I have learned to practice psychiatry with a suitcase half-unpacked.
There is a particular ritual to locum medicine. You arrive in a new place, find the hospital, learn another electronic medical record, discover which door your badge does not open, and begin memorizing names you will eventually have to leave behind. By afternoon, patients are telling you things they may not have told anyone else.
It is a strange kind of medicine, being temporary while being invited into some of the most significant moments of another person’s life.
Over the years, my work as a locum psychiatrist has taken me across Northern Ontario, the Northwest Territories, and Nunavut, into hospitals and communities where the practice of medicine is shaped as much by geography and available resources as it is by clinical knowledge. Each assignment begins with a familiar mixture of anticipation and uncertainty, because although my qualifications remain the same wherever I go, almost everything surrounding the delivery of care can change.
There is something quietly humbling about being an experienced physician who repeatedly becomes the new person.
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On my first day in an unfamiliar hospital, I might know how to assess psychosis, manage complex mood disorders, or navigate psychiatric emergencies, yet still have no idea where to find a printer, how to order a particular investigation, or whom to call when a patient needs a service that does not exist locally. The nurses, social workers, administrative staff, and physicians who work there every day understand the practical realities of their institution in ways that no orientation manual could adequately explain, and I have learned that listening to them is often the most useful thing I can do.
Locum medicine has made me increasingly comfortable saying, “I’m not sure how things work here. Can you show me?”
It has also challenged the assumption that expertise necessarily travels intact from one setting to another. Clinical knowledge may be transferable, but the systems through which that knowledge is applied are not always so accommodating.
A treatment plan that seems entirely reasonable in a large urban centre may become considerably more complicated in a remote community where specialist follow-up is limited, transportation depends on weather, or accessing a particular service requires a patient to leave home. Decisions that might otherwise be straightforward begin to involve questions about distance, family responsibilities, cultural context, and the realities of what can actually be arranged.
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Working in Northern Canada has repeatedly reminded me that good medicine cannot exist independently of the circumstances in which people live. It is not enough to know what the guidelines recommend if the resources required to follow them are unavailable, and there is little value in designing an elegant treatment plan that cannot realistically be implemented.
I have come to appreciate the creativity and practical wisdom of healthcare professionals who work within these constraints every day, often finding ways to deliver thoughtful care without the extensive infrastructure that larger centres may take for granted.
Perhaps the most unexpected lesson, however, has been about belonging.
When you arrive as a locum, you are entering a workplace that already has its own history, relationships, routines, and tensions. People have worked together through difficult shifts, staffing shortages, unexpected emergencies, and countless ordinary days that have gradually shaped how the institution functions. You are stepping into a story that began long before your arrival and will continue after you leave.
Early in my locum career, I sometimes felt an internal pressure to establish myself quickly, to demonstrate competence, contribute meaningfully, and become useful as soon as possible. With experience, I have learned that earning trust has less to do with arriving with answers than with taking the time to understand the people and systems already in place.
There is a difference between bringing experience into a new environment and assuming that experience gives you an immediate understanding of it.
The temporary nature of locum work also creates an unusual relationship with continuity, something that is especially important in psychiatry, where therapeutic relationships often develop over months or years.
I may meet a patient during an acute crisis, help establish a treatment plan, and leave before seeing how their story unfolds. Sometimes I return to the same hospital months later and recognize a familiar name, while at other times I must accept that I will never know what happened after our final conversation.
There is an inherent incompleteness to this kind of practice that I have had to become comfortable with, although I do not think comfort is quite the right word. Perhaps acceptance is closer.
I have learned to pay particular attention to the quality of the encounter in front of me, recognizing that although I may not be the physician who follows someone through the years, I still have a responsibility to make the time we share meaningful. Clear communication, careful documentation, collaboration with local colleagues, and thoughtful transitions of care become especially important when your own presence has an expiry date.
Being temporary does not make the responsibility temporary.
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Outside the hospital, locum life has its own peculiar rhythm. There are grocery stores to locate, unfamiliar kitchens to navigate, and temporary apartments that never quite feel like home. I have become accustomed to learning a new place through the small practical details of everyday living, including where to find decent coffee, which roads are walkable, and how much planning is required for what would otherwise be a simple errand.
There are evenings when the quiet feels welcome and others when the distance from familiar people and routines becomes more noticeable. Yet there is also a particular pleasure in discovering a new landscape, hearing about a community from those who know it well, and realizing how much of the country remains unfamiliar even after years of living and working in Canada.
These experiences have changed the way I understand professional identity.
For much of medical training, we are encouraged to develop confidence through increasing knowledge, familiarity, and mastery. We become comfortable with particular systems, establish routines, and gradually learn how to navigate our institutions almost without thinking. Locum medicine interrupts that familiarity, requiring us to remain adaptable even after reaching a stage in our careers when we might reasonably expect to feel settled.
I have found that this repeated experience of being new has made me more curious, less attached to doing things a particular way, and more appreciative of the many forms that clinical expertise can take.
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“Being temporary does not make the responsibility temporary.”
It has also given me a wider view of Canadian healthcare, one that cannot be fully understood through policy documents or national conversations about access. The differences between communities become much more tangible when you are sitting in an emergency department trying to arrange follow-up, speaking with colleagues about the services available to their patients, or considering how a person’s distance from home might affect their willingness to accept treatment.
These are not abstract discussions about healthcare delivery. They are the everyday realities through which patients and clinicians must make decisions.
I do not want to romanticize locum medicine, particularly in communities where reliance on temporary physicians can reflect longstanding recruitment and retention challenges. Visiting clinicians can provide important support, but they cannot replace the stability of well-resourced local services or the value of sustained therapeutic relationships. Being welcomed into a community for a few weeks does not mean fully understanding its history, culture, or healthcare needs, and I remain conscious that my experience as a visiting physician is very different from that of the people who live and work there permanently.
If anything, moving between healthcare settings has made me more aware of how much I do not know.
And perhaps that is what I value most about this work.
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Each assignment offers the opportunity to practice the medicine I know while remaining open to the medicine I have yet to learn. It asks me to arrive with clinical skills but without the assumption that those skills alone are sufficient, and to recognize that the people who understand a community best are often those who have been caring for it long before I appeared with my suitcase.
I still occasionally find myself standing in an unfamiliar corridor, wondering which direction leads to the psychiatric unit or why my password has stopped working. There will always be another electronic medical record to learn, another temporary apartment, another hospital where I must introduce myself before beginning the day’s work.
But somewhere between arriving as a stranger and leaving as a colleague, I am reminded that medicine is not defined solely by the institutions in which we practise or the length of time we remain.
Sometimes it is defined by our willingness to enter an unfamiliar place, listen carefully, learn from the people already there, and offer what we can during the time we have.
And then, eventually, to pack the suitcase again.
