What I learned from getting my medical license in British Columbia

My next book, “Sense & Sword Agility” starts off in New Brunswick and ends in British Columbia. Because I’m running away from real life and rewriting Jane Austen’s ”Sense and Sensibility” with sword-fighting sisters and dragons.I poked around for a suitable town name. Swords, Ontario was a ghost town that could have worked. I plotted out how to drive that far north.But I wanted a more dragon-oriented name. After some laborious searching, I decided on Bullion, B.C. Get it? Like gold bullion. Which it was, because they mined mercilessly for gold, even redirecting rivers to wash more gold out.I wasn’t sure I’d make it to northern B.C. for research, the way I’d gotten my Newfoundland license to write “Pride & Provocateur.” Then my friend said, “I’m doing a locum as a hospitalist in B.C.”“Really? I’m writing a book in B.C.!”Bullion was only about five-to-six hours’ drive from her hospital. Doable.Time to get my medical license in B.C.!But Canada doesn’t have a national licensing system. And getting licensed in B.C. is a BEAST.Newfoundland, I had to pay, but they did their best to expedite everything so I could practice.B.C.? I’m a relatively straightforward candidate, since I did all my training in Canada and have passed to requisite exams. The biggest issue for me was that B.C. separates out family and emergency medicine! On top of that, they require 960 hours of practice in the past three years.So, I started volunteering at clinics and the hospice to work up the hours.This meant that it was very tight on timing between my license and my locum. I arrived already exhausted from working in Ontario, plus the jet lag. But the hospital was welcoming and started me off with fewer patients so I could get used to their medical records and rushing around the hospital.On the upside, I had so many more resources than at my little hospital:For example, I had a potentially urgent ortho case, and ortho was at the bedside within 10 minutes. (Humourous side note: spellcheck suggested that I had an urgent “orthodontic” case, and “orthodox” at the bedside, which would be . . . a different scenario.)ER would CT almost everyone overnight before admission in the morning. If I ordered a CT, radiology tried to do it the same day. I consulted infectious diseases, vascular surgery, gastroenterology, general surgery, palliative care, and oncology—I haven’t worked at a hospital with oncology since residency!If I wanted a consult or a scan on a patient, I didn’t have to call and beg a physician at another hospital, and then another one, and possibly a third one, selling them on how sick my patient is. I just had to enter a consult order and either call or send a message through “the miniblog.” Incredible!Even radiation oncology at a nearby centre managed to get back to me, even though they are overwhelmed.Plus, the foundation CEO kindly took me and my daughter out for dinner, and I received “red carpet” passes for many attractions, including the B.C. Wildlife Park.There were some hitches, of course:The hospital was at 120% capacity, which increased the stress and the risk of errors.Patients were much sicker than I was used to on the floor, with unstable vital signs and age and comorbidities. It turned out that admission was dictated by their code status, MOST, which had at least six different levels instead of the three I’d been used to.I saw my first two cases of resistance to piperacillin/tazobactam. What will we do when meropenem doesn’t work anymore?What do you do when specialists disagree and you don’t want to offend anyone? I tried to navigate this tactfully.My billing number did not arrive until after I’d finished my week, and they mailed it instead of emailing it, which is not useful for when you’re doing a locum on the other side of the continent (they did say I could call for it too, but it was a lot of bugging and following up on my end that I would have liked to spend on patient care instead).Similarly, you need a special prescription pad for opioids, which takes three weeks to mail. That was just not enough time to arrive. The solution was to ask your colleagues to prescribe it for you, or to not prescribe opioids.I’m also not used to having to pay for accommodations (and everything else) and get reimbursed later. Ontario, Quebec and Newfoundland had simply provided accommodations, no questions asked. One drawback was that my daughter and I aren’t used to unhoused people yelling and waking us up, but they never scared us. In fact, only one man spoke to us downtown, and he said, “Do me a favour? STAY. AWESOME. You’re already awesome, so just stay that way.”Most of all, I met really cool patients who touched my heart. With 95% of the physicians writing meticulous notes, and nurses advocating for their patients, it was quite straightforward to follow their medical issues and figure out how to help.I have to admit, it was a nice change of pace from emergency medicine. Instead of putting out fires for people I’d never met before, who may or may not be able to articulate for themselves, and doing it as fast as possible—I could concentrate on my allotted patients.Once free of the hospital, my daughter Anastasia and I drove northeast to Buillion, B.C., to research “Sense & Sword Agility.” The magic had begun.

What I learned from getting my medical license in British Columbia

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Dr. Melissa Yuan-Innes

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