This month’s interview is with Dr. Martina Scholtens, a Psychiatry resident. Dr. Scholtens has not only had her work published since 2002, but also wrote Your Heart Is the Size of Your First: A Doctor Reflects on Ten Years at a Refugee Clinic in 2017 based on her ten years of work at BC’s only refugee clinic! Happy reading!
Your writing has been published in journals and media outlets since 2002, and your book, Your Heart Is the Size of Your First: A Doctor Reflects on Ten Years at a Refugee Clinic was published in 2017. As a physician, what is it that drives you to writing?
A day’s work at the refugee clinic didn’t feel complete to me unless I captured something of what was memorable that day in writing. There was so much that was moving, or funny, or interesting, that I knew would be lost if I didn’t document it. And so I wrote first of all to remember.
Then I began to write to sort out the things I found difficult, such as the disparity in wealth between patients and staff at the clinic, or whether I should accept an invitation to a patient’s birthday party. The word essay comes from the French, to try, and writing was a way to try to make sense of things.
I wrote because I wanted to, not because I thought I should. But then I attended a narrative medicine conference where American physician writer Louise Aronson said that physicians ought to write — that they have a triple obligation to patients, to themselves and to society. She said physicians ought to write to memorialize their patients, to reflect on the work of doctoring, and to advocate for what their patients need. And that’s what I tried to do with my book, Your Heart Is the Size of Your Fist, about working at the refugee clinic.
I also write to entertain. A reader once wrote that her kids were crying for dinner but she couldn’t put my book down, and that made me happier than it should have.
Finally, writing lets me make something. The one thing missing for me in medicine is the opportunity to make things.
From 2005 to 2015, you worked at the Bridge Refugee Clinic, which was the only refugee clinic in BC and has now been shut down. You now own and manage the website “Refugee Health Vancouver”, where you strive to provide resources to other physicians working with refugees. What do you hope for physicians interested in this area of work or, are only starting, to take with them into their practice?
Caring for refugees is fascinating and rewarding work, but challenging for linguistic, cultural, logistical, and financial reasons. I made the website to develop and collate resources to support clinicians at the point of care. In a broad sense, I hope new physicians bring curiosity and cultural humility to their encounters with refugees. Specifically, if they use one resource it ought to be this one: the Canadian Collaboration for Immigrant and Refugee Health checklist.
You switched into Psychiatry from Public Health & Preventive Medicine in the Fall of 2018, after receiving a Master of Public Health degree. What made you decide to head into Psychiatry? What has the experience been like thus far, compared to Family Medicine and Public Health?
After ten years as a family physician at the refugee clinic, I wanted to practice medicine through a different lens. Initially I decided to pull back for a wider view, looking at populations rather than individuals, and I started training in public health.
I soon realized two things. The first was that I sorely missed patient care. The second was that I would rather go narrow and deep than broad and general. Family medicine is vast, with its breadth of responsibility and the daily volume of patients. Public health is similarly broad, covering everything from water quality to health policy to pandemics. I’d enjoyed mental health at the refugee clinic, and so I was doing all of my public health electives in mental health, such as McGill’s Summer Program in Social and Cultural Psychiatry. Increasingly, I realized that psychiatry, with its direct patient care and specific focus, was a better fit with my skills and interests than public health.
Then I was asked in an interview related to my book about my alter ego, and I flippantly replied, “My alter ego is a psychiatrist who lives on ten acres on Vancouver Island and drives a red Jeep with a border collie riding in the passenger seat.” And then I thought — well, why not? So I made the leap and now I’m a psychiatry resident living on a half acre in Victoria with a cat. Getting there.
Public health and psychiatry are more closely related than you might think. Both dovetail with refugee medicine, which remains one of my main interests. Both are contextual, concerned with the bigger picture rather than an isolated complaint or data point. Both acknowledge the key role of social determinants of health. Both involve collaboration across sectors. And the skills I learned in my MPH — critical thinking, data analysis, program development, policy making — are applicable to psychiatry.
I’m happy with the change. Psychiatry suits me. I love the orderliness of the DSM-5, mental status exam, and psychopharmacology. I also love all the room for nuance and uncertainty. Spending a half hour or more with a patient feels luxurious. So does directing the patient back to their family physician for their back pain. I do miss my stethoscope. In my first week of residency, the patient I was seeing with my preceptor started vomiting. We handed him a garbage can and watched. The family physician in me was itching to get him on an exam table, do a physical exam, and find some Gravol in the sample cupboard.
What are your plans for the future, in terms of practice and your interest in narrative medicine?
I plan to practice general psychiatry with a cross-cultural focus. I want a mix of patient care, teaching, writing, and speaking. My ideal is a dual academic appointment in medicine and the humanities. I intend to carry on with medicine and writing throughout my career. Anton Chekhov said, “Medicine is my lawful wife, and literature is my mistress. When I get tired of one I spend the night with the other. Though it is irregular, it is less boring this way, and besides, neither of them loses anything through my infidelity.” Psychiatry residency has been rich with writing material, and I have a few literary projects on the go. I plan to continue to participate in narrative medicine events. This summer I will be co-facilitating the Taos Writing and Wellness Retreat for Health Professionals in New Mexico– residents welcome!