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Michael Klein: Canada’s dissident doctor

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Dr. Michael Klein, an American-born family physician and family medicine professor who spent most of his professional career in Canada, has just written his memoir, Dissident Doctor: Catching Babies and Challenging the Medical Status Quo. Klein is married to feminist filmmaker Bonnie Sherr Klein. They are the parents of Naomi Klein, an author and social activist, and Seth Klein, an economist for a left-wing think tank.

Klein headed family practice at the Jewish General Hospital (JGH) in Montreal (1975-1993) and the department of family practice at BC Children’s and BC Women’s hospitals in Vancouver (1993-2003).

You’ve been a principled and outspoken person. The book jacket describes you as a gadfly. Do you wear that title with honour?

It’s not my term. Other people might describe me that way. In my practice and in my research, I’m always asking questions about the appropriateness of a recommendation and whether it’s based on any real scientific evidence. I embraced midwifery when it was not yet regulated in both Quebec and later in B.C. I did that because it’s not about what the doctors need. It’s about what women need. Whenever you’re contesting conventional wisdom, you’re going to catch some heat. If you are butting up against an idea considered to be the normal idea, of course you’re going to get pushback. So you can’t take it personally; otherwise, you would be paralysed.

As an advocate for midwifery, you had quite a battle with your fellow physicians in Vancouver.

At this hospital in Vancouver, a handful of family doctors in my department where I was head for 10 years could not fathom how the head of family practice could support midwifery. They felt it was a conflict of interest. They felt I should only work on family practice issues. This small group tried to get me impeached. It tells you about the complexities about trying to be a leader in a group with different ideas. I had experienced the benefits of midwifery starting from medical school. I knew it could be done.

What would you say is your most important contribution to medicine.

My research in maternity care, particularly my research in episiotomies (the surgical procedure of making an incision at the base of the vagina to facilitate childbirth). From my own experience working with midwives, it was clear to me that the practice of routine episiotomies was a problem and we needed a randomized trial.

We conducted the only randomized trial in episiotomy in North America. Our study (published in 1994) showed that episiotomies caused vaginal trauma, the very trauma the procedure was supposed to prevent. As a consequence of that study, the rates of episiotomies have plummeted on both sides of the border. The rate went from 65 to 12 per cent. As a consequence of that, the number of cases of severe trauma to mothers during childbirth has dropped from 4.5 to one per cent.

You write that there were challenges in getting the study published.

I had trouble getting the study funded. Then there was the whole story of trying to get it published. Once I finally got through to the journal editor and I showed him the nonsense the peer reviewers were saying, he was embarrassed. He ended up publishing two more articles on episiotomy. The section in the conventional textbook finally changed in the early ’90s. Until then, that paragraph was unchanged from 1921.

When I look at your history, you were quite a rebellious doctor, even as a medical student. Do you think a person as strong-willed as yourself would be accepted into medicine today?

I think I would have a hard to time to get in now. It would be impossible, but less so because of my politics. I’m pretty well mathematically challenged. In today’s medicine, the kind of deficits that I had in mathematics would be a barrier to getting into medical school. I was very fortunate. The head at Stanford University and others could see something beyond my mathematical difficulties.

Have you seen a change in medical education and training?

The kind of liberal arts education I had at Oberland is less available to young doctors today. They go directly from high school to preparation for medical school. When you’re going to be dealing with people’s complex lives, you have to have a perspective that you don’t get if you’re just doing the sciences. Educators are trying to overcome this by teaching communication skills and a holistic approach towards the patients, which is good a thing.

As a professor in family medicine, you created a practice model at the JGH and later in B.C., whereby family physicians routinely deliver babies.

It is a challenge for family doctors to integrate maternity care into office practice. In B.C., we had to show a trainee that you can deliver babies and have a life. What we were able to show is that it’s possible. I founded the family practice maternity service. We would deliver the babies and return them to their doctors.

In Ontario and Quebec, there is one obstetrician for every seven family physicians. In B.C., it’s one in 13. It tells you immediately that the style of practice is different. About 50 per cent of family doctors in B.C. incorporate delivering babies into their practice.

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Could you talk a little about what you and your family went through during your wife’s illness? She had a stroke at a very young age.

It’s 31 years ago. Bonnie was in her early 40s and she was healthy. She wasn’t supposed to survive. I couldn’t practice. But my colleagues at the JGH took over my practice and took care of me while I was taking care of Bonnie. There was a period in there where all I did was deliver babies. I moved between the delivery suite and my wife’s room on the neurological intensive care unit. It was therapeutic for me to be catching babies because it was life affirming, while I was dealing with all this death and destruction on the neurological unit. I could not have survived it without my family practice colleagues.

Could you talk about how you avoided military service during the Vietnam War and your arrival in Canada for a medical residency at the Montreal Children’s Hospital?

I was inducted at Whitehall, the same place where folk singer Arlo Guthrie was inducted. I was on my way to becoming a medical officer. I had done all kinds of things to not get that far. The odd physician, depending on his draft board, got out as a conscientious objector (CO). My draft board in Newark, N.J., refused my CO application.

I was terrified when we left for Montreal on Oct. 2, 1967. Bonnie and I thought I would be taken off the plane by the Americans. In Montreal, we didn’t know if the Canadians would arrest me and send us back. I was a deserter. I was a U.S. military officer waiting for my assignment and I was escaping to Canada. In Montreal, I showed immigration the letter for my medical residency and we were landed immigrants in 20 minutes.

 

This interview has been edited and condensed for style and clarity.