believes that having a voice and connection to work through leadership opportunities is a vital part of avoiding burnout. She explains the variety of ways leadership can take shape. She also addresses releasing the fear of failure to realize that what we call ‘failure’ is really a necessary part of growth. Drs. Kevin Mailo and Katharine Smart have an enlightening conversation about burnout, mentorship, and the power of letting go of perfectionism in this must-hear episode.

About Dr. Katharine Smart:

Dr. Katharine Smart is a pediatrician in Whitehorse, Yukon and Past President of the CMA. Her work is centred on developing collaborative partnerships with community and government services to serve marginalized children using a model of social pediatrics. She works primarily with children who have experienced trauma and adverse childhood events, and she witnesses the broad and lasting impact these events have on children and their development daily. She is passionate about improving services for marginalized children in an effort to change their life trajectory.

In addition to her community-based work, Dr. Smart enjoys acute care and provides on-call services to the hospital. Before moving to the Yukon, she was a pediatric emergency medicine physician at the Alberta Children’s Hospital in Calgary. Dr. Smart is the past president of the Yukon Medical Association.

Resources discussed in this episode:

• Canadian Medical Assocation (CMA)

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Physician Empowerment: website | facebook | linkedin

Dr. Katharine Smart, Pediatrician and Past President of CMA: website | instagram | twitter

Transcript

Kevin Mailo: [00:00:00] Hi, I'm Dr. Kevin Mailo, and you're listening to the Physician Empowerment Podcast. At Physician Empowerment we're focused on transforming the lives of Canadian physicians through education in finance, practice transformation, wellness and leadership. After you've listened to today's episode, I encourage you to visit us at PhysEmpowerment.ca. That's P H Y S empowerment dot ca to learn more about the many resources we have to help you make that change in your own life, practice and personal finances. Now onto today's episode.

Kevin Mailo: [00:00:35] Hi there. I'm Dr. Kevin Mailo, one of the hosts of the Physician Empowerment Podcast. And today I am extremely, extremely excited to introduce everyone to Dr. Katharine Smart. And Dr. Smart is the past president of the Canadian Medical Association, and her term is recently expired as president of the Canadian Medical Association. She is kind of a super doctor. She is a pediatrician based in the Yukon with a practice centered on the emergency department, as well as community based clinic. And I'm honored and excited to be joined today by Katharine. Katharine, why don't you tell us a little bit about yourself and your work.

Dr. Katharine Smart: [00:01:17] Sure. Thanks, Kevin. Excited to be here as well. And thank you for all your work. So, yeah, I've been in pediatrics now for over 20 years. I started my career as a pediatric emergency medicine physician at the Alberta Children's Hospital in Calgary, but I've always done work in northern Canada, time in northern Manitoba, I had the opportunity to work in Nunavut as a pediatric resident, so I've always had a passion for rural and remote medicine as well. And an interest in First Nations health and Indigenous health. So I had the opportunity to move to the Yukon five years ago to create a child health program there. At that point in time, they had an amazing group of six pediatricians who were coming up twice a year for four days a month and providing services to kids in the territory. But as you can imagine, four days a month of pediatric coverage, no call coverage, nothing to support acute care was probably not really enough. And and in talking with those colleagues, they definitely saw the role for for more supports for children. So I moved there with my husband, who's an orthopedic surgeon, and the two of us built two new programs, me in pediatrics in him and orthopedic surgery. And that's what I've been doing clinically for the last five years. So now we've got four pediatricians, child psychiatrist, a social worker, a neonatal and pediatric medevac program, outreach to all our Indigenous communities, lots of partnerships with schools, mental health and our First Nations communities. And I'm really proud of our program and the work that we do to serve kids and families in the Territory.

Kevin Mailo: [00:02:40] That sounds absolutely outstanding. Now, I'll always just kind of pitch, but are you guys recruiting?

Dr. Katharine Smart: [00:02:46] Not currently. We're actually fully, fully staffed at the moment. Yeah, I think it's a testament to our program.

Kevin Mailo: [00:02:53] I would absolutely agree.

Dr. Katharine Smart: [00:02:54] Yeah.

Kevin Mailo: [00:02:55] I would absolutely agree.

Dr. Katharine Smart: [00:02:57] So, you know, Kevin, I know one of your passions is wellness. And when we designed the program and just the way we operate our clinic, that was one of the foundational principles for me. And I think one of the advantages of creating a program we've already been working for a long time is you kind of see the pitfalls. So I thought a lot about that and the way we structured the way we work. And we work as a team, the four of us, we support each other. The person who's on covers all the patients, they cover the inbox, the EMR, any emergency.

Kevin Mailo: [00:03:24] So when you're off, you're actually off.

Dr. Katharine Smart: [00:03:26] You're off. Yeah. And we still schedule in such a way that there's a lot of continuity. You know, most patients are follow ups. It'll be the same pediatrician, but they're always covered. So if something comes up, something's unexpected. There's no holes in care. But exactly for us workers, when we're off, we're off. And we have that total confidence in our colleagues, they're covering. So that structure, I think, has made it quite desirable. Another...

Kevin Mailo: [00:03:49] Isn't that amazing. It's rare. It's rarer than it should be.

Dr. Katharine Smart: [00:03:53] The other key piece I think to our success is, you know, I knew that we'd be dealing with a variety of challenges and a lot of our patients have a lot of social challenges. So I was able to negotiate with the government an alternative payment model. So we get paid a combination of a daily rate plus fee for service for after hours coverage. So I think we're well remunerated. It covers our time. It allows us to work in different ways, right, being very patient centered.

Kevin Mailo: [00:04:20] Creative. If it needs a phone call...

Dr. Katharine Smart: [00:04:22] It needs a phone call, a video call, an email, doesn't matter, right? Because we're just being paid to look after patients. And we do it in the right way that works for patients.

Kevin Mailo: [00:04:30] What a great example of how when the economics of health care align with well being and best patient outcomes. Isn't that wonderful? I love it. It's so important.

Dr. Katharine Smart: [00:04:39] Yeah, it's so important and it's made it possible for us to recruit and retain, but it's also made us desirable for locums because they know they're coming into a well run clinic.

Kevin Mailo: [00:04:47] Oh yeah.

Dr. Katharine Smart: [00:04:48] With a clear plan, clear ways things are covered. They're going to be well paid for their time. So it, and like you said, the win of that is now it's sustainable. We have great people. We're all aligned. We know what we're doing. We know our purpose and those things have come together. And that really links to me to one of my principles, which is I think solutions have to work for patients and physicians. And when they do, that's when you get the best wins. And I think our program is an example of that.

Kevin Mailo: [00:05:11] I absolutely love it. Let's talk briefly about your work as president of the Canadian Medical Association, because what really caught my attention was listening to you speak so boldly and courageously about the crisis facing our health care system. And I think we're all feeling that. I know we certainly get word through Physician Empowerment about physicians coast to coast struggling to deliver care under a health care system that's, frankly, under-resourced. So first off, I want to sincerely thank you for that advocacy because, you know, it's there, but we need to start talking about it. And you have done such a powerful job. And I would encourage anybody to look up Katharine's media interviews at CBC and some of the others that have been just remarkable in terms of crystallizing some of the issues that we're faced with. Do you want to just talk a little bit about that briefly, because the crisis isn't about to go away. We always try to create evergreen content, know things that are going to be relevant ten years from now. I worry this podcast is going to be just as relevant in ten years. If I can be blunt. So tell us about what's going on in Canadian health care.

Dr. Katharine Smart: [00:06:14] Yeah, for sure. I worry about that too, Kevin, and thank you for your kind words. Yeah, it was a really interesting journey into this role and it's quite a long landing kind of launchpad into becoming the CMA president. You know, there's the election, it's few years before then, you're the election year present, etc. So, you know, when I put my name in for this, it was pre-pandemic, when I found out I won the election, it was just like the month before the pandemic was declared. And then I came into the role of president-elect sort of a few months into the pandemic and then became the actual president kind of a year into the pandemic when things were really starting to get difficult, I think we were starting to see a lot of less social cohesiveness around how we were approaching the pandemic. There was, you know, vaccines were out, vaccine passports that was controversial, mandatory vaccines for health care workers. We were starting to see that narrative shift from health care as heroes to a lot more harassment and intimidation of health care workers, protesters outside a hospital. So things were really heating up. And of course, at that point, we were deep into the ICU crises with hospitals being overwhelmed, people not being able to receive care. And it was a really tense time. So I would say that the role I ended up being in was certainly not what I thought I was going to be doing when I when I took this on. But I felt an immense sense of privilege to be able to speak for my colleagues, because what I would say is, you know, whenever as a physician, I felt so proud of my colleagues because of the tremendous work they've done over these past two years. I mean, always people are doing tremendous work, but people have really had to rise to this challenge in a way that we haven't seen. And to be the person out there representing this profession to the public and publicly, I took that very seriously. And it's really meaningful for me to hear feedback from colleagues who felt that I did it justice. And that was my goal. And my personality is, I'm a straight shooter. If you ask my opinion, you're going to get it. I'm not always right, but I'm going to tell you what I think. And I tried to carry that authenticity into my role as CMA president because I felt my job was to state the facts and to state what I was hearing from colleagues and to put it out there, really distill for people this is where we are. And I, your question, what's the state of Canadian health care? I mean, I don't think it is an overexaggeration to say we are at, I think the low point that we've probably ever been at in our system. And it's not in one place, right? We are now seeing this across the system. It doesn't matter what you're talking about, from community clinics to emergency departments to inpatient wards to long term care to home care, it doesn't matter. There's no part of the system that's working well. There's no group of physicians who would say to you right now, I can deliver the care I want for my patients, Everyone is struggling. And the problem is fundamentally about access and being able to deliver care to patients in a timely way. And in none of those settings is that happening. And I think that's leading to the burnout and moral injury that we're seeing amongst not only physicians but across health professions. And that's now leading, I think, to the staffing challenges we're seeing as people are starting to walk away because they just can't compromise themselves any further, you know, both professionally, ethically, physically, mentally. The toll has been massive. And I always say the health care system, to me, it's the people. A hospital bed means nothing without the expert care of the staff. And it's not only doctors, as you and I know, it's the nurses and other parts, pharmacists and cleaners and everyone who comes in and supports that patient. And the fact that we have a system now that is eating those people alive and spitting them out is deeply worrisome because that is the most precious resource. And right now we have not invested adequately in the people to make them feel valued, and we're paying that price. And these are not resources that are easily recaptured.

Kevin Mailo: [00:09:58] Like when I think about my incredible nursing colleagues, for instance, that have decades of experience and I rely on them in the emergency department for their intuition and their experience and their knowledge. I mean, when somebody like that walks, there isn't going to be suddenly a replacement. There's no money for that. Do you know what I mean? And we're faced with this across the health care system. And, you know, the term that's getting thrown around in the Western world, kind of in terms of people being dissatisfied with their jobs are struggling, is that quiet quitting, right? You know, it's that person that decides to retire. It's that family physician who decides to retire this year instead of three years from now because she's burnt out. Do you know what I mean?

Dr. Katharine Smart: [00:10:42] Oh, absolutely. Absolutely.

Kevin Mailo: [00:10:43] It's, you know, a nurse that doesn't want to pick up that overtime shift because she or he is burnt out. Right? These are the things that are happening quietly and leaving fewer and fewer of us to work in a system that's putting more and more pressure on frontline staff.

Dr. Katharine Smart: [00:11:02] 100%. And that's the vicious cycle, right? Because now the people showing up are showing up to a system that's struggling more and more and more. So it just keeps building. And I agree. I think the other thing that people don't understand enough I mean, you and I understand it as providers, but the public doesn't understand is just what you said. You know that nurse who's been there 15, 20, 30 years in an ICU or an emergency department, that the skill of that person.

Kevin Mailo: [00:11:26] Goodness.

Dr. Katharine Smart: [00:11:26] The knowledge, you cannot replicate that. And then the mentorship that they provide.

Kevin Mailo: [00:11:31] Oh, my goodness.

Dr. Katharine Smart: [00:11:31] Not only to junior nurses, but junior doctors. Right. How many times did you have your butt saved as a junior doctor by - and even as a senior experienced doctor - by experienced nurses--

Kevin Mailo: [00:11:41] -- how about as a staff --

Dr. Katharine Smart: [00:11:42] -- like all the time, even today, right. Like Kevin hey, I think you missed this or that dose was wrong or actually this. Like, the reality is we all need each other. And when we lose those people, experienced anyone in any of the health professions, with them walks wealth of experience, insight, compassion, ability to mentor others. And that's what creates resiliency and safety in our system. And it's intangible, right, because we don't have a way to really track it.

Kevin Mailo: [00:12:07] It's our culture, it's our folklore, it's our essence. It's in the health care system.

Dr. Katharine Smart: [00:12:13] And it's irreplaceable. And those are the people we're losing.

Kevin Mailo: [00:12:16] It is, right? And also, you know, another thing that we've noticed is physicians that are exiting the public health care system and working more privately because they're burnt out and they're struggling with working conditions in the public health care system. So these are huge challenges that we're faced with. Huge challenges.

Dr. Katharine Smart: [00:12:35] Absolutely. And I think the real, at the heart of this is that providers are tired of having these systems failures downloaded onto them as individuals, both to be held to feel responsible for trying to prop up a broken system, to feel responsible for the bad outcomes that are coming from this broken system and at times being held liable and medically responsible for outcomes, which are nothing to do with them and not their fault.

Kevin Mailo: [00:12:59] Yeah, these are system-based issues, you know.

Dr. Katharine Smart: [00:13:02] 100%. So there's huge risk right now for people as well. I think both emotionally but also legally, all of these things. So it's, I think it's a really challenging, challenging time.

Kevin Mailo: [00:13:14] So you mentioned, you and I have talked about burnout and clearly we're both very passionate about it. Today's topic is fascinating, that you brought forward is leadership as an antidote to burnout. I'm fascinated. I want to hear it, about this. What does this mean? How is leadership an antidote to burnout?

Dr. Katharine Smart: [00:13:33] Well, what I've been thinking a lot about, right, is just what you and I have been saying. Like here we are, things are dire, but what we know is the people in the system are amazing. They're resilient, they're highly competent, they bring really an incredible skill set. Anybody in health care to me is the type of person I want to be friends with and have over for a beer, right? They're just my people. So what I've thought a lot about is so many of these things are out of our control, right? The systems pieces. In some ways we can't make it totally different tomorrow. SSo what can we do and where can we be putting our efforts or framing up our roles and our moments in the system to feel like we can regain some control and choose things and pass forward that make us feel like we're still contributing to making things better when it can feel so hopeless. And for me, and that's part of been, part of my experience in my journey as a leader, as president of the CMA and now as past president, has been through leadership. And I think what I would like younger doctors to consider is, is developing your leadership skills a way that you can feel you can start to position yourself to harness some control over what happens next. So maybe that's in a small way, in the way you design your clinic, the way you run your department, the way you show up in your staff meetings, in your hospital, in your community. Maybe it's more broadly as a representative in your PTMA, maybe it's getting involved with the CMA. There's all different things people can be doing, but I really believe that having those leadership skills, starting to see yourself as a leader, so that you start to feel you're someone who could be part of that change, however small. I think those are those steps to regaining sort of our power and feeling like we can be part of the solution. And I think to me it can be that antidote to hopelessness or burnout is that sense of, okay, it's not perfect, but I'm part of the conversation and I feel like I've got the skills to show up that way. And I think developing those leadership skills is really important so that you feel you can be at the table.

Kevin Mailo: [00:15:27] I think that's incredibly powerful because it is a source of burnout when people feel disconnected from their workplace. And that's not just specific to health care, that's across multiple industries, right? People don't feel like they have input, feel like they have a voice. And so giving yourself a voice by becoming a leader can be very, very powerful. What are some practical ways that people can do that? Right, like you mentioned, getting involved, but people say, Well, I've never been in a leadership position before, and I'm a big believer in at some point everyone has to jump, right? You know, at some point we have to deal with the uncertainties that life throws at us. We do it in medicine all the time, but we don't think about it in other aspects of our life, whether it's finance or leadership or practice management. But, you know, talk to us about, like, practical, small steps that we can take to get involved without feeling we're in over our heads and without that fear of failure, which I think is another thing we struggle with in the profession.

Dr. Katharine Smart: [00:16:22] Yeah, absolutely. I think those are all great questions. And I think the first thing is, you know, be flexible with yourself about what being a leader means, right? It doesn't always have to mean being the top person or having a really prominent role or even a role with a title. Being a leader might just be how you show up with your colleagues that day. You may just decide I'm going to show up and I'm going to make a point of really checking in with people authentically and leading that way within my cohort of friends and colleagues. That may be how you show leadership. I think find a mentor, right? Look around you, look at people who you admire or just show up in a way at work or in a leadership role in a way that you think, Yeah, I respect that, I'd like to be like that, and talk to them about their journey, what they've learned. I think people have a lot of wisdom to share that have been doing this longer that can tell you These were some of the pitfalls, these are things I wish I would have known, these are things that helped me. So don't be afraid to create that network. I think we're getting better at that as physicians, we're finding each other in these different informal and sometimes formal groups, like minded people, and we're trying to build each other up. Right? And I think that's really, really important. So lean into those opportunities, look for them. I think there's also some more formal opportunities. You know, the physician leadership courses that are available can be really helpful. And I've taken some of those myself over time that I found really valuable in terms of crystallizing my skills. I think we all come with a variety of skill sets, some things to help us, sometimes things hinder us. But the more you have insight into yourself and your own personality, what your strengths and weaknesses are, and can start to kind of put a framework around some of the challenges that we encounter as physicians and as leaders. I think that can build your skills and you show up feeling more confident and it gives you, just like you show up to a code with a plan, being able to show up to difficult communication situations, difficult, you know, organizational situations. If you come there with a framework of how you're going to deal with it, I think you feel less afraid, less intimidated, less afraid of failure because you actually kind of have a plan about what you're going to do. So I think building all those things can really put you in a position where you feel more empowered to take those leaps of faith and take things on. And then I think it starts to build from there, right? Once you see how you do, then you can start to build the confidence to take on more and more roles, and eventually you'll probably find yourself mentoring other people. And there's a lot of learning in those opportunities too.

Kevin Mailo: [00:18:43] Absolutely love it. Talk to us about the importance of passion when it comes to leadership roles, and I'll mention that I could really sense passion behind your vision of setting up the pediatrics program in the Yukon and serving those communities and serving your patients. So passion fuels leadership. But talk to us a little bit about what that means in our lives. Right? It's not just about sitting on a hospital committee so we can say we sat on a hospital committee.

Dr. Katharine Smart: [00:19:10] Yeah. So important. And it's funny you ask me about that because I've self-diagnosed myself with excessive passion syndrome. I call it hashtag EPS. So other people are welcome to join me in that diagnosis.

Kevin Mailo: [00:19:22] I love it. Yeah, I love it. That's why I spend all my time in Physician Empowerment.

Dr. Katharine Smart: [00:19:27] Yeah, No, totally. So, you know, in terms of passion, I think for me that's been something that I've really recognized I need to lean into in my career because it's really, I think, what makes me me, right? So again, I think part of figuring out how you want to show up as a leader, as a physician, is understanding yourself and what really drives you. So what I know about myself, that's why I've created my own DSM criteria for myself, is that I am a very passionate person. Now sometimes that gets me into trouble. Passion is not, doesn't always play out well, right? Because sometimes you're so passionate about what's going on that it can be overwhelming for people.

Kevin Mailo: [00:20:00] That was my question? Yeah, how do you navigate that when other people are like kind of lukewarm?

Dr. Katharine Smart: [00:20:05] Yeah, it could be a lot, right? And I know that I can be sometimes a lot and sometimes it can make you very emotional and sometimes, you know, tempering that so that it's not overwhelming or that it's appropriate, right? Because we don't always get what we want by being super emotional. Not that that's always good or bad. But again, it's just realizing, right? It's good and it's bad. It's got pros and cons. But for me, when I'm doing things I'm passionate about, that's when I hit my flow, right? That's when I know I'm doing the right things because that's where I feel excited, I feel that meaning, I can see myself being successful. I can see myself achieving things because I think often that passion is contagious. It gets people on board with you. You feel people find you authentic because they can tell you're really committed to it. And I think things I've been able to do where I've had success have been because I've fueled that with the passion that I feel. And for me, passion directly relates to purpose, right? Because I think that's the other value that really matters is you have to know your why and what your purpose is. And again, the beautiful thing about health care is there can be a whole variety of purposes for people. For me, I like building things. I really enjoy finding problems, trying to solve them, looking for solutions, and feeling like I'm creating something. So for me, that's kind of my why and it gets fueled by my passion. So that's why the Yukon opportunity was sort of perfect for me. I think I was at a point in my career where I had enough wisdom, having seen the health system for a long time, I knew kind of things I thought would work and not work. It was an environment that I felt passionate about. It was a patient population I felt passionate about, and I could see the ways to bring the various components of the system together in a way that could really serve patients. And I could feel like we were making an impact, but also doing it in a way that allowed me to feel like I could create a job that I felt I had some reasonable life balance in. I was, it was meaningful. I was able to create a group of colleagues that shared my vision and passion, and we have shared our values and view of how we wanted to deliver care, and then create that. And so that, for me, really kind of ticked all those boxes. But I think when you bring passion to your purpose, that's kind of the magical thing. And that's where I think things really start happening. And I think those are, again, why, in my view, leaning into leadership for people who are interested in that can really create those opportunities. Because once people start seeing you as a leader, you're able to make more things happen because people come to you and you have more opportunity to share your ideas and solutions and then you start to be part of seeing things change. And I think once we start to feel things changing and getting better, even if it's small, that fuels a lot of hope. And I think that's what people need right now in the system, is hope that it could actually be different.

Kevin Mailo: [00:22:38] Talk to us about failure and setbacks, and I'll frame it a little bit in terms of the broader medical culture. And one of the things we struggle with in medicine is failure, right? I mean, we're highly selected against it and we're not used to having setbacks. We're not used to failing. And we often try to fail privately. But leadership roles mean public failures. Right? And it can be as much as you get shot down at a committee meeting, it can be a giant flop with your clinic, it could be a major dysfunction at a hospital level, right? I mean, there are scales of failure, but failing. How do you approach failure or what wisdom do you have in this space, Katharine?

Dr. Katharine Smart: [00:23:20] I think that's so critically important. And I think our fear of acknowledging failure as an unavoidable part of career development, personal development, growth across the spectrum is actually a real problem, right? Because we all are going to fail. No one's perfect. The perfectionism in medicine, I think, is part of the weird hidden curriculum that drives all sorts of strange behaviors and interactions and ultimately, I think often doesn't create the best patient care because we're doing things that are performative just because we want other people to think we're good, not necessarily because it's the right thing to do. So I think that that fear of failure is really behind a lot of problems. You know, and I've absolutely had failures. I've had failures with relationships with colleagues, I've had clinical failures where I've made the wrong decision or the wrong diagnosis. I've had personal failures, where I've let down people that I care about in my life, or haven't shown up maybe the way I wanted to. I think like everyone I've had all those things happen. But how I try to approach it, and I think partly why I am where I am today is because of some major challenges I had at one point in my career professionally, with colleagues, where I was just in a clinical situation that I really didn't feel comfortable in and I had to make some major decisions about what I was going to do with my career at that point. But I really leaned into that as an opportunity for self improvement, right? I really reflected on that moment in time in my career and thought, you know, why did this turn out the way it turned out? What do you feel proud of in terms of how you handled it? What do you wish you'd done differently? How could you have made this more positive? What could you have done that would have been better and gotten a better outcome? And I took that as an opportunity to really develop some additional skills. I thought, okay, I don't think I communicated as well as I could have. So I took a course on communication. Right? I thought, you know, I don't want things to be like that again. So I took a course about getting to understand yourself better and how you show up as a leader. So I really tried to take that as not an opportunity for the blame and shame for anyone involved --

Kevin Mailo: [00:25:23] -- or to retreat --

Dr. Katharine Smart: [00:25:24] -- including myself --

Kevin Mailo: [00:25:25] -- or to retreat --

Dr. Katharine Smart: [00:25:25] -- or to retreat. But I really leaned into it, right? I was like, You've got to lean into this failure. Like, what could this mean for you and what can you take from this? And how do you leverage this moment to improve yourself? Because I think everything in life has a lesson in it, and you can either choose to be made smaller by it, you can choose to let it defeat you, or you can choose to not own your part in it, right? Because no matter what happens, you always have a role. And I thought, I've got, I'm either going to let this sort of destroy me or I'm going to lean into it and I'm going to come out better. And I think I did come out better. And I suspect I probably never would have became the president of the Medical Association had that not happened to me. So I think that we shouldn't be afraid of our failures. I think we shouldn't be afraid of knowing that we're never always going to be perfect. And that's okay. But we've got to stay open to what's the lesson here for us and how can I emerge from this a better version of who I was? And be okay with the fact that it took a failure to get there.

Kevin Mailo: [00:26:22] Wow, absolutely love that. And even just celebrating the journey and the process. And that's another thing in medicine, we're very goal oriented, like, okay, I just want to set this up or establish this or have this new process of doing things. But the reality is, is that we may not get there. Right? But in the process we've learned something about the system we work in or we've learned something about ourselves that allows us to become more powerful as leaders and more effective in communicating that vision and that passion.

Dr. Katharine Smart: [00:26:53] I totally agree.

Kevin Mailo: [00:26:54] It isn't just a saying that failure is an ingredient of success. Failure truly is key to success. You haven't tried if you haven't failed.

Dr. Katharine Smart: [00:27:03] I agree, and I don't think you're going to find any successful person in any walk of life who hasn't failed multiple times across spectrums of their life. That's just the journey, right? It's not a straight line from A to B, it's up and down. And again, I think the most interesting people are often the people that have been through some really hard things. And that's where we find ourselves, often, and find who we really are. And I think we have to be open to that. And again, I think this is why community is so important, right? Being able to talk honestly about this with each other, normalize, normalize failure, right? Be like, hey, man, this is part of it. Like, you know, one of the most powerful things that happened to me - I'll never forget this - I was a new attending, so I was a peds emerg doc in Calgary. I'd done my fellowship there. So on June 30th I was a resident, a fellow, and then July 1st I was attending physician. We've all had that transition. But, you know, in my case, like a pretty straightforward transition, right? The department I trained in, worked in, I'd had a lot of independence as a fellow, so it wasn't really all that different. But all of a sudden my anxiety around what I was doing was like ten times what it had been the day before. And I was just like perseverating about all the patients I was seeing, potentially making mistakes, and it was getting overwhelming, like it was like anxiety that was like I couldn't sleep, like it was a problem. And I talked to a colleague, a good friend of mine who's still a close friend, a more experienced emerg physician, and she said something to me that was really helpful. She said, Katharine, if you imagine the best doctor you know, like someone you really respect clinically, you think they're excellent. I was like, okay. She's like, Do you think they're right 100% of the time? And I was like, No, that's impossible. She's like, Right, so say you're amazing and you're right 98% of the time, which no one's even that good, you know that, right? That still means every month you're seeing thousands of patients, there's going to be several like 20, 30 or more patients where you were wrong. Now, most of the time we're lucky that the natural history of things is nothing untoward happens or people come back and there's this second go and it's fine. But other times, sometimes, bad things are going to happen and you're going to wish you'd done something different. She's like, What you have to understand is it doesn't matter if you're the very best of the very best, that is part of this work. It's always going to happen. It happens to all of us. And you have to let go of this pursuit of being perfect because it's impossible. And that was so powerful for me. It really allowed me to step back and go, You're right, I'm going to have, and even mistakes I don't know if that's even the right word, right?

Kevin Mailo: [00:29:23] I mean, it's a process of self forgiveness and learning to forgive ourselves before the event happens.

Dr. Katharine Smart: [00:29:30] That's right. And that really helped me. And then what I realized and what I tried to really march forward with from that in my career was, Okay, instead of seeing this as as bad and blaming, let's see this as learning, right? So when I had a case that bounced back or something went differently, really, honestly, look at what happened and ask yourself, could I have done something differently? And sometimes the answer is no, right? Sometimes you look at the care you gave and you're like, Given what I knew in that moment, I wouldn't have done anything differently. Other times you're like, You know what? The patient told me X and Y and I didn't really listen or I didn't pay enough attention --

Kevin Mailo: [00:30:03] -- I was distracted --

Dr. Katharine Smart: [00:30:04] -- and I should have done something else. Right? But I committed in that moment to really look at these, if you want to call them failures or misses or even going to term them, as opportunities to become better. And so that really shifted the way I felt about it from blaming and shaming myself to being like, No, I'm a continuous learner. I'm going to lean in to these moments. I'm going to make sure it makes me a better doctor, and I'm going to talk to my learners about this, right? I'm going to be overt with them about how I think, how I approach the things I do. And hopefully give them a framework too that allows them to be kinder to themselves. Because some of this is about kindness to yourself.

Kevin Mailo: [00:30:40] Absolutely. And just creating a culture of humanity within our health care system. We are not a bunch of metrics. Right? And it is not just about tracking a bunch of bounce back rates or whatever, a bunch of statistics. It's about creating a human health care system that ultimately is there to support the frontline workers and it benefits patients, right, when you're not paralyzed with fear going in to work.

Dr. Katharine Smart: [00:31:08] 100%. And I think the problem is operating from a place of fear iin medicine actually can cause a lot of harm. Because doing unnecessary things to people because you're anxious or fearful is actually harmful. Right? So we need to acknowledge that as well.

Kevin Mailo: [00:31:22] Yeah, without question. Without question. So I think we should probably begin to wrap it up. But we'd love to have you back on again because there was just so much here. Katharine, do you want to share any kind of closing thoughts or reflections or just something for physicians to take away with them today?

Dr. Katharine Smart: [00:31:40] Well, I think if I could say anything to physicians right now, it would be a resounding thank you. I mean, people have just shown up incredibly in this time. They've shown up in the system. They've shown up for their colleagues. They've shown up as leaders in the media and social media for their communities, for the country. I mean, I think it's really been incredible just to see how people have stepped up in this unprecedented time of a global pandemic and just tried to look for any way they could make a contribution. And people have done it in so many different ways and all of it's been needed and necessary. And I've felt so proud to be a physician. I've felt so proud and privileged to represent all of you as my colleagues. And I just really want to say thank you to people for the work that all of you are doing and continue to do, and that I hope that we can continue to support each other, even though it feels like dark times. I know the only thing that's going to get us out of this is the people in the system. So make sure you're looking after yourself. Don't sacrifice yourself on the altar of medicine. That is not the solution here. But continue to show up the way that works for you. Lean into your passion and purpose and most importantly, lean into your colleagues, who I know will be there to to support you when you need it.

Kevin Mailo: [00:32:49] Wow. Absolutely amazing. Again, I really want to thank you for being here today and speaking to us, Katharine. And again, I think on behalf of many, many physicians across the country and patients as well, thank you for your advocacy in getting us through the pandemic. But afterwards as well, and everything you do to improve this, the public health care system that we all love and cherish. And so, again, thank you so much,Katharine.

Dr. Katharine Smart: [00:33:17] Thanks for having me.

Kevin Mailo: [00:33:19] Thank you so much for listening to the Physician Empowerment Podcast. If you're ready to take those next steps in transforming your practice, finances or personal well-being, then come and join us at Phys Empowerment.ca P H Y S empowerment dot ca to learn more about how we can help. If today's episode resonated with you, I'd really appreciate it if you would share our podcast with a colleague or friend and head over to Apple Podcasts to give us a five star rating and review. If you've got feedback, questions, or suggestions for future episode topics, we'd love to hear from you. If you want to join us and be interviewed and share some of your story, we'd absolutely love that as well. Please send me an email at [email protected]. Thank you again for listening. Bye.