Klein, Michael. Dissident Doctor. Douglas & McIntyre, Madeira Park, 2018. NF; 11-23.

Like most Canadian family physicians I’ve known Dr. Klein by reputation for decades. He’s been a leader of Family Practice departments in various cities, and has published a lot of research, mainly on giving birth and general care issues. Honestly before meeting him recently I somehow got the impression that he was more interested in publication and professional advancement than patient care: a bit of an academic grand-stander. But that idea was badly mistaken as this autobiographical book indicates and sitting and chatting for with him proves to me beyond a doubt.

Michael has done a bunch of things in medicine that are nearly unique and in some ways brave and self-sacrificing. He judiciously breaks with tradition where necessary but sticks to the basic scientific and humane unwritten rules of the business, too often ignored these days in my opinion, also. Even a short conversation with him in person leaves me with the conviction that he is driven by belief in scientific rigour, determination to encourage and build excellence in family practice, but most of all by personal duty to patients and opposition to the nonsense which today I find everywhere in administration and clinical work in healthcare.

The writing style of this story is what I call transparent. Our interest is held by straightforward and simple narrative of well-chosen factual material. The events speak for themselves. Let me summarize some of the important things Michael tells us about his life.

Never much good at math (a characteristic I have personal experience with) living in the United States he wanted to be a physician. Unfortunately he was rejected multiple times by medical schools (again I sympathize) because his academic strengths didn’t exactly align with what was considered medical in the mid-20^th-century. Strangely, he was admitted to medicine at Stanford University, where the medical curriculum spanned five years, administrators apparently hoping that he would somehow learn what he needed to with an extra year of training.

At Stanford Michael went beyond learning anatomy, pathology, and clinical science, After three years of med school he spent six months in Ethiopia. There he functioned as a physician, doctors being thin on the ground. This experience led him to develop skills and approaches to patients that he never could have seen back in the US. Michael requested an extra year in Africa and this was endorsed by Stanford although it set him back a year in his training.

A focus in Ethiopia on illness unusual in the first world, especially dealing with natural human labour and delivery, set Michael on a path toward caring for newborn babies and in fact still in the United States he trained and qualified as a pediatric subspecialist in neonatology.

America’s focus on the Vietnam war in the late 1960s and because all physicians had to join the armed services (to keep military personnel healthy enough to fight) drove Michael north to Montréal, although he also convinced the authorities that he would not be a good candidate for the military. There he discovered that general or family practice didn’t have much that was academic and scientific going on, and so Michael became involved in helping develop teaching and research in primary care.

I’ve never heard of a fully qualified subspecialist becoming a family physician. I’m sure it’s happened but the hierarchy in the profession favours ever-increasing specialization. Michael apparently just followed his instinct for where he could make a difference. And he did. Before coming to the Canadian West Coast, he helped develop programs and mentored students in family practice, especially focused on the growing emphasis on natural childbirth.

Another critical event in his life was a near-fatal stroke his wife Bonnie suffered. Michael challenged the nihilism of specialists looking after her and also participated as a physician in her care and treatment. He was criticized for this as it is strongly traditionally prohibited for physicians to treat family members. But seeing highly qualified doctors failing to properly diagnose and look after his wife drove him to essentially save Bonnie’s life by forcing unusual treatment options.

I haven’t included many of the successes and anecdotes Michael describes in his autobiography. The examples he has given to the rest of us in his long practice life include getting away from a comfortable sophisticated care environment and learning to trust one’s instincts and knowledge helping patients in remote places, and also developing a sense of the importance of a relationship of trust with them. He has shown that there are times where following the accepted professional system of sometimes myopic specialized practice is not the most productive pathway.

On a much less significant scale I have also discovered that swimming against the stream of accepted practice can lead to benefits for individual patients and for the system. Michael Klein’s courageously being a Dissident Docter has helped illuminate when it is wise to work with the system and when it’s necessary to break the rules. And he has given us quite a few examples of having the wisdom to know the difference.

I don’t think you need to be a doctor or directly involved in healthcare to enjoy and benefit from this life history.

9.5/8.7