Rapid Rounds: 5 Minutes with Dr. Robinder Bahniwal

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Dr. Robinder (Robbi) Bahniwal is a family medicine physician who serves all age groups from newborns, pediatrics, adults to geriatrics. When approaching medicine, she has discovered that using a patient-centred approach and a shared decision-making model works best with the variety of age groups she works with. One important thing to note is that Dr. Bahniwal has a special interest in mental health. With the onset of the COVID-19 pandemic, as a physician, she realized that this area needs as much, if not more, attention as physical health.

Keep reading to find out more about Dr. Bahniwal…

1. Tell us a bit about yourself.

“My name is Dr. Robbi and I’m actually located in Ontario, Canada. I don’t have a specialty as I’m a family medicine provider, but I have gotten several certifications in the U.S. to do women’s health procedures and sports medicine procedures.”

2. What inspired you get into the medical field?

“At a very young age, my mother passed away of colon cancer. It had already spread by the time she was 32 as it was metastatic to her liver. We knew that she most likely wasn’t going to make it. I was really young to understand that, but I remember sometimes going with her to see her family doctor. I saw the relationship they had. It really did help her because the family doctor was able to spend a lot more time with her than the oncologist. As a result, he would reassure her, give her the supports that she needed, knowing that it wasn’t going to be a good outcome. He even gave her words of wisdom and advice on how to leave the family behind and so that was really nice. I saw that and sort of fell in love with family medicine at that time.”

3. What has been the biggest challenge in medicine for you thus far?

“Medicine is challenging, right? It’s such a long road and there were times when I didn’t initially end up being successful getting into medical school and I questioned whether this was really the path I wanted to take since it would take me so long to get to where I wanted to be. It takes four years of medical school, and then residency, depending on the specialty, and then fellowship or not. Eventually, I just laid out all of my options and I was thinking of going into physical therapy or doing a Ph.D., but I also didn’t want to be that person who would regret my decisions 10 years later. So, I decided just to do medical school and not worry about the time. Once I got into it, yeah it was challenging, but the best thing about medical school or residency is the comradery with the other students. You’re kind of going through the struggle together and it is really nice. Medicine, in general, is very tough, but you have people with you, you have your social supports, and at the end of the day, I don’t regret or look back now wishing I had done something else. I’m very happy with the decision I made.

My challenge is getting used to medicine now in Canada because I did do my residency at Penn State in the United States. Coming back here has been a little bit of a shock because medicine is different here. We don’t really have the insurance companies, we have more of a socialized model of medicine here. As a result, we have to be more mindful about what we order and why we’re ordering certain tasks. I think in a way, that makes you a great practitioner because you’re relying more on the physical examination before jumping on imaging and things like that. But that has definitely been different. Also, the preventative health guidelines are different. So, I’m getting used to all of that which has been a challenge, but I think that I’m getting through it just fine.”

4. As a family practitioner, what would you consider to be your most difficult case?

“There’s always difficult medical cases, but the cases that I really find interesting are the ones that take into consideration social determinacy of health. In Buffalo, and even now in Canada, I’ve chosen to work in high-needs areas. When I was in Buffalo, I was working in a federally qualified health center. In Canada, I’m working in Downtown Toronto, but also my main clinic is in a high-needs area. The interesting thing about working in those populations is that they don’t always have a lot of money. For example, sometimes transportation is an issue. Those have been challenging to me because you have to consider whether patients can afford the medication and if they can’t, what other options are out there. When it comes to finances and medical care, especially if patients don’t have ODSP, which is our Ontario drug plan, they will have to pay for it out of pocket. If they have to pay a lot of money for it then they probably aren’t going to adhere to the treatment protocol. Especially for chronic conditions like diabetes, high blood pressure, high cholesterol, or patients with heart problems. That’s one of the issues that I find difficult on a regular basis.

Another issue is language barriers. In these high needs areas, there’s a lot of patients where English is not their first language. So you have to find a way to not speak medical jargon and get them to understand things in their language. And also take into consideration their culture as well. Every culture is so different too in how they interpret medicine. If you have a patient on six to seven medications and you’re trying to explain it to them in their language for administration and dosing, that becomes challenging. Now with the COVID-19 pandemic, a lot of doctor’s offices weren’t initially open. So, a lot of those patients were actually going into walk-in clinics or using virtual platforms. That made it even more confusing. The patients didn’t know what medications they were on and unfortunately, in Ontario, our electronic medical records are not integrated. So we were trying to figure out what medications patients were taking, without making any mistakes.

Those have been my more challenging cases, but also the most rewarding, especially when the patient walks out and completely understands what is going on with their health.”

5. How do you ensure the quality of patient care is constantly improving?

“I always want to know if I’m doing a good job by them. I want to do my due diligence and just make sure that they’re happy with their family doctor. So, at the end of the visit, especially with my chronic patients, my mental health patients, my chronic diabetic patients, I always ask, ‘has this made your life better? Has your quality of life improved? Do you find that you’re able to manage your condition a lot more?’ That’s really important because the way I approach things is not by dictating what a patient is going to do. Again, there’s a lot of research showing that when we dictate things, adherence can potentially go down. Whereas when you use a shared patient-physician model, where the patient is also part of that decision-making model, they’re more likely to adhere to it. So asking them how their life has improved, a lot of the time they’re happy because they were part of that decision process and now their condition is improving. I always ask my patients how they’re feeling and how their quality of life has improved during my visits.”

6. What do you believe are the most important qualities of a doctor?

“I think a lot of the time, it depends on what kind of doctor you are, right? It depends on the caseload, it depends on how much interaction you actually have with the patient when they’re in an awake state. For family providers, it is so important because we’re the ones who are at the first point of contact with that patient. We’re the ones they need to be trusting. If you have a really strong relationship, that sort of sets the tone for how they look at healthcare, how they look at their specialists. If they don’t have a strong relationship with their family doctor, they’re probably not going to think very highly of medicine in general, because that is the doctor they spend most of their time with.

I think the most important quality for a family doctor to have is compassion. A lot of the time, like when I’m at a walk-in clinic and things are really busy, I can’t give patients the time that I’d ideally love to give them just because the clinic is really busy and I’m the only provider there. Sometimes you have people walk in saying ‘the doctors don’t listen’ or ‘the doctors don’t care’ and that is not a good feeling, that is not the goal. We don’t want patients leaving a doctor’s office thinking that. We want them to think that we do care and want them to feel better. Sometimes, unfortunately, scheduling can kind of take hold of the situation. As a result, the compassion, or the patient interaction suffers.

I, personally, was in a very severe accident back in 2014. I was a patient. I was in a hospital and was there for six weeks and I wasn’t able to go home. I had people coming and doing rounds on me. I’ve been on the other end and I have definitely disliked certain things and I’ve loved other things. Through my journey, I sort of picked up on the things I loved doing. Sometimes when I’m overworked and I’m getting burnt out, which I’m sure you can see on my Instagram sometimes with how much I’m working, I just try to revert back to that experience and think ‘you know what, it made you feel really bad when x happened, so make sure you don’t end up projecting that onto your patients even if you’re having a bad day.’ I always try to be mindful of that as much as possible, especially on busy days.