Episode Notes

Dr. Kevin Mailo welcomes Alberta-based anesthesiologist and first Indigenous president of the Canadian Medical Association, Dr. Alika Lafontaine, to the show. Dr. Lafontaine talks about the importance of narrative, our personal narratives and the stories shared about medicine and with patients, to create hope and foster well-being. 

Dr. Alika Lafontaine shares his personal story, some of the struggles he faced with learning and growth in his early years and the ways in which narratives offered to him affected his outlook. He tells about how his parents helped shape him in positive ways and the personal self reflection ability he developed through performing with his siblings. His experiences, good and bad, have shaped how he views medicine and the importance of the stories told within the profession and to each other.  

In this episode, Dr. Kevin Mailo and Dr. Alika Lafontaine address the question of what you’re willing to sacrifice to the altar of medicine as a physician. They examine how the narrative we have with ourselves influences how we do medicine, and how the narrative we have about medicine influences the experiences we have with patients. Alika shines a light on reframing perspectives and realizing how the narratives we tell ourselves about others contributes to bias and exclusion in treatment. This is a powerful episode about the possibilities of medicine and the vitality of connection with oneself and others through the stories we tell.

About Dr. Alika Lafontaine

Dr. Alika Lafontaine is an award-winning physician and the first Indigenous doctor listed in Medical Post’s 50 Most Powerful Doctors. He was born and raised in Treaty 4 Territory (Southern Saskatchewan) and has Metis, Oji-Cree and Pacific Islander ancestry.

Dr. Lafontaine has served in medical leadership positions for almost two decades. At the Alberta Medical Association, he has served on the representative forum (since 2012), the nominations committee and the Indigenous health committee, and he is a current board member. At the Canadian Medical Association, he has served as an Alberta AGM delegate, has been a member of the appointments committee and has chaired the governance council of the Canadian Medical Association Journal. At the Royal College of Physicians and Surgeons of Canada, he has served on the Indigenous health advisory committee and search/selection subcommittees, he has chaired the regional advisory committee (western provinces) and he is a current council member. He is a member of the board of HealthCareCAN. He has also served as vice-president and president of the Indigenous Physicians Association of Canada.

From 2013 to 2017 Dr. Lafontaine co-led the Indigenous Health Alliance project, one of the most ambitious health transformation initiatives in Canadian history. Led politically by Indigenous leadership representing more than 150 First Nations across three provinces, the alliance successfully advocated for $68 million of federal funding for Indigenous health transformation in Saskatchewan, Manitoba and Ontario. He was recognized for his work in the alliance by the Public Policy Forum, where Prime Minister Justin Trudeau presented the award.

In 2020, Dr. Lafontaine launched the Safespace Networks project with friendship centres across British Columbia. Safespace provides a safe and anonymous workflow to report and identify patterns of care; patients and providers use the platform to share their own experiences and contribute to system change without the risk of retaliation for sharing their truths.

Dr. Lafontaine continues to practice anesthesia in Grande Prairie, where he has lived with his family for the last 10 years.

Resources Discussed in this Episode:

• Save the Date for May 6-7, 2023 in Toronto
• Dr. Alika Lafontaine
• Val Arnault-Pelletier
• Dr. Krishna Kumar

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Physician Empowerment: website | facebook | linkedin

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Transcript

Dr. Kevin Mailo: [00:00:01] 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.cam- 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 on to today's episode.

Dr. Kevin Mailo: [00:00:35] Hi, I'm Doctor Kevin Mailo, one of the co-hosts of the Physician Empowerment Podcast. And today I'm very, very excited to be bringing on current president of the Canadian Medical Association, Dr. Alika Lafontaine, who is an Alberta-based anesthesiologist who is also our first Indigenous Canadian Medical Association president. And today we've got Alika on the show to talk about the power of narrative in our personal and professional lives as a way of connecting with one another, but even connecting with ourselves. And this is one of the central themes of Physician Empowerment, where, you know, we come together and we talk about our practice journey or our wellness journey or our financial journey, but it's important to discuss, you know, not only, you know, facts and figures, data, but it's important to share our struggles, our failures, our successes and what we learned from those. So with that being said, Alika, why don't you say a few words? Tell us about yourself.

Dr. Alika Lafontaine: [00:01:39] Yeah, absolutely. So first off, thanks for inviting me on to the podcast today. I think that the subject of narratives and the stories that we hear and the stories we tell ourselves about medicine is something that has definitely gained greater focus in this year. You know, when you talk about moving people just generally, before getting into my own story, people are moved by where they think they're going, not necessarily where they're at. You know, I think when you talk about why we get stuck is because we get so focused on, you know, what's going on in the moment. But when you talk about really being motivated, when you talk about big system change, when you talk about doing things differently, it's because we get caught up in a narrative that has this imagined, like a better world, a better place, you know, somewhere that we should aspire and you know, work towards getting towards. And that definitely has application in my own life. So when I was young, I grew up in a great family, two parent home, my dad made enough for my mom to stay at home and raise us five kids. We weren't a rich family, but we always had enough food on the table. We had a warm home. Like we didn't go vacation in exotic places, but we had a lot of fun together. Right? And my mom was a first generation immigrant from the island of Tonga. She came to California before meeting my dad and coming up to Saskatchewan. My dad was a Metis kid who grew up in small town Saskatchewan, a place called Lestock. And together they raised a family where we were really taught that, you know, community was super important. You know, respect for oneself and each other was super important, but really, really central to their message of where we could get to if we worked hard was the idea of education. My dad was the first one to go off and get an undergrad and a master's degree in his family. My mom gave up her education dreams and she reminded us, you know, I'm here for you. I've lived my life. Now I'm here to support you. So you need to go off and, you know, achieve that next step so you and your family can continue to have a better and better life. Right? Similar narrative to a lot of things that we've all been taught, you know, in the generation that we grew up in. And I remember in grade school, my teachers were very concerned around, you know, grade three, grade four, grade five about my ability to read. And it wasn't that I couldn't pick up concepts, its that I had a very difficult time expressing myself in a way that they could understand. So I would mispronounce letters. I had a very bad stutter. I think all of these things created a lot of anxiety for me, you know? And as a result, I had a great difficulty reading out loud to teachers.

Dr. Alika Lafontaine: [00:04:39] And they did a lot of work to try and figure out what was going on, but eventually reached a point where they sat down with my parents and me and they told my mom and dad, you should plan for him not to graduate high school. He's not going to do anything else with his life. And I remember that moment in the vehicle after my mom was holding me and she was kind of rocking me back and forth. And she was telling me, you know, you're not broken. You're not broken. And that really set into me, you know, this narrative that I told myself growing up, you know, I have to prove to each other that, to other people, that they're wrong about me. You know, I have to live up to, you know, not only the dreams that my mom had, but also I have to, like, prove to myself that I'm not broken. Right? And, you know, my parents, to their credit, they put a lot of time into me. My mom doubled down with kind of taking care of us at home by, you know, becoming a teacher for me and home school. You know, eventually my younger siblings were pulled out of school so we could all do home school together, which I think was was really positive for me. So my two older brothers continued on to high school, but me and my younger siblings, we all took home school together. My dad went off and he had been trained as a teacher. He had gone to law school for a little bit, went off and did his master's in educational administration. So he went down to the States and got some extra training in different learning techniques, whether it's a mix of what they did or whether I grew out of it or whether it was, you know, addressing ear infections that I had when I was a kid, for whatever reason, I started to turn a corner. And it was interesting because I was labeled as learning disabled. So a learning delay with a speech impediment when I was younger, and a few years later I was labeled as gifted. And so now suddenly I had a completely different narrative that was going on in my life. And you know, that really propelled me, I think, through a lot of the frustrations that we all go through when we're trying to get into medicine and, you know, going through med school and other things. You know, what is it that drives you to, you know, do what you do? And obviously, I had the same sorts of things that I wanted, that a lot of people that come into medicine want, where we want to help people, we want to have a life of meaning, you know, these other things. But there was the added motivation that I had that I had to prove myself, right?

Dr. Alika Lafontaine: [00:07:09] And I think those things together, you know, not just having my own life story, but also sharing a lot of the stories that we all have when we come into medicine, it made me particularly sensitive to burn out this belief that I had to be everything to everyone. This intense disappointment when I didn't succeed. I remember in my first year of medicine getting a, I think it was like a 74 on a histology exam, average person they're like, oh, 74 that's probably not a big deal. I thought my my life was over. I went over to the histology professor and I asked them for extra tutoring help. And I remember that whole first few weeks just really feeling out of place. I was meeting these kids who came from multigenerational physician families, people that were fairly well off. I was the only Indigenous kid in all four years at the time. And the teacher, instead of reassuring me, said, You know, it's probably not the end of the world if you don't pass first year and repeat it. And kind of waving me away and I remember walking out of that room and saying to myself, I'm done, I'm done med school, I'm not going to continue on in a place that I don't feel like I belong and I'm not going to be able to succeed. And I walked down that hallway and I met Val Arnault-Pelletier, she's a current lead for the Indigenous program over at University of Saskatchewan right now. So she's been there for a very long time, helping many, many kids like me get through the challenges that I know I shared with many, many people. And, you know, she really helped me along with many, many coffees with the dean over the next four years to help me tell a different story to myself that it was okay not to always be perfect in every situation and that there was a lot of learning and growing that had to go through and I had to give myself space to do that, you know. So my life's interesting in retrospect now because I can see how the very negative narratives that I was taught were both heartbreaking but also motivating. But then the very things that brought me into med school were the very things that broke me early on in med school as well, you know. And so I've learned different stories about myself over and over again over my career. I continue to learn different stories about myself. And I think when we talk about telling stories, it's not only about stories that sweep other people up in movements to create a better type of health care system. It's also stories that we can believe, so we can thrive, so we can address a changing world around us in a way that's maybe a lot more healthy than we did before.

Dr. Kevin Mailo: [00:10:05] Yeah, that's so powerful. I mean, I think what you're touching on is what perception can do in our lives, right? I mean, you know, the same events occur to us, but our perception changes our experience of that set of events in a given moment in our lives. So before we get to, you know, our relation to other people in narrative and storytelling, I like the word storytelling. How do you look inward? What does that process look like for you? Because I think everybody's a little bit different. You know, some people will go take a vacation by themselves. I drive with the radio off in my truck for a few moments here and there and just reflect or people will meditate. But what does connecting with our own narrative look like for you, and looking inward look like for you?

Dr. Alika Lafontaine: [00:10:56] It's interesting how you have a lot of experiences that seem very disconnected over your life. But then when you end up doing something really meaningful, it seems like everything kind of converges into a single point, right? And you realize, hey, that thing that I thought was very different than what I ended up doing maybe is at the core of why I do what I do well. Right? So another thing my mom really encouraged us to do when we were young was to sing together, I was actually part of a boy band for like two decades, right? It was, it was me and my five, the five of us siblings, like touring across Saskatchewan, Manitoba, Alberta. Eventually it was Canada-wide, we toured parts of the US and performed in the Pacific Islands and things. But over those two decades of performing, you start to get a real sense for feeling the emotions of the people that you perform for, but then becoming hyper aware of your own feelings. Because if you're not, you actually can't give a good performance.

Dr. Kevin Mailo: [00:11:53] Wow. Yeah.

Dr. Alika Lafontaine: [00:11:54] And so, I, over the years of performing with my family, really had a lot of opportunity to verbalize the way that I was feeling, reflect on how I was feeling, you know, inject that into this performance piece. So we were vocalists, like it was an R&B kind of pop group. We wrote our own music. We published three albums over the time that we were performing. This was all before YouTube, so you're not going to find a whole lot of stuff on us online.

Dr. Kevin Mailo: [00:12:25] So I can't just look you up on TikTok.

Dr. Alika Lafontaine: [00:12:27] No, no, you can't look me up on TikTok. But we ended up doing some pretty big shows. Like when EPTN opened, we were part of kind of the opening set, we opened for Susan Aglukark, I think was right after us. We were on the Inspire Awards, which back then was called the National Aboriginal Achievement Awards. So that had viewership of like 2, 3 million people across the country. So I had a lot of opportunity to self-reflect and understand why I did the things that I did. Now you can obviously be educated about something but not be able to, in the moment, manage yourself. So I mean this isn't to say was like a philosopher at the time of being in med school, but I did have tools available to me to understand myself. And some experiences where I could sit back and say to myself, Well, this is what we did when we wrote this song. This is what we did when we prepared for this set. So maybe I'll sit down and kind of figure out exactly where my head is at with all of this. And I think when you're looking at yourself, there's two parts that I found really, really useful. And it's different for everybody, but two things that I've found really useful. The first is being brutally honest with yourself about how you're feeling in the moment.

Dr. Kevin Mailo: [00:13:35] Wow. Yeah.

Dr. Alika Lafontaine: [00:13:37] You know, it doesn't make a ton of sense to deny yourself the reality that, hey, I'm sad, I'm happy, like all this other stuff. And then the second part is linking that and understanding how the things you experience trigger those emotions and put you into different cycles. Right? And I get caught up in them just the same as everyone else. I mean, we all know that there's unhealthy habits that we get into once we get into heavy call, right? I mean, you're up at 3 am, you had a horrible night, maybe in extremely horrible nights you had bad patient outcomes or some sort of disagreement with a colleague or other things. There are natural like things that we reach out for whenever we're feeling like that. Right? And so being able to understand those two parts of myself, I think has been really helpful. And I think when you're looking at how do you bridge, how you feel about yourself to now interacting with the world, it's negotiating with yourself about what exactly you're going to give the world to bring the world to that point where it can give you what you're looking for. I had a physician that did research projects under when I was a medical student. His name was Krishna Kumar. He was a neurosurgeon in Regina. And, you know, consistent with my story, I picked the hardest thing I could think of once I got into med school as far as what I was going to go after, as far as, you know, residency and is this true or not? I'm not really sure. But 19 year old me thought that this was what what I should chase after. So I wanted to do neurosurgery. And so I followed around Dr. Kumar for a couple of years. And this guy, I mean you won't find a harder working physician anywhere. 16 hour days, 12 hour surgery standing up, working on Saturdays and Sundays, flying around the world, doing presentations. He had the largest research body for spinal cord stimulation, I believe in the in the world at the time that I worked with him. So I kind of fell in this opportunity with this amazing physician. And I really poured my heart and soul into it for the first, like year and a half, showing up his house at 2 am to do presentations, being available any time of the day to to sit down and do different things, following around inside the OR and other places. But he noticed halfway through my second summer, I became a little disinterested in what was going on. And at that time I'd actually met my now wife, and I remember him sitting down with me over lunch and he had this thing where he'd like, peel radishes and like, give you slices as he was eating. And he's like giving me these radish slices as we're chatting.

Dr. Kevin Mailo: [00:16:21] It's funny how we remember...

Dr. Alika Lafontaine: [00:16:22] Oh, yeah, totally.

Dr. Kevin Mailo: [00:16:23] .. those things in the moment, right? Yeah.

Dr. Alika Lafontaine: [00:16:26] Yeah, sense and sounds. And I still remember how he looked and and all that stuff. And he's, he's chatting with me about work and then he makes a turn in the conversation, asking, like what's going on. You know, you seem just a little bit distracted, was the word that he said. And I told him about this amazing girl that I'd met. And I'm sorry if it seems like I'm not paying as much attention, she's just really incredible and all this other stuff. And Dr. Kumar was not an emotional guy, right? He was a warm guy, don't get me wrong, but he was very business. Right? And I noticed a softening that came over him. He reached his hand out onto my shoulder. He wasn't big for physical contact, but it was like a very, like fatherly touch.

Dr. Kevin Mailo: [00:17:11] It meant something.

Dr. Alika Lafontaine: [00:17:12] It totally meant something. And he leaned in and he said, you know, Alika, don't sacrifice your life on the altar of medicine. It's not worth it. And then we went back to talking and, you know, it never came up again. And I look back at that moment as really formative for me. I don't think I realized just how much it impacted me until later. But you have this person who, world leader in what he does, sacrifices almost all of his life to medicine, raised a beautiful family, had a good relationship with his wife and kids, but he missed out on a lot of important events in his family's life because he was focused on creating those moments for other folks who were sick and otherwise. And, you know, he's telling me, don't sacrifice too much. You know what I mean? And so it's interesting when you think about the stories we tell ourselves about our contribution to medicine and how much we need to give and all these other things. And the reflection of someone like him at the waning years of his life that maybe what we think we're getting out of medicine isn't really worth the amount that we think we're getting out.

Dr. Kevin Mailo: [00:18:29] I think that's very powerful. And, you know, my own reflection on that is that we can give the health care system, our communities, our best when we are at our best. And part of that process involves self rejuvenation and having a notion of self outside of the profession because it's, I think, very easy for medicine to become quite consuming to the point that you look in the mirror and you say, Well, I'm such and such type of doctor. Right? Or our credentials. But the real us is so much more. It's all the way back to those formative years in our childhood, even the inner child, if you want to call it that, but our relationships with the others, but even with ourselves. And that's a very powerful observation. So how do you set that balance then, Alika, of, you know, the professional self and the personal self? And that's a concept we actually talk about at our wellness events, is the notion of different selves, that there's a financial self, a personal self, a professional self. How do you find that balance between personal and professional self?

Dr. Alika Lafontaine: [00:19:34] So as someone who has been both balanced and unbalanced throughout my life, I think the first thing to recognize is that there will be times when you'll be completely unbalanced. Right? So this year, as president of the Canadian Medical Association, has been all consuming. And it's just the nature of, you know, the value add that I want to provide to colleagues across the country, but also just the nature of the work. Right? Residency is all consuming, right? Early practice, to some degree, can be very all consuming. The first time you take a leadership position as, you know, someone in your department contributing or elsewhere, it can be all consuming for a period of time. Right? And so I think that there's times and seasons to everything. And just to be aware that balance 100% of the time is probably not, it's not the accurate way of describing it.

Dr. Kevin Mailo: [00:20:32] It's very hard to do.

Dr. Alika Lafontaine: [00:20:34] The way that we work. Yeah, yeah, the way that we work in medicine. So I think the goal is to work towards balance and at times achieve it, but then recognize that from time to time it's unbalanced and just own those moments, right? And if it's too unbalanced, reorganize your life so it becomes less unbalanced, but it will remain unbalanced from time to time. Right? So that's kind of the first part. I think the second part is that when we look back, so I'm a big student of history, right? So I think one of the best ways for us to understand where we're going is to know where we came from. And if you look at the medical system and what a lot of us would refer to as very unbalanced practice patterns, I think the world has changed a lot from the times of folks that we train under who've been practicing for, you know, 40, 45 years. Right? If you go back even 20, 25 years, a physician in a community was at the center of a lot of the work in the community. Right? When you volunteered at the hospital, you were also volunteering at your community. There wasn't a division between the two things, right? You could especially see this in small town Canada, where your doctor was also someone who interacted pretty closely with the Parents Council, the community association, you know, the mayor's office, like all these things.

Dr. Kevin Mailo: [00:21:56] Like people look to you.

Dr. Alika Lafontaine: [00:21:57] People look to the doctor or doctors as part of building up the community. Now, since that time, that's shifted, right? And so we introduced these new divisions into the way that society interacted, but we didn't update the way that we saw ourselves. And so there was a turn in the late 90 seconds, early 2000, where there was like this value extraction, for lack of a better word, that occurred where people leaned into this narrative that we had that we were willing to sacrifice on the altar of medicine in order to get, you know, meaning out. But that meaning increasingly disappeared from the practice of medicine. You know, we still had those moments where we really connected with patients. I mean, I've had lots of experiences that I mean I'll always treasure that I've had with patients, both good and bad. But the job itself become became much less of a place where you could you could wear dual hats at the same time, you know, be a part of the community, be a part of your family, be a part of, you know, work. Right? And I think that value extraction has continued up until today and it accelerated, I think, in the last five years. And it wasn't until COVID came along that I think a lot of us sat back and realized just what was happening. We were moving too fast.

Dr. Kevin Mailo: [00:23:25] No question. I mean, there's no limit to what this career can ask of us as individuals. Truthfully, there is no limit.

Dr. Alika Lafontaine: [00:23:34] Yeah, Yeah. And so with that pause that COVID gave us and that opportunity to reevaluate what was important, and I think it was a moment where we, a lot of us honestly sat there and said, Do I want to live and die for this? I remember March of 2020 coming back from a canceled leadership gathering because of this unknown virus that was floating around. Touching down, going into work, we started putting masks on patients who were coming down from the floor. We started continuous masking. We were told we're going to run out of masks if we, you know, continue to do this. We're going to run out of protective equipment. And so there was strong efforts to really, really slow down the utilization of this, which to many of us, we felt like there was no protection.

Dr. Kevin Mailo: [00:24:24] Yeah, there were those moments. Absolutely. Absolutely.

Dr. Alika Lafontaine: [00:24:27] Yeah, yeah, yeah, absolutely. And so I remember coming home from work that, the second night that I had been back, and sleeping in the garage. And I actually slept in the garage for like the next three, four weeks. I know many of my colleagues that slept in the, because you didn't want to get your family sick.

Dr. Kevin Mailo: [00:24:44] You didn't know. And that's when it becomes so real. What we might be asked to give up.

Dr. Alika Lafontaine: [00:24:52] Yeah. And I think a lot of us sat there for the first time in our careers. I mean, we always knew it in the back of our minds that it could be possible. But we were actually confronted with that moment of if someone was dying in front of you and you could get infected, were you willing to die for that patient and were you willing to potentially make people that you loved very sick and potentially die as well. You know, it's, I think it's easier right now to look back and, you know, say to ourselves, well, we know this now and all these other things. And I think pre-vaccine, it obviously was a completely different game. You know, we didn't have what we have now. But I really think in that moment, a lot of us realized for the first time, I don't, I think there's a line to what I'm willing to give. You know, and I know for myself, I never actually defined a line of how far I'd go in order to, you know, sacrifice for the health care system. And I think that was the beginning of me realizing I really do need to make sure that the most meaningful parts of my life are protected. And that I can find a way forward to separate, you know, the story I tell myself about the doctor that I want to be and the kind of person I want to be in the rest of my life. And I see that that conversation going on in the minds of a lot of colleagues across the country still.

Dr. Kevin Mailo: [00:26:16] And I think you're absolutely right what a powerful experience the pandemic was, because in that, in those moments, you know, we're worried about catching the virus, getting sick or getting a loved one sick. You know, it crystallized that reality of what medicine asks of us, but in reality, day to day, medicine is chipping away at us or some of us in terms of our health and well-being or our relationships. Right? You know, when you're, you know, you're working those long hours or you're constantly on call, you're constantly exhausted, you're constantly tired, how present are you for the people in your life? How present are you for yourself, for your own wellness? And, you know, it's just those those things aren't so explicit because we say, well, it's just one more night shift or it's just, you know, one more week of call and I'll be off for a few days or whatever. Right? But in reality, these are big asks of us in terms of our well-being. And we just don't necessarily recognize them because they're built into the culture of medicine. Like you said. You know, it's begun sort of, it's ubiquitous.

Dr. Alika Lafontaine: [00:27:25] And sometimes it's pretty striking things that in the moment you think are so normal, but in retrospect, you're like, wow, that was really abnormal. I mean, I remember in residency knowing that at 72 hours of no sleeping, I would just kind of collapse on the floor and fall asleep. Right? And I know that it happened multiple times. Like I'd, I would push myself past what I could do and then keep on going. And I'd go home at the end of the day and I'd wake up on the floor at like 1 am and young kids and my wife had just kind of, step over, let me sleep there. They put a pillow under my head and threw a blanket on me. But, like, they they knew that it was more disruptive to try and wake me up and get me to bed than it was just to let me lay there. And I just thought it was something that everyone just did. And then you get out into the real world where you're not interacting with just doctors anymore and you realize that that's not normal at all.

Dr. Kevin Mailo: [00:28:24] So talking about narrative, we talk about relating to ourselves and connecting to our self with our own stories. And I thought this was so powerful to go back through the decades of your life and see those moments, like you said, like cutting what was it, radishes on a kitchen counter, you know, in the middle of the night. And so talk to us about narrative as it relates to one another professionally. Right? And talk about, you know, how narrative relates to our patient encounters. Because I think there's a lot of beauty there.

Dr. Alika Lafontaine: [00:28:54] Yeah, absolutely. And we we've talked so far a lot about, you know, our personal narrative that we have with each other or with ourselves. And then we we talked a bit about that value exchange that goes on between us and kind of the broader narrative of what is medicine and what does medicine expect of us? I think when we're interacting with each other, there's the narratives that we also tell ourselves about what other people think about us and how they interpret what we do. And then there's also narratives that we project onto other folks, you know, so I've obviously done quite a bit of work in the area of equity, diversity, inclusion, anti-racism, etcetera. And part of the way that I now explain things has come from my own feeling about performing and audiences. You know, I think people to a great degree are always well meaning. And they're being taken on this emotional journey that they may or may not be consciously aware of. That's not to say that unconscious bias is what drives inequity and exclusion and racism, etcetera. But it helps to frame things in a way that people can plug into emotionally instead of just telling them that you're like a bad person, right? The worst, the worst feeling I think for a physician is to be told after 36 hours of being on call that you don't care about patients.

Dr. Kevin Mailo: [00:30:22] Exactly. Nobody's going to work trying to screw up here.

Dr. Alika Lafontaine: [00:30:25] Yeah, 100%. And I think if you take that as a starting point for the majority of people, that's a place that you can have people come together more easily than other places. It also gives someone the opportunity to be more harsh with themselves than you are with them. Because the truth is, if people want to change and recognize that they're creating bad experiences for those around them and potentially harm, you know, because sometimes the decisions that we make, because of bias and other things, actually do create harm. If you want people to be introspective and actually change, they're going to be way more harsh with themselves than you could ever be. Right? And so that's kind of the first point. The second point is that we're often swept up by these things because the ways that we thought about things kind of worked. You know, even going back to what I was talking about with physicians who sacrificed their life and, you know, spent all their time at the hospital, you know, 25, 30 years ago, it worked for them. They were still able to see their family. They were still able to be a part of the community and all these things. But the world changed, right? And I think that that's the same case with a lot of the stories that we project on to other people. At some point that story made sense, right? At some point that story was true. But it's whether or not in that moment, is that story true? Is that story adaptive? And I think increasingly people are realizing that stories that tend to be pretty prevalent can lead to significant, you know, harm and pain for folks and especially patients. So one of the things that I've had the chance to be an advocate for and, you know, participate to some degree as president is, like, in the area of forced sterilizations for Indigenous women. And I and I remember as a resident, that there were situations where, you know, the surgeon would lean over, your patient would be under a spinal like doing a C-section or whatever, and they'd say, okay, I'm going to clip your tubes. And then a tear would roll down their face. And in the moment, I would sit there and think to myself, Oh, my spinal must not be working. So then I'd go grab the ice, I'd like check whether or not things are moving around, I'd peek over and see whether or not they externalized the uterus, which can sometimes cause referred pain up into the shoulder. It just never crossed my mind that they did not feel that they had a conversation where they were fully informed that this was happening. And in retrospect, it's easy for me to see what could have happened. Right? But I think for a lot of folks who are currently practicing, if you want to understand how to be a better physician, you have to be open to, you know, reframing what you thought you were doing and how you thought you were affecting other people and why people were reacting in the way that they did to you, into a way where you give some space, Hey, maybe I just didn't see what was going on. Maybe I actually was, you know, I don't think a lot of folks realize just how how hurtful it is when you meet, you know, an Indigenous person with a traditional name and you don't even try and pronounce it. So some folks, yeah, and people think, well, I'm being respectful, right? When in reality, like, it's very, very hurtful. Right? But you wouldn't know that unless you actually were able to talk to someone about it. That's not something that's a classic narrative that you would pick up just from day to day life. And so, you know, I think when we talk about patients and each other and other things, we have to get to the point where we can talk about the stories that that we believe and project on to other folks and also hear them tell us what are they feeling.

Dr. Alika Lafontaine: [00:34:07] And I do feel that we we should celebrate to some degree that we are in a place where we can say racism out loud, sexism out loud, discrimination out loud. And I do hope as we continue to move forward, we'll start to realize that the goal is not to get rid of everyone who has those those thoughts or those feelings, because that's kind of a part of the world that we grew in, grew up in. Right? Those are the stories that we heard and adopted. But instead try and help people not to, you know, mindlessly act in a way that's harmful to other folks. Like that, I think, is the actual end point. Because when you when you talk to patients about, you know, racism, what do they want? They just want the harm to stop. Right? They don't necessarily need, you know, every racist thought or other things to be eliminated from the provider's mind. What they actually want is for the actions to stop. And I think if we approach it from that point of view, it's a very different, it's a very different problem. It's a much more achievable problem. Solvable problem.

Dr. Kevin Mailo: [00:35:10] But I think it's so powerful when we hear the stories of what patients have experienced going through our healthcare system with systemic racism or sexism and hearing the stories on an individual level, like the case of that patient having her tubal ligation really with no with no discussion or consent. Proper consent at least. And so those are the kinds of things that can be very powerful to motivate us, to help us to see things from another's perspective.

Dr. Alika Lafontaine: [00:35:44] And I think that that brings us closer to what we actually want to get out of medicine. And this goes back to like the the the the altar analogy, is not that we can't get meaning out of medicine, it's just that the world has changed. So we have to change too, like our meaning has to change. You know, the way that we get it has to change. And I think at the very beginning of all of this, like you talked a lot about, or you mentioned burnout and the need for wellness and, you know, having people step back and realize there's different parts of who they are and what their needs are and and other things. And 20, 30 years ago, we wouldn't talk about that. Right? And I think today we have to confront it because that's a necessary part of the new story we have to tell ourselves so we can start to thrive in medicine again.

Dr. Kevin Mailo: [00:36:25] And I think it's important to use, you know, storytelling and shared experiences to humanize medicine because too often I think we look at it from a very technical perspective. I mean, you know, you come into the emergency department and you're there to, for instance, you know, on shift and you're there to say, Oh, you're not having a heart attack. You rule out anything serious, but maybe that patient's having chest pain because you need someone to talk to. You know, that they're struggling with anxiety or depression and it's presenting, you know. But when we don't create that space to hear people's stories, we end up being very technical. But there's a downside. It's not only, you know, that the patient has lost out, but so have we, because some of the most meaningful moments in my practice have been when I actually just sit and listen to a patient. As we humanize the experience in medicine and humanize our interactions not only with our patients but with one another, I think we feel more connected to our jobs and we derive more meaning from it and we do better care.

Dr. Alika Lafontaine: [00:37:26] And, you know, this has me thinking about, you know, something that that's come up over and over again with with being president of the CMA, and that's how do you get unity within the profession towards things that will not just help us, but also help patients. Right? And my mind over the past year has gone back a lot to this whole idea of social cohesion. You know, this idea that we're, we have shared values, we have shared problems, and we find shared solutions together. And I think increasingly, what's the number one challenge of patients across the country? It's access. It doesn't matter which part of the ideological spectrum you're, right, how much you think government should be involved or not involved in your life. You know, if you're sick, you want access to care. You want access to to people that, access for people that you care about. And the polarization that we have, I think, has introduced this idea that somehow we'll get that access if we're right, if only people would do our solution, you know, everything would work out. When in reality, I think the way that we improve access is to improve cohesion within the health care system and between like the people that provide us care and the people who are coming for care. If you don't feel united with your provider, you're not going to share with them what's actually on your mind. If you don't work in a team where you feel like you can lean on them, you're not going to be able to find those moments where you can create additional time that you didn't have the day before because now you're working with the team that you're working well with, right?

Dr. Kevin Mailo: [00:38:55] Absolutely. Absolutely. It's so true. I mean, just again, it's that shared experience, not that we have to agree on everything, but like access will improve when we identify it as the key, key priority that we need to address in our health care system currently. So, Alika, this has been absolutely outstanding and we would love to get you back on the show. Right? Just to hear more of your experience, you know, more of your wisdom in this space. But we would love to hear your final thoughts on what narratives meant in your life and how we can use it in our day to day. Because I think it's important to have medical education meetings, programing that's based around narrative. But I also think it's important that we can integrate narrative into our day to day interactions with patients, allied health and even one another, because I think that binds us together. I think that's cohesion, as you talk about. But practically speaking, how can we integrate, how can we integrate this into our day to day practice lives or our leadership roles?

Dr. Alika Lafontaine: [00:39:59] Yeah so I'll maybe just touch on one thing, and that's the importance of narratives driving emotion. You know, why do we believe different stories is because we think we're going to feel different ways, right? And that was a lesson I learned from performing. You know, people didn't come to listen to you sing they didn't come to see you, they came because they thought they were going to get a feeling out of them showing up. And I would say in the moment that we're in right now, there's a lot of hopelessness that's going on. And the reason why people are drawing back from clinical practice, why they're leaving for other things, is because they think if I sit still and continue doing what I'm doing, this hopelessness will continue to build. Right? And so when we talk about the stories we tell ourselves, it's really important to find hope in the hopelessness and to ensure people act in a way that can actually generate hope again. You know, and so that's one part of of the point. The second part is that hopelessness, I think, transitions at some point into indifference. You know, you can see it with certain patient interactions that you had, you know, coming across folks who show up because they're going to die otherwise. But they really have no hope that the system is going to help them. Right? They come in very indifferent. You know, you're just going to be like every other physician, every other health provider that I've ever met who hasn't been able to actually help me get out of this hopelessness. And that is a much more difficult problem to confront. Indifference is many magnitudes worse than hopelessness, regardless of how bad it feels, right?

Dr. Kevin Mailo: [00:41:42] Yeah, that's a very powerful observation.

Dr. Alika Lafontaine: [00:41:44] Yeah, and so we have a moment right now where we can really focus on doing things that will generate hope. I mean, you look at what's going to happen with the budget later on this month. I do honestly feel that there are going to be some very significant changes in the way that we collect data. The fact that we're going to share depersonalized data between jurisdictions now. We haven't really done that except in huge emergencies like having a unique patient identifier across the country means you now can compare all databases, I mean there's all these different things. The regional license opening up on May the 1st in Atlantic Canada, you know, finally taking a measurable step towards having folks be able to register once for a license and be able to practice in multiple jurisdictions simultaneously. That could transform practice in a lot of different ways. Suddenly, you meet somebody at a conference and you know that you all share a regional license. You could set up a virtual team together the next day. You know, you wouldn't have to worry, how am I going to practice if you move from, you know, a place like New Brunswick to Nova Scotia for school, for example, you know, you could keep your family doc. Because now your family doc's licensed to work in Nova Scotia, they can follow you where you go. You know, there's all these like, really amazing changes that could happen. But we haven't done the greatest job in helping people understand the hope in those actions.

Dr. Kevin Mailo: [00:43:07] Right, Right. The emotion that sits there.

Dr. Alika Lafontaine: [00:43:10] Yeah, 100%. And so, I think if we can focus on being authentic, because I think false hope is almost worse than remaining hopeless, you know, but we can take people to places where things are very likely to actually change practice, you know, actually make things better. It's important that we all kind of lean in and do that right now because once we start to become indifferent and once indifferent starts to spread and entrench itself across the health care system, it's going to be even harder to change things.

Dr. Kevin Mailo: [00:43:44] Absolutely. Absolutely. All right. I think we should wrap it up. But this was outstanding. It was just great. And I really want to sincerely thank you for your time, Alika, because I know you're busy. And on behalf of the profession, and I know you get a lot of thanks, I just want to share another thanks for all you've done to advocate for the profession, but also, again, you know, to advocate for Indigenous voices within our health care system to start meaningful, meaningful change towards one of the most marginalized groups in our society. So, again, thank you. And, you know, we should have you on the show for sure at another point.

Dr. Alika Lafontaine: [00:44:23] All right. Thanks for having me.

Dr. Kevin Mailo: [00:44:29] 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 PhysEmpowerment.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.