Vancouver-based medical maverick Dr. Michael Klein has released an autobiography, Dissident Doctor: Catching Babies and Challenging the Medical Status Quo, describing his five decades in medicine.
Klein graduated from medical school at Stanford University in 1966, doing practical training in pediatrics and maternity care in Mexico and Ethiopia, before fleeing to Montreal with his wife Bonnie Sherr Klein to avoid being drafted in the Vietnam War.
After heading the department of family medicine at McGill University for 17 years, Klein was appointed head of the department of family practice at B.C. Children’s and Women’s Hospital where he remained for 10 years. He is known for his advocacy of midwifery and doulas, of family-friendly birthing practices and groundbreaking research that helped reduce unnecessary episiotomies and epidurals, all of which led to critical rethinks on unnecessary medical interventions during childbirth.
His family includes highly accomplished son Seth, until recently, the director of the Canadian Centre for Policy Alternatives, and daughter Naomi, a high profile social activist and author. Klein also has a daughter, Misha, from a first marriage.
Klein, who is semi-retired but still teaches at UBC, recently chatted with Postmedia News. The interview has been condensed and edited.
Q: You’ve had a long career in medicine and the book has a lot of detail. I’m assuming you’ve kept a journal all these decades?
A: Actually, I have never kept a diary, everything in the book is straight from my memory. Certain things I never forget. Basically, I remember every birth I’ve attended and there have been a few thousand.
Q: The title of your book is perfectly appropriate since you’ve always bucked the status quo. You have been, for 50 years, an agitator, a feisty iconoclast, a maverick, a nonconformist; of course everything we want our medical leaders to be!
A: That’s nice of you to say, I take it as a compliment. The title was chosen by the publisher. Mine would have been “The Making of a Radical Physician.”
Q: You call yourself a red diaper baby.
A: I don’t know who coined the term, but basically it refers to children of left wingers from the pre-McCarthy period.
Q: You were already a political activist by the age of three, actually living in a protest tent city in Los Angeles, participating in political rallies.
A: Of course I have no memory of these things, like “scab” being the first word I said. They are family stories.
Q: You write in the book that Vietnam was a “bogus, illegal, immoral, unwinnable war” and you were willing to go to jail rather than serve. In 1967, just when Montreal was hosting Expo, you became a draft dodger and moved to Montreal with your new wife. There was a measles outbreak just when you got there and the vaccine to prevent it was made by Dow chemicals, the manufacturer of Napalm.
A: That’s one of many ironies in the book. In Quebec at the time, the government supported its own vaccine producer and it wasn’t ready yet. Children were really being damaged by measles, so rather than wait for the government to develop its own vaccine, I got my hands on the Dow product. It was a necessary compromise with my principals.
Q: And now we routinely have infectious disease outbreaks because of parents who refuse to vaccinate their kids based on religious reasons or hocus-pocus studies.
A: Well, it’s ongoing. In the Fraser Valley, we have communities that refuse to immunize their children so of course we have outbreaks of measles and mumps in places where it shouldn’t happen. That debate among vaccine deniers is not going to go away soon. People think of it as a personal right as opposed to collective rights. The public needs to recognize these diseases are not benign.
Q: When I became the medical/health reporter in 1996, one of the first controversies I heard about had to do with you. You were making waves at B.C. Women’s Hospital to bring midwifery into the fold. Other doctors were aghast. You had also just handed out envelopes to each doctor with information inside showing their personal rates of episiotomy, labour induction, C-sections, etc. I recall it didn’t go over well with some.
A: I arrived in Vancouver in 1993. In Montreal, I had worked with midwives when it was being implemented and I felt they could make a contribution. There was an absolute need to be focused not on what doctors needed but what women and the public needed. I was asked by B.C. Women’s to support the development of legalized midwifery. There was a need for all midwifery births to be attended by a licensed physician so there was a group of family doctors I put together who attended all these births. Obstetricians were tired of the role (supervising midwives), some felt it was beneath them, so they wanted family doctors to take it on. Eventually, it became redundant for us (family doctors) to be present too. Observations and evidence showed the midwives were quite skilled.
Q: The payment model for midwives really offended doctors.
A: You’re not kidding! The family doctors were especially threatened because of the way midwifery was implemented. When the NDP government rolled it out, they did it in a way that was guaranteed to cause conflict. They failed to explain all the differences in the fee payment models. The midwives weren’t being overpaid, they were being differently paid but none of this was adequately explained. So it was a prescription for conflict when it was rolled out by the government. And today, there are lingering aspects of this which is unfortunate. But in some cases, midwives and doctors are collaborating, pooling their incomes. It’s experimental but its exciting. And everyone is doing this with a lot of goodwill.
Q: There’s a scene in the TV series, The Crown, when Queen Elizabeth is delivering a baby in 1960, and she’s knocked out for the whole thing. Is this how it worked? Doctors pulled babies out of heavily sedated women who couldn’t push?
A: The uterus is a pretty clever organ in the way it contracts on its own. But what was happening up to the end of the 1950s was that women were given twilight sedation so they couldn’t feel or remember a damn thing. They got episiotomies and doctors used forceps routinely.
Q: B.C. is known as the C-section capital of Canada.
A: There is a false belief that C-sections are safer, that childbirth is an opportunity for things to go wrong as opposed to being a transformative experience. That women are unexploded bombs. Some Asians and certain women from the Middle East have been exposed to mythologies about what a vagina is for: it serves one purpose only and not for babies. Those macho cultures tend to have higher C-section rates.
Q: You’ve been very outspoken in your support of the provincial governments position against private surgery clinics. You say Canada’s health care system is drifting towards the American model and the private provision of medical care must be stamped out. Why do some folks always stoke fears about the American system? All the European countries — including the ones that consistently rank at the top in terms of health care systems — have private options as well.
A: You’re right. It may be a sensational tactic, but at the same time we know we’re vulnerable to American multinational health care companies that are ready to come here. The only good thing about the Canadian system is it is a little bit better than the American system because we cover our whole population. But we don’t actually have a health system, we have a payment system for medical services. In France, New Zealand, Australia and the Scandinavian countries they have a fully organized system to deliver health care.
Q: You’ve had surgery yourself in a private clinic?
A: Across the street from St. Paul’s Hospital is an orthopedic surgery centre. I had shoulder surgery there (but) I paid nothing. The government (health authority) negotiated the rate (through a contract). It works fine, I don’t have a problem with these public pay, private delivery models. It provides extra operating room time. My difficulty is with private pay, private delivery. We all know that if the government put more money into keeping operating rooms open and supporting necessary nurses and surgeons, private surgery centres would be diminished substantially, or even vanish. This is a political decision about how much money to put into the public system.
Q: Pro-medicare folks sometimes sound hypocritical when they criticize private clinics and the individuals who use them. You ignore the long waiting times. You portray people who use private surgery clinics as rich but I interview these people a lot and, trust me, they aren’t rich, they just don’t want to suffer while waiting many months for their non-emergency surgery.
A: They’re not all rich people, I agree. The problem is people are told by the same surgeon that they will have to wait nine months for the surgery in a public hospital but only two weeks in a private clinic so they dip into their savings and do it. I know the waiting lists are too long but that violates the essential principals of equity. Our system needs a complete rethink. I’m in favour of improving medicare, not defying it.