He was a mere boy when he heard them. But the stranger’s words would prove prophetic and impactful in shaping John Stewart’s professional future.
“If you turn out to be half the man your father is, you will have accomplished something,” a patient told the youngster accompanying his surgeon father on hospital rounds. “He saved my life.”
John’s understanding of the public’s deep respect for a talented physician crystallized in that moment. By itself, the brief conversation would not determine the course of his life, yet his fresh memory today of that otherwise-trivial comment proves how strongly it continues to resonate decades later.
Bloodlines weighed equally in promoting a medical choice. Both of John’s parents were doctors, as was his grandfather and an astounding assortment of aunts, uncles, and cousins.
“I was surrounded by medical professionals,” he recalls with a warm smile.
That combination, one might assume, set the table for the single-minded pursuit of a medical career. But the reality was much different. In fact, John’s path was punctuated more by ambivalence than devotion.
“As a teenager, I saw my dad working odd hours, being on-call, and told myself: ‘I’ll never do that.’ Still, I applied to medical school, but hesitated even after I was accepted. My choice was in doubt until the final moment.”
In a general sense, entry into medical school clarified John’s future course. One important question remained: what branch of medicine would he follow?
Arguably, graduating as a specialist might be more prestigious, and John found encouragement among his professors to enter obstetrics and internal medicine. But after exposure to many potential areas of specialization, John opted for a different direction.
“I liked the variety and challenge of family medicine,” he remembers of the decision to become a General Practitioner. “It allows me to treat the ‘entire person.’
“I also have the privilege of seeing multiple generations of the same family. Five generations in one case right now! When I examine the eldest, I see evidence of my grandfather’s impeccable surgical work, and that’s really special.”
Graduation saw John begin two years in Kitchener emergency rooms. Usually, a doctor will divide time between a practice and ER duty, but John’s work was done entirely in the emergency room. He looks back on the experience philosophically.
“I figured if I could do ‘the deep end,’ I’d be ready for anything.”
Fate came calling. At a family gathering, a chance conversation revealed that Port Perry’s newly-formed Medical Associates was seeking to add to its three-person staff. John fit the clinic’s basic requirement, an interest and capability in all areas of medicine. And its location fit him.
“I wanted to be closer to family than Kitchener,” he remembers. “Port Perry was perfect.”
Each doctor on Medical Associates’ roster needed broad knowledge, such that all would be interchangeable. And each had to offer something unique. In John’s case, his interest in long-term care would provide that the clinic with that additional skill. So began a lifetime association, both with Medical Associates and with the community’s nursing home.
Time passed and as Medical Associates prospered, John’s practice grew. The experienced doctor received an invitation to sit on a provincial review panel. The opportunity would, in his words, change his life.
“In the early 90s, the Ontario government planned to publish guidelines for the appropriate use of antibiotics,” he recalls. “I learned that the Ministry’s long-term plan would link pharmacies to a central database, and require a physician’s diagnosis for each prescription. Where the diagnosis didn’t match their guidelines, OHIP would reject the patient’s claim.
“I felt strongly this was an invasion of privacy. The government’s strategy also implied that we doctors were at fault for overuse and misuse of antibiotics. I raised my concerns to the Deputy Minister, who wouldn’t budge. So I vowed to take it one step further and prove their approach wrong.”
John spearheaded a three-pronged initiative to do just that, using Port Perry for his study area. Across-the-board education would prove the key to its success. Doctors, pharmacists, and patients would receive a consistent message, delivered in a concentrated timeframe.
“We targeted an overall reduction in antibiotic prescriptions. As well, we counseled the medical professionals – pharmacists and doctors – to reduce the use of stronger ‘second-line’ drugs. The problem with readily prescribing those more powerful antibiotics is that bacteria quickly develop immunity, so their effectiveness is lost. It’s a huge issue for hospitals: the bacteria spreads and soon can’t be effectively controlled.”
Studying 10,000 patient visits and comparing to the prior year, the project showed impressive results. Overall prescriptions declined by 10%, while there was a 29% shift to less potent “first-line” antibiotics.
“Port Perry was the perfect location for the initial study,” John says. “The right size to easily spread our message, cooperative enough to respond.”
The group successfully replicated its impressive results in nine GTA communities, but couldn’t sustain funding.
Ironically, the project drew worldwide accolades.
“I spoke in Brussels on behalf of our group at a conference on antibiotic stewardship. They were amazed at what we’d done.”
The experience sharpened John’s interest in the academic side of medical practice. He incorporated its lessons into teaching medical residents at Port Perry Hospital. With an associate, he is currently developing a two-level website tailored to very different audiences with an equal stake in learning.
“There’s so much new information rushing at today’s family physicians. It’s our goal, on the website, to make information available in both medical and layman’s terms. The antibiotic study taught me the power of delivering a consistent message to the public and those in the medical community.”
The ever-increasing speed of information flow is only one change John has seen over his years of practice.
“Technology has provided better diagnostic tools. But there’s a tradeoff: it’s moved us away from using ‘clinical instinct.’ I emphasize the need for that instinctive element in my teaching.”
Operating a busy practice and sporting a lengthy resume of advisory board memberships, John finds release from the stresses of a full professional life with a variety of exercise.
Today, at 62 years of age, he cycles and regularly meets the challenge of a backyard wave pool. And for more than 35 years, he’s kept a standing squash date at least two mornings a week with longtime friend and local dentist, Jack Cottrell.
But his hidden passion lies in theatre. John’s trod the boards, and worked backstage, with the local Borelians and Choral Society, earning multiple award nominations from the Ontario Association of Community Theatres.
“Being on stage gives me total escape from reality,” he says. “It’s make-believe, just like being a kid again.”
John and his wife Barb have two grown sons. Older son Kevin teaches science at a Toronto private school, while Todd, two years younger, flies for Air Canada. John chuckles at the observation that the Stewart family’s medical “dynasty” will end with his generation.
“We never pushed our kids in a particular direction. Instead, we encouraged them to be happy with themselves, and they are.”
As is John. From the teenager who initially disdained a medical career, he now has no doubt about the wisdom of that choice.
“I have no regrets. It’s been an amazing opportunity, to make a difference in people’s lives.” Just like his father did.
But years previous, an anonymous hospital patient had sagely predicted that outcome, and unwittingly offered the inspiration for a talented young man to follow his ideal calling.
BY SCOTT MERCER
FOCUS ON SCUGOG