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Dr. Sarah Kawaguchi

dr. sarah kawaguchi

Role at the Centre

Hospital Education Supervisor

In-hospital doctor

Year started at the Centre

2015

Some people are bold and expansive with their words, painting word pictures with broad strokes and strong colours. Dr. Sarah Kawaguchi strikes me as the antithesis of such people: careful, precise, like a painter of ink-wash art. 

It’s clearly important to her, choosing the right word.  She takes her time when she answers my questions, thinks before she speaks. She’s not intimidated, as many are, by a long pause, but is more interested in finding the right answer.  

So she’s careful to point out that it wasn’t her medical school training’s fault that she didn’t have much exposure to palliative care until fairly late in the day. She did her undergraduate medical training at Queen’s University and moved to Western University in London for her Family Medicine residency. It was during residency that she really became drawn toward palliative care. She followed up her Family Medicine residency with a Palliative Care fellowship in Toronto, and from there moved straight to the Latner Centre.

She describes her introduction to palliative care as transformational. “It was just this total change in the way I perceived medicine and what we could do for people. I noticed that in every patient encounter, even though I obviously couldn’t change the course of the disease, I always came away feeling there was something that we could do.”

I asked for an example, a case in point. “Working at Mount Sinai Hospital we see a lot of younger patients, because it's a sarcoma referral centre. I might have thought before, that any time a young person dies it’s going to be a bad outcome: how could you ever find a positive in a 21 year-old dying? I’ve actually found that with a lot of work from a team of physicians, nurses, social workers and other interdisciplinary members focusing on quality of life for the time remaining, even for those young patients, it can be an important phase in somebody’s life. Even when it’s horrible that somebody is dying, there can be value in bringing families together and making it a peaceful end. I’ve seen enough cases where I never feel like I’m spinning my wheels, I do actually feel that as a group we are able to help a lot of folks to have a good outcome, or as good an outcome as it could be.”

It’s a thorough answer to my question, but not thorough enough for Dr. Kawaguchi, apparently, because she comes back to it later in our conversation. “When you asked why I went into palliative care, it’s such a hard question to answer. I don’t think it’s just because of seeing the benefits from day to day for patients. For me it’s also very much for the teaching aspects of it. That’s sometimes what I most look forward to about my day. I work in the hospital, with lots of learners (medical students and residents) all the time. And I interact with learners on other teams. When I can help other people learn how to do palliative care or empower them to take some of this on, I feel like I’m not in isolation working on making things better for patients but hopefully spreading what I do to other physicians.”

It is, she says, one of the aspects of the work that drives her. “I can’t help myself. It’s a huge part of my job and I think it will continue to be a huge part. Everything I’ve taken on outside of the hospital relates to education and improving education in palliative care.”

So when I ask her what single thing she would change about her job if given the magical power to change it, her answer is no real surprise. “I’ve thought a lot about this. As a group we’re trying to work on optimising palliative care provision in the hospital. It comes back to what I said about teaching. If I could change one thing I would get rid of some of the inefficiencies.” 

What inefficiencies does she mean, I wonder? “Where I’m doing things that aren't promoting good patient care and collaboration. (I’d like to) get rid of some of the inefficiencies that are just built into working in a hospital setting and take that time to focus on teaching, use that time to do even more teaching for residents and medical students. I think that’s probably one of the biggest parts of my job outside of just caring for patients day to day is being able to empower other people to do palliative care. There are only a few people in this organization and a few other organizations in the city who are specialists in palliative care but every physician should be able to do some palliative care at least on a basic level. So if I had more time to teach all of the learners in the hospital more about palliative care that would be what I want.”

 

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