Dissident Doctor

Michael C. Klein

Description

How often do you hear a doctor saying doctors need to be more accountable, Medicare needs more support and family medicine deserves more respect? Dissident Doctor bristles with refreshingly frank criticisms from inside the health sector, and its author is not just any doctor but a distinguished scientific researcher, veteran medical administrator, Professor Emeritus, recipient of the Order of Canada and lifelong gadfly.

In Dissident Doctor, Michael C. Klein intersperses fascinating tales of individual cases with formative elements of his personal life. As the son of American left-wing activists, he grew up singing folk songs about justice and racial equality; as a young doctor his refusal to serve as a military physician during the Vietnam War prompted his immigration to Canada. His early experience working with midwives in Ethiopia—delivering babies using techniques for natural pain relief and without routine episiotomy—were formative, leading him to question many standard but unjustified procedures in Western maternity care. He made many unconventional decisions as a result of his focus on humane medicine, transitioning from a specialization in pediatrics and newborn care to become a family physician, and embracing midwifery before it was approved in Canada. Klein’s determination in the face of great opposition, the strength of his convictions, and his humility and sense of humour drive this powerful story of a life and career dedicated to his patients and his principles.

Informations

• Publié par: Douglas and McIntyre (2013) Ltd.
• Date de parution: 08 septembre 2018
• Nombre de lectures: 0
• EAN13: 9781771621939
• Langue: English

Extrait

Dissident Doctor
Dissident Doctor
Catching Babies And Challenging the Medical Status Quo
Michael C. Klein, MD
Copyright © 2018 Michael C. Klein
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system or transmitted, in any form or by any means, without prior permission of the publisher or, in the case of photocopying or other reprographic copying, a licence from Access Copyright, www.accesscopyright.ca , 1-800-893-5777 , [e-mail] /
Douglas and McIntyre (2013) Ltd.
P.O. Box 219, Madeira Park, BC, V0N 2H0
www.douglas-mcintyre.com
All photographs are from the author’s collection except where otherwise noted.
The excerpt on pages 180–181 is reprinted from Michael C. Klein, “Too Close for Comfort? A Family Physician Questions Whether Medical Professionals Should Be Excluded from Their Loved Ones’ Care,” Canadian Medical Association Journal , January 1997, Volume 156, Issue 1, 53–55. © Canadian Medical Association 1997. This work is protected by copyright and the making of this copy was with the permission of the Canadian Medical Association Journal ( www.cmaj.ca ) and Access Copyright. Any alteration of its content or further copying in any form whatsoever is strictly prohibited unless otherwise permitted by law.
Edited by Amanda Lewis
Indexed by Emma Skagen
Dust jacket design by Anna Comfort O’Keeffe
Text design by Sari Naworynski
Printed and bound in Canada
Douglas and McIntyre (2013) Ltd. acknowledges the support of the Canada Council for the Arts, which last year invested $153 million to bring the arts to Canadians throughout the country. We also gratefully acknowledge financial support from the Government of Canada and from the Province of British Columbia through the BC Arts Council and the Book Publishing Tax Credit.
Library and Archives Canada Cataloguing in Publication
Klein, Michael C., 1938-, author
Dissident doctor : catching babies and challenging the medical status quo / Michael C. Klein.
Includes bibliographical references and index.
Issued in print and electronic formats.
ISBN 978-1-77162-192-2 (hardcover).--ISBN 978-1-77162-193-9 (HTML)
1. Klein, Michael C., 1938-. 2. Physicians--Canada--Biography. 3. Midwifery--Canada. 4. Maternal health services--Canada. 5. Pediatrics--Canada. I. Title.
R464.K54A3 2018 610.92 C2018-902129-2
C2018-902130-6
To Dr. Howard Levy, who was jailed by the US Army for refusing to train Green Beret corpsmen, who would use their skills for political purposes. The other charge against him was “promoting disloyalty and disobedience” by discussing his anti-war views with GIs. Dr. Levy’s treatment by the Army was central to my decision to try to avoid such an experience and, in the end, leave for Canada.
To my lawyer, John Somers, whose advice and advocacy (without his realizing it) prepared me to try to convince the US Army that I was more trouble than I was worth.
To our kids, Seth and Naomi, who put up with my rants at the dinner table, and with whom I partnered in helping with Bonnie’s recovery. I am so proud of their values and contributions to making a better world. To Zoe, Toma and Aaron, our grandchildren, who light up our lives and who will carry the family story.
To my life partner, Bonnie, who despite her profound illness and disability, remains the force that holds our family together.
Table of Contents
Foreword ix
Introduction xiii
1. A Bunch of Lefties 1
2. Walt Disney Shapes Everything 4
3. WOCHICA 9
4. My Jewish Education 12
5. The Red Scare 14
6. Implications of My Early History 20
7. Oberlin College and Preparing for Medical School 23
8. Medical School 27
9. The Stanford Clinical Years 33
10. Chiapas, Mexico 36
11. Ethiopia: A Turning Point 47
12. Midwifery Influences 55
13. Bringing It Home 65
14. Obstetrics Comes Back to Bite Me 71
15. Internship at Albert Einstein College of Medicine in New York 77
16. New Love 81
17. Dr. Michael Klein versus the US Army 83
18. Life in Canada Begins 96
19. A Country Deeply Divided 101
20. My Life as a Pediatric Resident in Montreal 105
21. Job Hunting 115
22. Vania Calls from Montreal 123
23. Family Practice Evolves in Rochester 125
24. Return to Montreal 130
25. Teaching Family Practice Residents to Meet Community Needs 136
26. Herzl Doctors Expand 140
27. Oxford Sabbatical 143
28. The Herzl Family Practice Maternity Group Is Born 148
29. Bethune Visiting Professor 153
30. Birth: Why Do This Work When It Sounds So Exhausting? 156
31. Caring for the Religious Jewish Community of Montreal 159
32. The Joys, Dangers and Benefits of Family Practice 163
33. Episiotomy Surfaces Yet Again 166
34. Bonnie’s Illness 169
35. The Episiotomy Trial 173
36. Bonnie Beats the Odds 179
37. Coming Home 185
38. Back Pain 189
39. Making Trouble in Vancouver 194
40. Leaving Montreal 196
41. Unfinished Business 201
42. My Last Montreal Birth 205
43. BC Women’s and Children’s Hospitals 208
44. Anxiety Rules 212
45. Organizational Shenanigans 101 217
46. “Too Posh to Push” 219
47. Attitudes Trump Evidence 224
48. Rural Maternity Care 230
49. Midwives and the Home Birth Demonstration Project 238
50. Birth Rooms and Doulas Come to Vancouver 241
51. International Cooperation: It’s Not All about Birth 244
52. Living with a Diagnosis: More System Failures 247
53. My Mother’s Death 255
54. More Advocacy: Butting in Where You Have No Business 258
55. Nothing Fails Like Success 260
56. Private For-Profit Care 263
57. Winding Down 268
Afterword 271
Final Reflection: My Mentors 276
Endnotes 277
Acknowledgments 280
Bibliography 281
Index 284
Foreword
Michael Klein is my age, and because I have known him about half our lives, through tumultuous times in our world and in maternity care, my fascination with this book is deep. As I read it, I learned about this rugged individualist who thinks outside the box and can be very persuasive with his clear thinking and ability to support his beliefs with rational explanations and scientific evidence. The book enriched my knowledge of him and the interest we have shared for these many years—a passionate concern for the well-being of families from conception to successful, healthy integration of the family. For me, the book provided much background to explain how Michael came by his sense of justice, sharp wit and independent thinking skills that have led him to question widely accepted care practices that most clinicians follow without curiosity. Combine those traits with a feisty personality, a trace of stubbornness and a good deal of empathy for childbearing people, and you have a change-maker. I should add that Michael’s analyses of published research are most helpful to those of us who lack the time or skills to objectively analyze and evaluate methods and conclusions of research studies. He is a good teacher.
Because I am what some call a “birth junkie,” known for my work with doulas and childbirth education, I emphasize this area of our shared interest. This is not to minimize the importance of Michael’s work in family practice, pediatrics, neonatology and the social determinants of health and the place of birth in the larger context of society’s values. Michael’s exposure to the Red Scare and McCarthyism, his cross-cultural experiences in Mexico and Ethiopia, his struggles with the US Army and support for single-payer health care dating from his early years as a medical student at Stanford, and his own illnesses and the dramatic life-saving surgery for his wife, Bonnie (and his role in it)—all set the stage for his iconoclastic research on birth and critical analysis of old and new technologies. Michael thinks of himself not as a dispassionate physician-scientist but as a fully engaged human, free to use his own personal experiences within the therapeutic relationship.
Within family practice, his research emanates directly from questions posed by his patients or directly from his personal experience with family illness. As he puts it: “Apart from treating the condition, I could not afford not to look deeper into why the patient was vulnerable to the disease.” Although a substantial portion of the book is about the challenges of providing high-quality caring birth environments for women and families, it is not a birth book. Michael uses birth as a window through which to understand the values of a society.
Because of my particular background and focus, I’ve decided to highlight several areas of maternity care where Michael has made unique and original contributions, thereby changing maternity care practices or raising questions that challenge current entrenched maternity care customs or “sacred cows.” The bibliography at the end of the book includes references to his publications on these topics. I encourage readers to check out these sources. You will admire his critical-thinking skills and learn a lot! Although his studies are scientific, they are devoid of jargon and easy to read and understand by a general reader.
Research Methodology: Critical Examination of Meta-Analyses and Randomized Controlled Trials
Michael has authored numerous studies, commentaries and editorials analyzing and questioning