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Three Decades of Taking Care of Women and Those They Care For - by Dr. Sandra Landolt

Updated: Nov 10, 2021

The Pandemic has forced us to connect and teach via virtual means, which has actually been surprisingly enjoyable. I had the great pleasure recently to participate in a virtual speaking evening to a group of enthused medical students across Canada. The evening was centered around Dermatology and Women’s Health. One draw was seeing a couple of my colleague/friends whom I have shared the past couple of decades with. Our lives and careers have been intertwined in what CWIM has rebranded as Peer Related Networking, what we define as a form of fluid mentorship. I decided to pick a non clinical topic for my portion of the evening and to focus on the Art of Medicine and the Beauty of lived experience.

This is a talk originally presented at “Women’s Health: A Dermatologist’s Perspective.” April 8th 2021 (virtually).

There are always a handful of key pieces in the foundation of our individual and collective experiences that have some sort of formative relevance. I don’t believe that when I was a student I realized any of these factors.. I was too busy getting from point A to point B and then looking for the route to point C.

This is where I am going to digress a bit..

I literally heard this on CBC “The Current” when I was driving Note to all.. to save time apart from listening to podcasts you can plan your daily commute to take in curated current events via osmosis. This is what I heard ….

“A couple of weeks ago history was made.. on March 24th, for the first time ever in NBA history, there was an All Women announcing team broadcasting the game. It was done in honour of International Women’s Day, but apparently there are no plans in the foreseeable future for a repeat event. The VP of the Raptors stated that they were making a point in this gesture, and especially hoped that girls would take home from this message that there is a place for them in Sports and Sports Announcing..”

First event in history?

No plans for another all women announcing team in the foreseeable future?

Take-home message for girls that there is a place for women in sports announcing?

I realized at that point that opportunities that I had always taken to be a basic given, were not necessarily that at all. I was shocked at myself that as an advocate for women’s empowerment that I had missed this completely.

I am going to pause for a moment so that we can all think about our influences, inspirations, mentors.. The women who allowed us to dream, think, and ultimately pursue what we felt was possible. For each of us it will be something different, or maybe we haven’t even thought about it. But I think for many of us, the picture is complicated.

While you are all thinking I can start with my own influences…

The Obstetrician who delivered me in 1962, was in the first medical school class after WW2. After further post graduate studies became a Professor and Consultant in high risk pregnancy at Hong Kong University Queen Mary Hospital. This Obstetrician was a young biracial woman (In those days there was no such term as BIPOC and we used the term Eurasian) She was part of the small Macanese Community that my family was an integral part of when I grew up in Hong Kong.

She was my vibrant, beautiful and badass Godmother.

She moved to San Francisco in 1969 and I lost the opportunity to have frequent contact with her, but realized that she was a gentle force and pioneer in the male dominated specialty which became her passion, Gyne Oncology. She eventually became Clinical Professor in Gyne Oncology at UCSF Medical School at Parnassus and taught colposcopy to an entire generation of residents. Although colposcopy had originated in the 1920’s, it wasn’t used in North America until the 1960’s. PAP smears and colposcopy have saved the lives of millions of women over the past 6 decades.

Sadly she died this past January at the age of 95.

My association with her definitely allowed me to believe at a very early age that a career in Medicine, including caring for and advocating for women was something worthwhile and definitely within my bandwidth, although honestly Obs Gyne never had the same appeal for my visually driven mind. Definitely she had a subliminal influence in my interest in Medicine, present from about age 5 onwards, and my belief that I could somehow succeed in any discipline that I applied myself to.

Women, and especially women physicians and physicians in training, have this opportunity to lead by example, what I call soft longitudinal mentorship. We have the opportunity to influence our patients, students, children on many levels both directly and indirectly, formally and informally, during individual encounters as well as over the course of time in small incremental but important ways.

This is very true in Medicine and especially true in the practice of Dermatology.

The first month after I passed my Dermatology Fellowship exam I had the task of doing a 2 week locum for one of the Giants of Dermatology in Toronto, Dr Ricky Kanee Schacter.

I think I identified with Dr Schacter because she was very similar to my Godmother. Both women were from racial and cultural minorities. They both chose to specialize in fields that were important in Women’s Health and travelled away from their families, at a time when such a decision was culturally unacceptable - to abandon family commitments to pursue additional post graduate education. Both pioneered medical initiatives, my Godmother re: colposcopy and Dr Schacter re: the outpatient treatment of psoriasis in the creation of PERC. In my mind they were and still are both legends and regular women, in the same breath.

Although Dr Schacter had officially retired even before I started as a resident, she was still seeing patients full steam even after I became a freshly minted FRCPC. For me it actually was a busy and extremely educational 2 weeks. Mainly because I was able to observe from her notes, and my interactions with her patients, how remarkably skillful she was in the Art of Medicine. Her detailed social histories, apart from often leading to more expedient diagnoses and better management plans, allowed her to establish and maintain trust and common ground with her patients . I funnily enough hadn’t during 6 years of residency seen anyone take notation of kids names, birthdays, special events, hobbies and other personal details. It subsequently has become the first thing I do with my own patients. The incredible power of personal interest was revealed to me.

Dermatology patients tend on the whole to have great trust and regard for their Dermatologist.

Firstly, often after seeing many other individuals, physicians included, we are able to very frequently quickly make a diagnosis and formulate a plan of action despite being faced with a problem or puzzle that has appeared to be elusive and unknown to others. We are masters of pattern recognition and have finely honed observational skills which have taken all of us years to perfect.. This ability to problem solve inspires a huge degree of confidence.

As a dermatologist your care is more of a constant than their other health care providers because of your track record in being helpful when others could not address the situation and the resultant confidence they have in you and your recommendations.

So for me it really has been 3 decades of taking care of women and those they care for. In the majority of cases, women in the family dynamic, take on the burden of the health care decisions in most family units. That is still usually the case although there are more gender non traditional family units today. I don’t think my experience is different from many of my colleagues in this manner.

Some patients will have acute issues episodically over the course of time, but a significant number will have more complex chronic skin problems requiring ongoing, even lifelong management. They include moderate to severe atopics and psoriatics, patients with immune and connective tissue disorders, and many other skin dermatoses requiring expert ongoing dermatologic care.

Unless they move to a different part of the country, or a different country, or very rarely if there is some sort of impasse in your therapeutic relationship, they are literally yours forever. I find that my relationship with these patients spans Graduations, Weddings, Birth of children, Divorces, Deaths. Celebrations and Tragedies. You laugh and cry with them.. especially if you have done a “Ricky Schacter” and taken a few notes along the way to remind yourself of the details.

As I mentioned earlier, not all patients are complicated, (thankfully) but many have intermittent reasons to seek your care. They appear every few years with some new issue and an update on their lives as my treat, and I take more little cheat notes on them at that point.

It’s also OK to share what you might want to about yourself while maintaining your professional boundaries.

What I find the most gratifying are the 3 or sometimes even 4 generations of patients that I care for, and their extended families. A lot of the time they share the same genetic predisposition to whatever skin issues are at hand. They already have some of the tools that you have given their family members when counselling them, but quickly realize that seeing a dermatologist will be extremely useful, and seeing one that is aware of the family history etc even more so..

Or sometimes they just happen to discuss their skin and promote your name at family get togethers .. That is ok too.

There are many other interrelated congregate groups, .. Block parties (yes I take care of entire streets and neighbourhoods) Office lunchrooms, Religious gatherings (yes entire congregations ) . The list can be endless.

Before I got NEXUS it was always a bit of a laugh going through the US border control at Pearson as a significant number of the officers were patients for reasons still unclear to myself. It is also unclear why they had so many derm issues…

It is wonderful to take care of patients of all ages (newborn to 100+ years) and to be allowed the privilege of of providing advice, guidance, mentorship. Maintaining a rich physician patient relationship is a small time investment but ultimately rewarding. Actually most of the time that sort of longitudinal mentorship and guidance is passive, ie by example.

Girls and young women, as patients see you in your role and see that role as one that they could also aspire to achieving. The same concept as the women sports announcers in a male dominated forum, and my casual observational relationship (ie girlcrush) with my Godmother.

What do I suggest from my 3 decades of taking care of women and those they care about?

1: Provide consultative excellence in addressing the problem and pathology - but don’t lose sight of the patient as a whole.

2: Embrace that your own experience in Medicine both as a science and as an art is based on longitudinal care. You learn as much from your patients as they do from you.

3: Remember your connection with your patients makes your practice richer as well as their lives, their circle and those that they care about.

Dr. Sandra Landolt is a medical dermatologist in in Thornhill Ontario. She is a foodie, animal lover, mixed media artist and spends summer weekends in her garden.

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