Country Doctor

Summer 2010 CSANews Issue 75  |  Posted date : Jul 20, 2010.Back to list

Dr. MacMillan started his career as a country doctor. He then practised family medicine in Peterborough, Ontario, for 15 years before joining the Ontario Public Service, first as regional supervising coroner for Eastern Ontario, then as an assistant deputy minister of health and latterly, as executive director at the Ontario Health Insurance Program (OHIP). He then embarked on a career with the travel health insurance industry and has been the medical director of Medipac International, Inc. since 2002.

I was in grade 7 when I read a book about how Dr. Fredrick Banting and Dr. Charles Best discovered insulin and restored the lives of thousands of sick people with diabetes. It was probably the first time that I thought I might like to be a doctor some day. And it was during medical school at Queen's in the early 60s that I knew I wanted to start my career as a country doctor. In fact, I was so certain, that I committed to serving two years in a rural area of the province upon completion of my training and in return, received a $2,000 grant from the Ontario government. I promptly bought an MGA roadster and took off for my final summer before graduation to work in a California hospital.

During post-graduate training at the Toronto Western Hospital and the Hospital for Sick Children, I learned of a doctor who had recently started a country practice in the village of Apsley, Ontario, in the Kawartha Lakes region near Peterborough. He wanted a replacement, as he intended to serve in Malaysia for several years. In those years, "general practice" was often considered the destiny for "specialist dropouts," although the College of Family Physicians had recently been formed and had started a certification program for those who were voluntarily choosing the new "family practice" for their careers. The Toronto Western Hospital was particularly focused on this effort at that time.

After looking at a number of choices, I was certain that the practice in Apsley was what I wanted and in the summer of 1965, with our entire belongings (including our 17-year-old dog) in the back of a truck, my wife of one year, Tess and I set out from the big city for our new life in the country. Our home/office was to be a former small outpost hospital that had for many years served the area before its closure a few years earlier... when the village lost its last doctor. The practice had been revived a year earlier with the purchase and conversion of the building into a doctor's office and home by my predecessor. The building was old and quaint, but was equipped and furnished adequately. For $95.00 per month for our office and home, it was a pretty good deal! Furthermore, I was now making $2.25 per office call, at least from those who had private insurance, those who could pay cash or medical-welfare recipients. But from those unable to pay, there was always plenty of fresh fish, vegetables and homemade bread. The provincial health plan for physician services was initiated in Ontario the following year and, although there was payment for all services via government, there was something lost between doctor and patient with that transition.

For one month, the doctor who was leaving spent time with us, introducing us to patients, taking me on house calls, getting me signed up at the Peterborough hospitals 40 miles away and teaching me the "ropes" of country practice (of which he now had a whole year's experience).

Then I was on my own. Tess, a Kingston General Hospital graduate in nursing, had been an experienced intensive-care nurse and had worked in the recovery room at the Toronto Western Hospital during my internship, helping to supplement my salary of $77.00 every two weeks! She was now the office nurse and was working "pro bono." Although working with me most of the time, as the only medical resources for 40 miles and in an area of the province that grew by about 10,000 people in the summer, she was often called upon for emergency care when I was at the hospital or unavailable. On one occasion, she diagnosed a tourist with a gastrointestinal hemorrhage, started an IV and accompanied him in the back of a station wagon on the rushed trip to the emergency department in Peterborough. He survived.

It was a cultural shock going from a large teaching hospital in Toronto to a rural setting with no other nearby medical services or immediate specialist assistance. Emergency ambulance services were still unregulated and privately run, usually by funeral homes. When I needed an ambulance, I had to wait for about an hour for the vehicle, usually a funeral vehicle with a red cross and siren added. Rare internal diseases taught to me in the large city hospitals were not often seen and many common conditions which were present in the community, I had never seen in training. Following my treatment with cortisone cream for several youngsters with an uncertain rash, I remember receiving a call from the county medical officer of health saying that the school nurse had seen a number of children with scabies and asking me if I had seen the same in my practice. Of course, I agreed that I had. I quickly recalled my patients to provide the proper treatment!

I had never seen a hyfrecator used, but there was a brand-new one in my surgery. This was an instrument that produced a low-power, high-frequency AC electrical spark via an electrode and was used to treat skin tags and benign skin lesions. It seemed quite simple to use, although I had never used one in my training and one of my first "patients" to be offered this wonderful, quick way of removing such spots was my mother, who came to visit. I noticed a skin tag on her cheek and said I could quickly and painlessly remove it and she agreed. I cleansed the skin with an alcohol wipe but, unfortunately, did not wait for the alcohol to dry before activating the instrument near the spot. The electrical spark ignited the alcohol and her cheek was on fire. After I quickly suppressed the flame she exited my surgery, saying that she was going to consult her own doctor.

It was also necessary for me to learn how to be a pharmacist. Although I had studied pharmacology as part of my training and knew appropriate prescribing, I was suddenly the local pharmacist, as well as the doctor. The practice came with a fairly well-stocked pharmacy and country doctors were expected to stock and sell a limited number of drugs when there was no pharmacy nearby. It would be of little value to visit a local physician and then have to drive 40 miles to fill a prescription. Included in the stock of drugs I assumed, were thousands of amphetamines ("uppers"), formerly readily available, as well as thousands of phenobarbital tablets ("downers"), which were commonly prescribed before the days of Valium and other modern drugs for mood behaviour.
I was quick to replace many of the outdated and antiquated drugs in my pharmacy.

Another new experience for me was my appointment as a county coroner. At age 26, I was probably one of the youngest physicians ever appointed to this post. I had just returned from the hospital to start my afternoon hours, when my wife indicated that two gentlemen from the Ontario Chief Coroner's office had been to my office to see me before noon. She had sent them to the local tavern for lunch until my return. Soon after they entered my office, I concluded that part of their lunch had been liquid! I was trying to think of whom I had lost in my practice, but I was relieved when they announced that the purpose of their visit was to offer me an appointment as a coroner. Now I was extremely impressed, as often such an offer was precipitated by a politician's recommendation or exemplary community involvement. When asked, however, I was a little dismayed when I was told - "Well frankly, doctor, there's no one else from whom to choose." I became a coroner and continued with my interest in forensic medicine for more than 25 years.

Life as a lone physician in a remote community is not simple, but I enjoyed every minute of it. I was on call 24/7 when "in town," but the residents had great respect for our time off when the office was closed, except in emergencies. There was usually ample time for all patients, especially in the winter, and no person was refused treatment. From common colds to fish hook removals and stitching lacerations, we also saw complicated medical cases, patients with cancer and other serious illnesses. There was a lot of "counselling" and bereavement management, along with unexpected emergencies often requiring our attendance during transport to hospital. House calls were common and often required trips to remote homes down country lanes, but I enjoyed this break from the office to visit infirm patients or to be there for sick children in their homes.

And then, the proper treatment taught to me for certain conditions did not necessarily always apply. I went on a house call to see an elderly widower one night who was experiencing chest pain and had no way to come to my office. I took my portable ECG (electrocardiogram) machine and, with his history and ECG findings, confirmed that he was having a heart attack and promptly went to the phone to summon an ambulance. But I was stopped. There was "no way" he was going to the hospital. "That's where people go to die." In spite of my persistence, he still refused and I had to treat him at home. I made several house calls over the next few weeks and he recovered without incident.

I had a similar experience one morning when a U.S. tourist arrived at my office complaining of chest pain. He had been lifting the anchor while fishing and had a sudden onset of severe pain. After my initial examination, I felt strongly that he was having a heart attack and said that I would call an ambulance. He insisted that I just give him pain medication. He had saved for and planned this holiday for 10 months and there was no way he was going to hospital. When all of my efforts failed and, realizing the potentially grave consequences of his ignoring my advice, I returned to the examining room with a clipboard and a document that I had just drafted, asking him to sign it. He took my pen and asked what it was. I told him that it was to absolve me of any blame if he dropped dead upon leaving my office. He was flabbergasted and rather quickly changed his mind, asking me to go ahead and call the ambulance. He recovered without complications and actually returned the next summer. I know, because he presented this time with acute appendicitis and was sent to the same hospital. I don't think he ever returned to Canada!

Probably the most nerve-racking time in testing my skills was my first obstetrical case. The local OPP constable and his wife already had a two-year-old when she presented to my office to attend her through this second pregnancy. I think that I was more nervous than she was when she went into labour six months later. Young doctors are always released from training with maybe a couple of normal deliveries through which they have gained their experience, but it's always in a teaching hospital with lots of expertise readily available. Now, out on my own in a community hospital with the nearest specialist home asleep, it was a very special event for me. Thankfully, all went well and I never confessed that it was my first delivery until more than 20 years later at a government conference, when I sat beside and chatted with a very attractive woman. When asked where she was from, she mentioned Apsley and, looking at her name again, I told her that it was I who had attended her delivery and that it had been my first!

Then there were the incidents which were rather humorous, especially when recalling them later. It was summer and we had hired the 16-year-old girl next door to do the cleaning. She was very polite and always referred to Tess as the nurse and to me as the doctor. It was a Saturday morning about 8:00 a.m. and we were just awakening in the bedroom just up the front stairs from the waiting room. The doorbell rang and I heard Karen going to the door. The caller was obviously a tourist with a southern accent asking for the doctor. Karen promptly replied in the most innocent way, "Oh I'm sorry, sir, the doctor and nurse are up in bed!" I think I put the covers over my head. That potential patient never returned, either.

I had always been fascinated with old cars (and still am). The revenue from the pharmacy was added up at the end of one week, put it in my pocket and I went looking for an antique car to restore. Three hours later, in Bancroft, I was the proud new owner of a 1929 Willys Overland Whippet. I towed it home and spent the next two years refurbishing it. Since that time, I have probably owned and worked on three dozen old vehicles and am presently restoring a 1928 Model A Ford Roadster. But it wasn't just old cars. I acquired an old 1915 McLaughlin buggy and restored it, as well as a beautiful old cutter. Then I had to have a horse and, although I never actually made a house call with horse and buggy, there were many Sunday afternoons when we would take a country ride in the cutter or buggy.

I also thought that I deserved a fine modern vehicle as I was making the 80-mile return trip to the Peterborough hospitals three or four times a week. With my new-found wealth (I made $10,000 my first year in practice and was ecstatic), I ordered a brand-new 1966 Corvette Coupe ($4,500) from my local GM dealer, which made the routine Peterborough trips and house calls much more enjoyable. I recall a time when I had made a house call to a 90-year-old woman whom I diagnosed with acute appendicitis. Not wanting to waste an hour waiting for the ambulance and knowing that I would attend her at the hospital and assist at her surgery, we both agreed that riding there right away in the Corvette would be OK. She recovered from her illness and never complained about the ride, but I did not make a habit of using my sports car as an ambulance! In fact, in the two years, the only one to complain was Tess, who took her 40-mile trip to the hospital while in labour. She said that it was like riding an ironing board on wheels. Our new son certainly had no complains about riding home in the back of the 'Vette in a bassinet!

After two years as a solo practitioner and being enticed to begin practising in Peterborough, I found a replacement - another new physician - and announced my departure from Apsley. With my nurse preoccupied with our new son (now a family doctor in Huntsville, Ontario), we left the country practice and moved to Peterborough, where I spent another 15 years in family practice and we raised our four children.

As I reflect on my "checkered" career and on the various very satisfying occupations I've had related to medicine, I will always have, as some of my fondest memories, those of my days as a country doctor.