After 37 Years Saving Lives, Doctor Eyeing Ways To Improve Patient Care, Reduce Physician Burnout

He helped his patients bring life into the world and guided some to the end of their suffering.

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Reflecting on his 37-year medical career, Dr. Peter MacKean cannot imagine a more fulfilling role than serving as a small-town family physician in Kensington, P.E.I., thanks to all those he encountered that helped frame, change, and enrich his life.

“You know whole families through generations, even attending the deliveries of women who you previously delivered by yourself,” says MacKean, who retired last year but answered the call to work at the busy COVID-19 clinics in P.E.I.

He recalls a poignant moment during work in obstetrics where the power of human resilience, connection, and teamwork helped save a life.

“At the time of delivery, the baby’s shoulder became stuck (shoulder dystocia). It is not an uncommon situation. Usually, the shoulder will release using specific methods. However, in this situation, it became almost impossible to release,” explains MacKean while remembering the acute stress in the delivery room.

“When my colleague and I were able to release the wedged shoulder, the baby had no heartbeat at full birth. We began cardiac resuscitation and called in our pediatrician, who thankfully restored the baby’s heartbeat using an advanced medical procedure.”

Fearing the baby would suffer from brain damage, they transferred him to the IWK Health Centre in Halifax for advanced and specialist care.

“As it turns out, the baby did very well and has since grown to become a delightful young man," he said. "We called him the ‘miracle boy.’ As a family doctor, you want the best for your patients, especially when they are suffering.”

With the coincidence of being in Halifax to attend meetings a few days later, MacKean jumped on the opportunity to see the baby and family at the Health Centre. He continued to build on their patient-doctor relationship and others while practicing medicine in the small rural community.

Sharing unspoken truths

Dr. Peter MacKean on his graduation day at Dalhousie Medical School.​

MacKean, keeping busy in retirement, is shedding light on common unspoken truths in the hope to change the medical practice, improve patient health, boost clinical camaraderie while alleviating the pain doctors feel.

One of these unspoken truths is physician “burnout.”

“It is quite common for doctors to feel if they had done something different, the patient would have survived. And some doctors carry this burden for the rest of their career to their detriment.”

It's something he's personally familiar with, adding that it's essential that physicians maintain a healthy work-life balance.

During the first half of his career, MacKean worked as an independent practitioner. By taking on too much, he began to suffer from burnout.

“I had overhead, staff to care for, patients, and would end up missing family time by taking my work home each night to finish.”

MacKean realized he had too much going on and switched to a salaried position that guaranteed time off.

But, he warns, those who suffer burnout are more likely to commit a severe medical error. He stresses the importance of sharing with close colleagues when clinical mistakes happen to debrief, learn, and improve with safeguards.

“We are all human and make mistakes. Speaking for the profession, even though a doctor’s knowledge is good, clinical errors are alarmingly prevalent. The culture in medicine traditionally is that you do not talk about this because of fear or shame," he explains.

“It is quite common for doctors to feel if they had done something different, the patient would have survived. And some doctors carry this burden for the rest of their career to their detriment.”

Working to effect change

A program is currently in the works to help physicians when they have suffered – either through witnessing or being a part of – a clinical error. MacKean is one of the program leaders and aims to change this traditional culture of medicine to ensure physicians have the proper support and follow-ups on P.E.I.

Two essential things for doctors to remember, says MacKean, are to ensure that a person feels valued and the patient does not feel a power imbalance (with a doctor).

This service will ultimately improve the level of care to patients, he believes.

“Doctors should know the patient as a person, not as the disease. These are meaningful relationships. Treat disease and care for how people feel and how they function. And, always have someone accompany them to the office when delivering bad news.”

Two essential things for doctors to remember, says MacKean, are to ensure that a person feels valued and the patient does not feel a power imbalance (with a doctor).

“We should be partners on making the decision. The patient’s perspective matters. They are the expert in their condition, and this should be encouraged," he says.

"I would always sit slightly below the patient if they were in a bed because it was more personal.”

Psychological suffering is far greater than physical, he adds.

“This suffering is ubiquitous. We need to be knowledgeable about patient assessment and somatic (affecting the body) medicine, and we need to connect with the patient and their family at that human level, through thick and thin.”

Taking steps forward

There are many physical illnesses, but luckily medical science has advanced.

“Notably, with the advent of mRNA vaccine technology - which will be a key piece and public health measures to help end the worldwide pandemic,” MacKean says.

He notes many things people can do in the meantime to improve their mood and reduce pain, including those struggling through the coronavirus pandemic.

“Stay physically active, connect with friends even if it is online, and if possible, get out in nature. I am a big believer in the issue of mental health. When the chips are down, people come through. Their spirit is strong, and for a doctor, that is rewarding to see,” says MacKean.

I found in my practice, through all the suffering, that people can be amazing.”

“When a baby was born, I would be on top of the world until the next one. When someone died (a good death), if everyone involved got through emotionally, that was always a good feeling.”

Many patients in his practice showed tremendous courage when given a terminal diagnosis, he says.

“They were the heroes in my eyes,” says MacKean, who says that since he was a child, he had wanted to be a doctor.

“There was a show called Marcus Welby, M.D., an American medical drama that aired in the 1960s. In this television show, the doctor talked to his patients with a psychological edge. I thought that was great. I wanted to be like that doctor, looking after the whole patient.”

He became that doctor.

“I found in my practice, through all the suffering, that people can be amazing,” he adds.

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