Reminiscing on residency: Dr. Josiah Osagie on switching course, meeting patients where they’re at and the importance of humility

Dr. Josiah Osagie describes his move to Canada as the typical immigrant story: at 17, his parents uprooted the family, moving him—17 at the time—and his siblings from their home in West Africa to North America. “Nigeria is a wonderful country. It’s rich in culture and beauty, but Nigeria—the political and social situation—doesn’t let you be your best self or achieve as much as you could,” he says. While he doesn't remember the exact age, Dr. Osagie recalls being "youngish" when he knew he wanted to become a doctor. Inspired by a family friend who is a pediatrician "back home," he moved to Canada with plans to complete his undergraduate degree at the University of Toronto and pursue a Doctor of Medicine in pediatrics.“I shadowed a paediatrician during my training, and I decided it wasn’t what I wanted to be. There’s a difference between liking children and working with children,” he says. Young and inexperienced, Dr. Osagie quickly noticed the stark difference in wanting to be kind, loving and nurturing to children versus the complexity of treating both sick and healthy kids, while also managing the expectations of parents and families. He also noticed a growing passion for a different area of medicine he hadn't previously considered: psychiatry. The field aligned with his fascination with the mind—an interest he continues to explore even as he works within it. It was during medical school that he developed a passion for mental health, even becoming a vocal advocate for free psychotherapy.His commitment led to him being awarded the Dr. Benjamin W. Appleton Prize in Psychiatry, a prize given to a student in their final year who has demonstrated outstanding achievement in the field of psychiatry. The award, he says, took him by surprise. “When you’re in medical school, everyone around you is excellent, so to win an award in the environment, surrounded by brilliant people, is amazing.” The bulk of his advocacy has been to support the mental wellbeing of Black people: a group featuring diverse cultures, beliefs and creeds. During his clinical hours—where he spends the majority of his work—at the Centre for Addiction and Mental Health (CAMH) in Toronto, Dr. Osagie works with youth through the AMANI Mental Health & Substance Use Program. Formerly known as the Substance Abuse Program for African Canadian and Caribbean Youth (SAPACCY), the program offers culturally affirming mental health support to Black youth ages 12 to 25. On the ground, the situation is messy: transitioning from medical school to practice has shifted his mindset from some of the idealism he held in medical school to the reality of what it is like in clinical care. A lot of his work involves advocating on behalf of his patients: writing letters, speaking to lawyers on his patients’ behalf and incorporating parents and caregivers to treat his patients. Jumping into practice has meant shifting his mindset on how the textbook says treatment should look versus the reality of trusting a patient and respecting their autonomy. Medication, he says, can also become a point of contention with the patients he works with. And as a new doctor, it’s easy, he says, to become frustrated with the brutal reality that some psychiatric medicines don't work for every patient.“Trying to get them to buy into the idea that a medication can be good is already hard. There’s a lot of leg work that goes into building that trust, especially with a community that has historically not been treated well in medicine, and has that skepticism—which is justified—about medicine already.” With this in mind, he wants to see a broader set of options for his patients. “I would love to see innovations in mental health care. I want there to be better access to the non-medication treatments for mental problems. We know that therapy can be very effective, but it could be difficult to access it. I would love to see that change.”1. What is the biggest thing that residency taught you about being a doctor? The importance of humility: as a resident you know things, but you know very little. You already have an MD when you reach your training, but there are a lot of things that you don’t know. You need to approach residency with that curiosity. You’re there to learn from the doctors that are around you, but also from your patients and the day-to-day. Building relationships is unbelievably important for so many reasons. The relationships that I formed with other doctors, nurses, staff, admins, social workers, occupational therapists, the people that cleaned the units, the security guard, gave me another layer of protection and perspective—both mentally and physically—on those tough days.2. What is something you've learned further down in your career?The importance of confidence as the MRP: most responsible physician. The real world is a lot more messy, filled with a lot more uncertainty, there are many different truths operating at the same time. Everyday life is ambiguous. Something that has been a big part of my day-to-day is relying on those more experienced doctors. You have to be a decision maker, that has to come from a place of humility. I’m actively learning that: to be the decision maker, and to have the confidence. You can consult those other more experienced doctors, but at the end of the day, you have to be comfortable making decisions. As the MRP, you know your patient best, you know their situation and you’ve been part of their journey, advice from experienced doctors helps, but you need to be confident enough to make decisions.3. What is your number one tip for residents?The pressure is very high on residents. I think residents should remember that we, as doctors, are only one small piece in a person’s life. A lot of residents internalize failures. Making mistakes and negative feedback from supervisors can hit you hard, and if you internalize it, it could affect your self-esteem. My mantra throughout was that 'I’m a person' and 'it’s deep but it’s not that deep.' You learn from things and you grow, but you don’t let them affect how you see yourself.No resident needs me to tell them to try their best, they all are. They’re training, they’re learning, they’re striving for their best, they’re already doing that. I think we need to be reminded that we’re just human.

Reminiscing on residency: Dr. Josiah Osagie on switching course, meeting patients where they’re at and the importance of humility

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