Chair's Column: Ensuring Our Patients' Perspectives and Experiences Drive Our Work
Happy New Year!
I hope each of you got the opportunity to “refuel” over the holidays so that you are ready to embark on this New Year with renewed energy and excitement. I got to spend precious time with my three adult children, who live in Israel, the UK and Sweden, which was fantastic!
For this first newsletter of 2017, I decided to put my neck out there a bit and talk about our role as a profession in the dialogue about healthcare funding and patient-centred care.
A little over a year ago, our departmental executive committee and invited key stakeholders met over a couple of days to create our ‘strategic plan’ for the department. We emerged with eight guiding principles that we tasked our leaders — departmental division heads, physicians-in-chief and vice-chairs — to communicate to their constituencies and figure out how best to instill these principles into the work that we do. I spoke about this in my ‘activity report’ at City-Wide Rounds in June 2016. Here are the principles again in case you’ve missed them:
- Patients’ preferences & priorities drive our work
- Equity, diversity and professionalism
- Social accountability
- Training to meet population needs
- Generation & translation of new knowledge to impact health
- Inclusiveness (all our faculty members, inter-professional colleagues, hospital & university identities)
- Mentorship across the academic lifespan
- Fund-raising to achieve our goals
Right before the holidays, we mini-retreated again — this time, to talk about how, as leaders, we can most effectively ensure that by embracing these guiding principles we can move towards our vision to meaningfully impact health through international leadership in education, research and the translation of new knowledge into better care and health outcomes.
In the course of the evening, there was much discussion of the first principle — to ensure patients’ preferences and priorities drive our work. Was the department simply paying lip-service to this aspiration? After all, doesn’t every healthcare organization — hospital, government, NGO, the Ontario Medical Association — espouse a commitment to patient-centered care? There was much cynicism — even abject disbelief — that within the current limits of our ‘healthcare system’ we could truly put the interests of patients and their families first in our day to day work and that we as academic physician leaders were likely to be able to change this fact.
I get this. We have admitted medical patients lined up in hallways in our emergency departments because there are no beds. In some of our hospitals, we are forced to ‘admit’ sick patients to ‘light-switch 3.’ We aren’t paid to use widely available e-technologies to renew prescriptions or do a quick follow-up with a patient regarding how they are tolerating a medication or have recovered from a procedure. So we bring them in to see us — they take off work, or their family member does — and pay exorbitant amounts of money for parking for a ridiculously short visit. We cannot get the tests or test results we need in a diagnostic work-up for a patient in a timely fashion, so the patient is compelled to wait and worry. We discharge patients from hospital without having fully communicated with the primary care providers because we cannot get them on the phone, have no time to try, or don’t have secure emails with which to communicate patient information thoroughly. We admit dying patients to hospital because there are insufficient resources in the community to allow them to die in the comfort of their homes, if that is their preference. Ditto for the elderly folks who are no longer able to live independently but who have no desire to move to assisted living or long-term care. Unless the family is wealthy, it is near impossible to procure the necessary resources to keep them at home. Instead, they fill our ALC beds. And we compete with each other across hospitals for donor support to advance research and patient care for disease X, or to be the best in the management of disease X when, in fact, working as a team to advance care for disease X across our university hospitals has potential to raise much more money (case in point for our recent recruitment of a leader for a city wide multiple sclerosis program) and raise the quality of care for these patients as a whole.
I am not trying to depress anyone, but to make a point — there’s been a lot of talk about putting patients first, but not so much action. And, I would like to suggest that if we academic physicians don’t take the lead to bring about real change in healthcare, change is unlikely to happen. Governments come and go – we are here for the long haul. We have the brains, passion, and, as Dante Morra said it to me recently, “The moral responsibility as academic leaders to lead healthcare transformation.”
The question is how?
Yesterday, I completed the online OMA membership survey. Among other things, they asked about our appetite as Ontario physicians to withdraw non-essential services (who defines what’s ‘non-essential?’) or stop accepting new patients in order to force the Ontario government to negotiate. Is this what’s best for patients? When asked to provide additional commentary, I felt compelled to tell the OMA that I am embarrassed by our profession’s public stance - or at least that of those holding the megaphone. The self-interest and income-focused tenor of the physician funding debate has, at least for me, seemed to ignore the fact that we as a profession are here to serve the public. I understand money is important and we deserve to be paid well, but at what cost? We are in a highly constrained fiscal environment in healthcare — the population is aging and the prevalence and severity of chronic illnesses is rising. This is affecting medicine as much if not more so than other disciplines. Surely a willingness to engage in an open, evidence-based dialogue that focuses on what’s truly best for the health of Ontarians — and our patients — and what we could do less of to allow more of something else would get us back to the negotiating table? I realize it’s not that simple, and I understand the importance of arbitration, but still, something has got to give!
I know that those of us in academia do not generally represent the mainstream physician voice. We are a minority of physicians, who have chosen to make teaching, research and creative professional activities a major focus of our careers. We have individual department members who are actively engaged in the healthcare debate — take the amazing Andreas Laupacis and his Healthy Debate for example. But, as the largest academic medicine department in Canada, if not the world, isn’t it time to ensure that our collective voice be heard by government and tax payers? I’d like your thoughts.
If this is perhaps too daunting to contemplate, or at least will take time to formulate, maybe we could start with something a little simpler?
During his interview for the position of Vice-Chair, Education, Dr. Kumagai talked about the undergraduate MD curriculum he had developed and implemented a U Michigan. He described how, on the first day of medical school, he asked the students to reflect on a healthcare experience they had had as a patient, or as a family member or friend of a patient. They were then asked to describe the experience and speak to what had been good, and what had been not so good, about this experience. Simple and effective! It gets right to the core of patient-centred care and by reflecting in this way, we can help focus not only our clinical efforts, but also identify patient care-relevant questions that warrant further scholarly investigation. I have several personal examples as I am sure you do as well. After delivering a 32-weeker who was rushed off to the neonatal ICU, I was wheeled into the recovery room where all the women around me were snuggling and feeding their newborns. This was a really horrible experience, but did I tell anyone? Did I suggest to the hospital that they alter this practice? I did not. Maybe someone else has done so and the practice exists no longer – that would be great! If not, how disappointing. Perhaps tackling the low hanging fruit would be a good place to start.
So, as we embark on a new year — 2017 — I would ask you to consider this New Year’s resolution (if you’re not already doing this): As you move through your daily activities, keep asking yourself, “Is this what’s best for patients and their families?” If you find yourself unable to take the ‘best’ course of action, consider why this is so — what are the barriers and how could we remove them? Ask your patients about their experiences and try not to be defensive — they know that not everything (or little) is in your control. Ask them what was good and what could have been better. And let’s talk about it — with trainees during rounds, with our faculty during departmental and divisional meetings, and with staff and administrators in our hospitals. Let’s be proactive – speak up! And, if there’s an appetite, perhaps we can shape and voice our collective thoughts with regards to advancing the public discourse about healthcare in our role as leaders in academic medicine.
I would love to hear your thoughts. Feel free to tweet me – so we can have an open dialogue – or email me.
