Emergency Physician Martin Kuuskne Saving Lives
Dr. Martin Kuuskne is an Emergency Doctor. He currently resides in Toronto, Ontario and practices emergency medicine at the William Osler Health System at Brampton Civic Hospital and Peel Memorial Hospital. Before his starting his practice, he received a Bachelor of Health Sciences (BHSc) at McMaster University in Hamilton, Ontario. He also completed his medical school training at McMaster at the Michael G. Degroote School of Medicine where he was versed in problem based and small group learning. He completed his residency at McGill University in Montreal, Quebec, earning a specialist designation in Emergency Medicine with the Royal College of Physicians and Surgeons of Canada. During his residency, he developed and led his program’s simulation curriculum and completed a Fellowship in Medical Education, concentrating on medical simulation and its application towards teaching and professional development. On his off time, Martin is an avid scuba diver and snowboarder. He likes to come home and play piano after his shifts in the emergency department. His role as a ringside physician for professional boxing matches for the Ontario Ministry of Tourism, Culture and Sport allows him to apply his knowledge of emergency medicine outside of the hospital. To keep up with the ever changing field of emergency medicine, Martin turns to Free Open Access Medical education (FOAMed) online; he also helped create emsimcases.com, a free, peer-reviewed repository for simulation cases. He was most recently asked to speak on Subarachnoid Hemorrhage, one of his favourite topics in emergency medicine, at the 2nd Royal Hospital International Conference in Muscat, Oman.
Tell us a bit about what you do in your current positions at the William Osler Health System, and for the Ontario Ministry of Tourism, Culture and Sport.
At William Osler, my role is that of an emergency physician. I see, diagnose and treat anyone who comes to the emergency department either ill or worried about their health. The range of illness I see can range drastically given the day. That’s exactly why I love working in emergency; no two days are ever remotely the same! I can be setting a broken ankle in a cast, to addressing a patient’s depression or anxiety to doing chest compressions and resuscitating yet another patient who is in cardiac arrest. The key to working in the emergency department is teamwork; each member has a pivotal role toward the patient and as the emergency physician, my role is to help coordinate the efforts of all staff members in a way that allows the department to function optimally.
For the Ontario Ministry of Tourism, Culture and Sport, I work as a ringside boxing physician. On the mornings of professional boxing matches, my role is to assess the fighters pre-fight health by conducting a history and physical examination as well as reviewing their EKG, echocardiography, MRI or CT scans, ocular health and blood work. I also make sure that the fighter has made their weight in a safe manner. Once I deem the fighter cleared from a medical perspective for the fight, they can participate in their bout scheduled for later in the day. During the fights, I sit ringside with a second physician and watch the bouts. We ensure that the fighters are safe during and after their matches. After each fight, I conduct a thorough neurological exam and physical exam and I issue periods of rest or investigations based on the punishment index or injuries that a fighter may have sustained. As technical as all of this sounds, it is an amazingly exciting way to apply what I have learned in medicine toward a sport and the health of young athletes. I also get to meet fighters from all around the world and of course get the best seat in the house for the fights.
What gave you the idea for a career in emergency medicine? How did it start?
After I chose to pursue science in university, I thought medical school would be a great way to apply my love of the sciences toward helping others. I didn’t decide on emergency medicine until late in my medical school training. I found myself truly enjoying each of my rotations and it made it difficult for me to choose one. During my time on Gynecology and Obstetrics, delivering babies was such a joyous occasion in a family’s life. In the intensive care unit, carefully tweaking the volumes and pressures of a patient’s ventilator and the math associated with complex acid-base problems spoke to my proficiency with numbers. Working alongside a general surgeon completing Whipple Procedures for patients with pancreatic cancer revealed to me the pinnacle of our understanding of the human digestive system and our ability to surgically correct a devastating disease. I even enjoyed rounding on internal medicine and would show up early to drain patients’ tubes so I could get accurate values for the patients with thoracenteses. It dawned on to me that my interest in a wide variety of diseases, surgical procedures and resuscitation can best be explored through emergency medicine. While our practical knowledge may not be as in depth as a nephrologist’s for the kidney or a neurologist’s for the brain, we have to know how to diagnose and treat the emergencies of each specialty; what can be more exciting than that!
What’s the most rewarding aspect of your chosen profession?
It would be obvious to say that saving someone’s life who needs immediate resuscitation is the most rewarding aspect of being an emergency physician, but I think it is very rewarding to find and treat something before it gets to that point. Diagnosing a young person with diabetes before they present in diabetic ketoacidosis, using bedside ultrasound and finding a 4.5cm abdominal aortic aneurysm before it ruptures and admitting a high-risk transient ischemic attack to prevent it from developing into a stroke are examples of the non-heroic but likely more important and rewarding aspects of being an emergency doctor. I also think the teamwork and comradery that I experience with my colleague physicians, nurses, respiratory technicians and other allied staff is unique to our specialty and it is very rewarding to work in a supportive and collaborative environment.
What keys to being productive can you share with our readers?
For me, productivity in the emergency department requires organization. I have developed a system for seeing and reassessing patients that I stick to that allows me to work at the pace required in one of Canada’s busiest emergency departments. I am always looking to improve; I do so by monitoring my personal data at home. After each shift, I have an excel file where I input the total amount of patients seen as well as the complexity of the cases. I can then review the number of patients I saw per hour based on the type and time of the shift. I then compare the data to previous shifts and reflect on ways to improve my efficiency and try them on my next shift. The key to productivity is organization, self-assessment, reflection, and implantation of new ideas; rinse and repeat.
Tell us one long-term goal in your career. How do you plan on achieving that goal?
One of my long-term career goals is to develop an international emergency medicine practice. I would like to expand my knowledge of how emergency departments function in different countries in order to better understand logistics and implement strategies to improve our own system. I plan on achieving this by working as an emergency physician in different countries as well as volunteering through disaster relief organizations. Also, I plan on becoming more active with the International Federation for Emergency Medicine (IFEM) to achieve this goal.
What’s the most valuable lesson you’ve learned through the course of your career?
The importance of listening; in a fast-paced environment, it is easy to become hyper-focused on what you believe is the way things should proceed. However, I find that so much can be learned though taking a few extra moments to listen. Actively listen to the patient describing the history of their presentation; the answer to their problem is usually already apparent just based on their story. Listen to the junior nurse who is concerned about the patient in hallway bed. Listen to your specialist colleague who proposes a different treatment plan than admission to the hospital. There is so much to be learned in the emergency department every day and it all begins with listening.
What advice would you give to others aspiring to succeed in your field?
I think exposure is very important for someone pursuing emergency medicine as a career. During my medical school training and residency, I made sure to diversify my electives by rotating through a plethora of specialties in order to understand the downstream care of patients once they are stabilized. I completed trauma electives in Chicago, Illinois, and Miami, Florida where the unfortunately high rate of gunshot and stabbing victims reinforced my confidence with penetrating trauma victims. My time in the neurocritical care unit at The Neuro in Montreal, Quebec allowed me to gain a deeper understanding of the complications of subarachnoid hemorrhage that occur hours to days after the initial event so I try to initiate treatments to potentially avoid these complications while the patient is initially treated in the emergency department. My rotations in plastic surgery and radiology taught me higher level skills that I use on a daily basis. I believe the more you diversify your electives the greater insight you can have on your role as the patient makes their way through the health care system, allowing you to expedite care as you can more easily predict what the patient will need downstream.
What are your favorite things to do outside of work?
I love to unwind after a shift by playing the piano; it allows me to clear my mind and lose myself in music. I also recently started scuba diving and have taken trips in different countries solely for that purpose. It is amazing for me to see the underwater world and the beautiful reefs. Landscape photography is something that I started as a pastime, but now I consider it a full time hobby as I can spend hours choosing and carefully editing pictures.
Name a few influential books you’ve read and/or websites you keep up with that you’d recommend to readers.
Lifeinthefastlane.com is an emergency medicine blog that I follow; it serves as a reference for emergency medicine concepts and also posts on up to date research. Aliem.com is also another great emergency medicine blog with short reads and refreshers on relevant presentations.
An interesting book I read recently was “The small BIG: small changes that spark big Influence” by Steve Martin, Noah Goldstein and Robert Cialdini. The name of the book is essentially self-explanatory, but the authors provide examples and tips that can teach you to consciously realize how seemingly small actions or habits can lead to significant and productive changes in one’s life. Definitely a must read in our busy world!
What career advice would you give to a 16-year old Martin Kuuskne?
Follow your passions; enjoy every aspect of your education. Set your goals and do something every day that contributes to you achieving it. Don’t be afraid to try something new and out of your comfort zone because you may end up enjoying it much more than you would think. Have fun!
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