Reflection of a career in paediatrics: A calling becomes a fulfilling profession

Department of Paediatrics, The Montreal Children’s Hospital, Montreal, Quebec Correspondence and reprints: Dr Alice M Chan-Yip, Department of Paediatrics, The Montreal Children’s Hospital, 2300 Tupper Street, Montreal, Quebec H3H 1P3. Telephone 514-412-4400 ext 24433, fax 514-412-4255, e-mail alice.chan-yip@mcgill.ca Accepted for publication January 26, 2011 I was born to physician parents in China. My father died of tuberculosis during World War II when my brother and I were still young, leaving my mother to practice medicine as a single parent while we fled from Hong Kong to Macau and finally to Guangzhou. I attended high school when we returned to Hong Kong. My mother’s influence and the helpful nature of the profession inspired me to apply to medical school after my high school graduation. The only medical school existing at the time was at the University of Hong Kong, where English fluency was a prerequisite for admission – a skill that I had not yet mastered. Fortunately, with my mother’s support, I was able to pursue my higher education abroad. I began studying biochemistry at the University of Ottawa (Ottawa, Ontario). The next three years were full of challenges such as language barriers, academic pressures and acculturation stresses. This early experience definitely sensitized me as a clinician to the plight of new immigrants, and later influenced my acute awareness of the inequity in the quality of health care received by the children of immigrants compared with those of mainstream Canadian families. During my training as a medical student and paediatric resident, the faculty staff became my role models because they demonstrated professionalism, scientific curiosity and enthusiasm in teaching evidencebased medicine. I received paediatric training at both the Montreal Children’s Hospital (Montreal, Quebec) and The Hospital for Sick Children (Toronto, Ontario), where I later completed a Clinical Research Fellowship in metabolic bone diseases under the supervision of Dr Donald Fraser. This experience was invaluable and fostered my future interest in community research. However, the intense demand of metabolic laboratory research was not compatible with my personal life. It was clear to me that the choice between professional advancement and family commitments could affect the balance of a meaningful life. I also firmly believed that both family and personal leisure, recreational activities and exercise, were essential in maintaining one’s well-being. I returned to Montreal when my husband joined McGill University (Montreal, Quebec) as a Professor of Engineering. I eventually took over the well-established community practice of Dr Brock Dundas, who informed me of the three A’s of being a good paediatrician: be Affable, Available and Able. Joining his community colleagues for weekend calls taught me the importance of the continuity of care. Dr Dundas had a unique patient filing system. All sibling records of each family were placed in one file under the name of the father or mother. This filing system enabled me to familiarize myself with the family structure and dynamics at each child’s office visit. The information provided relevant cues on psychosocial attributes related to the wellbeing or health problems of each child and the family. The current electronic filing system facilitated family centred childcare practice. I am a firm believer in integrating developmental monitoring and anticipatory guidance in patient care; such practice can enhance our knowledge in behavioural paediatrics and psychosocial medicine. A well-managed practice can reduce patient waiting time, guarantee daily available appointments for acute care visits and screen telephone calls efficiently for urgent appointments. I always reminded the receptionist to ensure my prompt response to telephone calls from anxious parents so that serious problems would not be missed. I was invited to develop a half-day per week paediatric ambulatory clinic at the Montreal Chinese Hospital. I soon realized that the lack of culture-specific community health services for immigrant families was often associated with prevalent health problems. For example, there were no language-specific (Chinese) social services, prenatal classes or health information on subjects such as nutrition and dental care. The prevalent health problems among Chinese immigrant children then included low breastfeeding rates, failure to thrive, iron-deficiency anemia, nursing caries, as well as emotional and behavioural problems associated with unidentified developmental delays and specific learning disorders. The goal to improve health care for a target cultural group requires multiprong approaches (1). One could first identify prevalent health problems, then engage interest groups, sensitize specific community leaders about unmet health care needs and inspire them to join in to make a difference. My involvement with action groups from social services, school boards, volunteers and community organizers resulted in the establishment of the Chinese Family Service of Greater Montreal, creation of a culture-specific prenatal class for Chinese-speaking families and the publication of a Chinese manual entitled, “Family-Centered Child Birth and Infant Care”. In 1986, I also joined forces with multidisciplinary groups to develop a Multicultural Program at the Montreal Children’s Hospital. Collaborating with a psychiatrist colleague in a summer research project, I was able to study the association of psychological function and acculturation styles of a group of multiethnic immigrant children and their parents (2). This study showed that A letter to my younger colleAgues