Dr. Robert Fowler, Sunnybrook Health Sciences Centre
October 25, 2016
October 25, 2016
Posted by Nadine Abdullah, MD, MEd, FRCPC
Unplugged medicine: meaning intimate, bare,
without extra accompaniments, where the art of the physical exam supersedes
limited technological resources. In his compelling manner, Dr. Fowler walked us
through his journey, from First World critical care where the art of medicine
often falls off to the reliance on machines and numbers, down unexpected paths.
He first experienced working in an outbreak
during SARS in Toronto, and at the time made connections with colleagues who
were experiencing similar outbreaks elsewhere. A network of clinical
researchers was born that would set the stage for international collaboration as
globalization of disease grew. Not long after, he received calls from
colleagues in other countries to help study their outbreaks; H1N1 in Mexico,
MERS-CoV in Saudi Arabia. He established himself as a leader in researching and
managing outbreaks, and was sought out for his knowledge. This led to a
sabbatical at the World Health Organization (WHO) in Geneva where his task was
to review lessons learned from these past outbreaks, and to establish
international standard protocols for future outbreaks. He employed the
principles of clinical epidemiology to define acute respiratory illness
outbreak terminology to improve the reporting of disease, and enhance global
collaboration.
During his term, word came of a potential Ebola
outbreak in West Africa, and he naturally traveled there with his colleague to
see firsthand what was emerging. They found themselves immersed in providing
clinical care and managing the outbreak. He described the makeshift setup of a
hospital, transfer of sick health care staff, patients and rudimentary supplies
from one hospital to this new centralized "facility" to provide
ongoing care to the population. In the course of observing the evolution of
this illness in individual patients, Dr. Fowler and his colleague noted the impact
of dehydration on mortality, and began to institute aggressive IV hydration
protocols, with point of care blood testing, oxygenation, and management of
target organ damage. Despite limited resources, they began to collect formal
data, and through careful documentation and analysis, demonstrated that they
could see a 50% reduction in mortality with basic supportive medical
care. The unprecedented high mortality previously documented in Ebola was
not simply the result of an inevitably fatal virulent disease, but due in large
part to the consequent treatable dehydration, resultant metabolic derangement,
shock and organ failure.
Early publication of their data in the New
England Journal of Medicine led to widespread understanding of the disease and
its management, and put Ebola on the radar of governments and agencies allowing
them to recognize need and mobilize resources, eventually halting the outbreak.
Dr. Fowler and his colleague's work has set a
new standard for live epidemiological research while simultaneously providing
emergency medical care in a devastating outbreak. The individual patient and
global population impact is measurable; the timeliness incomparable to the vast
clinical research we pore over in medical journals. Their work will serve
global health immensely when the next outbreak hits.
This talk was not merely a physician's biography and resume of academic achievements. It was a captivating narrative about the blending of science and humanistic medicine. It illustrated the impact of applying the science of clinical epidemiology to global health. When time was up, and groups lingered to talk more, the discussion turned to the practical personal impact and sacrifice, an intimate experience of leading care amidst a frightening health crisis, and returning to the comfort of a First World health care system. As with our last lecture on MAID by Dr. Gary Rodin, this talk exemplified how the Medical Expert role is inseparable from the intrinsic CanMEDS Roles, this time with a particular emphasis on the Collaborator, Leader and Scholar Roles. But it also had several take-home messages for the learners and junior faculty seeking mentorship and role models for career planning. Here are some lessons I took away:
1. Take advantage of the clinical experiences around you; they will prepare you to be a leader in future unexpected roles.
2. Take a sabbatical that will give you an opportunity to be part of a global collaboration. You might find yourself being the right person, in the right place, at the right time.
3. Get out of your comfort zone. It gives you new perspective from where you work.
4. Remember the importance of giving back. We have developed critical skills and knowledge that can impact the health of a broader, more vulnerable population than that we serve daily.
I wondered; do we spend enough time explicitly
teaching and modelling these lessons as educators? Were the senior attending
physicians present who had formerly taught and supervised Dr. Fowler thinking
with pride that they might have contributed in small part to inspiring this
passion? Were the students and residents inspired to think how their future
careers would unfold?
A month later, the buzz lingers in the air.
Inspired by this talk, what stories about their careers will they in turn be
talking about in twenty years?
Bio – Rob Fowler, MD
Dr. Fowler
is a General Internist and Critical Care Physician at Sunnybrook Health
Sciences Centre, Adjunct Scientist at the Institute for Clinical and Evaluative
Sciences (ICES), Associate Director of the Clinical Epidemiology and Health
Care Research graduate program of the Institute of Health Policy, Management
and Evaluation at the University of Toronto, and a senior Scientist at
Sunnybrook Research Institute. He was a WHO consultant during the 2014 Ebola
outbreak in West Africa. He has an active research program focused on clinical
outcomes of critically ill patients, holds a number of peer-reviewed grants,
and has published widely. More recently, he was appointed to the Order of
Ontario.
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