Health-care advocacy bridges gaps in a challenged system

Physicians weigh in on the influential role doctors can play outside of their practices as advocates for health care. Personal stories and perspectives shared illustrate the difference they’ve made in their communities, health-care settings and the system overall, as well as the patients who benefit most.

Transcript

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Georgia Balogiannis: In this podcast, the Ontario Medical Association looks at current issues of interest in healthcare. Spotlight on Health gives you all the straight talk. We’re Ontario's doctors and your health matters to us. I'm Georgia Balogiannis for the Ontario Medical Association. 

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Balogiannis: With the fallout from the COVID pandemic, a shortage of doctors and nurses, long wait times, and inadequate palliative care, it is a critical time for Ontario’s healthcare system.

In this episode, physicians discuss the importance and benefits of advocacy roles and the need to take action in calling for healthcare improvements. 

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Balogiannis: Dr. David Schieck is a Guelph family doctor and immediate past chair of the OMA Section on General and Family Practice.

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Dr. David Schieck: As far as my involvement with advocacy goes, I mostly got involved initially because of wanting to advocate for and raise the profile of family doctors and primary care, and the important role that we play in the system. I was particularly interested in how compensation might influence the way we organize our practices and how we provide care, and over the years have become more and more involved in advocating on specific issues very directly related to primary care.

Family doctors have often, for as long as I’ve been a practicing family physician, able to step up and help out in communities and in groups across the population, and with hospitals and specific initiatives to solve problems for the broader community. As family physicians, we certainly have a particular interest in seeing that we can provide the best care for our particular patients and our only individual practices. But I think there is an even greater potential to be tapped into with family doctors and how we work together in communities with other health care professionals, and with our specialist colleagues, to provide even more effective and better care for our patients.

I think what works really well for family doctors in being effective at advocacy comes from our relationship with our patients. I think all physicians develop relationships with their patients, family doctors particularly, even specialists and other healthcare providers. But I do think that there is something special about the relationship that’s there between patients and their family physicians. These are relationships that are cultivated and shepherded along for years and years. 

And there’s a real trust that’s developed between our patients and ourselves as family physicians and that trust in that relationship translates into some really meaningful understanding of what our patients need, where the problems are in the system for our patients, and I think it gives us a lot of credibility when we talk to decision makers that can actually make a difference in how our system is organized and how care is provided.

I’ve developed a good relationship with our MPP here in Guelph and he’s taken a particular interest in creating a space for healthcare sector individuals in our community to come together every two or three months with the healthcare roundtable that he organizes, and it’s just a great place to be able to bring issues to him and share ideas and hear what he has the ability to help advocate for us in his role at Queen’s Park.

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Dr. Schieck: I think it’s really important that physicians are involved in advocacy, because we have that experience on the front lines. And seeing the system up close and in our face, and how it affects the way we are able to work in the system, we see how the system affects the care that our patients receive, the challenges that are often in place, and being able to provide the care that our patients need.

We just bring that lived experience and that really personal flavour to a really important part of our lives. And especially the last three or four years through the pandemic. We’re just sort of seeing how fragile our healthcare system is and it doesn’t take much to push things over the edge. And we now are seeing a system really in crisis. This is particularly a time when we need to be focusing on some real solid solutions to the system that can make it more robust and able to handle the types of challenges that get thrown at a very complex system like Ontario healthcare.

Almost everybody that is in the system, whether it’s the politicians or whether it’s the staff that work in the bureaucracy behind the politicians, they really are actually very open people that want to hear what physicians and our patients are experiencing as they go through the system. And they, I believe, have a true interest in better understanding the problems and the potential solutions that we can work together on.

Thinking about advocacy and engaging with decision-makers in the system, it really opens other doors to being able to participate in other very interesting work that’s going on. Everybody really wants to kind of do the right thing. And my experience has been really positive — that they want to hear from us, and they make time for us, and they can be really rewarding relationships. 

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Balogiannis: Rohit Kumar is an anesthesiologist at Trillium Health Partners in Mississauga and chair of Ontario’s Anesthesiologists.

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Dr. Rohit Kumar: My initial entry into sort of advocacy-type work was probably in the mid-2000s when many other physicians also entered into advocacy for a variety of reasons, with the most notable one being just successive fee cuts by the government at the time. And so, threats to our autonomy and the way we practice, and the sort of decreasing ability for us to advocate for ourselves.

I really feel that we’ve really worked quite hard to become physicians and to be where we’re at and ultimately we’re the quarterbacks of our patients' medical care and we really can’t afford to have our voice and our ability to advocate on behalf of our patients eroded. And we need to protect that voice.

The issues that I tend to advocate on are broad. So I initially start out very general on behalf of all physicians because we all need to have a voice, and the better our collective voice is we all benefit. But at the end of the day, my sort of space or area of expertise or knowledge is in the perioperative services, so I’m able to speak on that better. 

So, often I will narrow down into broad categories like surgical care and then I’ll tie in medical or family medicine-based care. And then one step beyond that, as chair of Ontario’s Anesthesiologist, we advocate on specific issues like in the current health human resource struggles that we’re having, not just in nursing, or physicians in general, but with anesthesia.

It’s incredibly important for physicians to be involved in advocacy, and I’ve learned that more as I’ve met with politicians. When we go and meet with politicians or anybody that we want to advocate for health care, we have to keep in mind that we are putting things in their ears that they’re going to then use in their conversations and sometimes they may hear something that is different than what you’re saying and they’ll be able to question that effectively, because they trust what you’ve said. 

And when somebody brings up something different, they’ll be able to say, “Well, actually, Dr. So-and-so actually said this. So we might need to look at this a little bit differently. Also, you empower them with the ability to have the knowledge to ask better questions, whether it’s in parliament or to other stakeholders.

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Dr. Kumar: Physicians can be incredibly effective advocates. I think, naturally, politicians and patients and the public in general regard physicians as trusted and knowledgeable people and we are respected members of the society and people listen to us when we speak, for the most part. The other reason why we’re effective advocates is that we are naturally solutions-based or problem-fixing oriented people. So, if there is a problem presented to us, or if there is an issue that’s there, we very quickly move to diagnose and treat. For that reason we are effective advocates.

There’s some simple advice that we can give other doctors who are considering getting involved in advocacy. To start off, I would say do it at your pace and at your comfort level. We are all incredibly busy people and by no means should we all drop everything that we’re doing and go two feet in to just advocacy. I think that’s a really unreasonable expectation. But if we’re all doing a little bit, everybody has that much less on their own.

The other thing is, advocacy is a skill that you can use across all areas of medicine and life in general, but specifically to medicine. You can use your advocacy skills with politics, you can use it within your departments, you can use it within your hospitals. Advocating on behalf of patients effectively is something that we should all learn how to do and learn how to do well, because our voice does matter.

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Balogiannis: Dr. Shehnaz Pabani is a Sudbury family physician and a member of the OMA Physician Leadership Group’s advocacy panel.

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Dr. Shehnaz Pabani: Working at the urgent care clinic, I found that a large sector of the population that needed the care the most did not get it. Sometimes it was care that could wait, but quite often it was care that could not, like the frail elderly having an emergency, or an injury, or an ill child. And then I saw patients, new Canadians, with an urgent need for care and serious care. So our system is broken. Those that really need urgent medical primary care are not able to access it. 

One evening, when I was working at this urgent care clinic, I saw a very pregnant woman — this was her third pregnancy, type one diabetic — who came in very, very scared. And she told me, “my baby is not moving”. So I listened to her very pregnant abdomen and could hear a heartbeat, although didn’t really feel any fetal movements. Now, she was two or three weeks prior to delivery and I said, you know, I have few resources at the walk-in clinic. She knew about her type one diabetes and the risks and her pregnancy risks and the risks she faces and the risks her baby faces.

These are the kind of people who need to be attached to a family physician right away. They have to have urgent access to primary care. And so we have to overhaul the whole system. We have to disrupt healthcare, not continue the way we are continuing right now. But we need to have parameters which measure ‘are the people who really need healthcare getting it?’ And if not, why not?

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Dr. Pabani: I just lost my mother and even with her three daughters, including myself, advocating for her, her end of life was not good. So, I was thinking what do frail elderly who do not have family do when they need healthcare? And we need healthcare navigators for them who would advocate for them. We need to invest in people. The very people who need care — the frail elderly, the people with mental illness and addiction, the Indigenous, the new Canadians — are not getting access. 

During the pandemic it really highlighted the problem, because only virtual care was being done and in-person care was slow to start, even after the lockdowns ended. And the people who suffered the most I found was people without access to technology. The frail elderly did not know how to use it. The homeless and mentally ill did not have access to any technology. And the Indigenous in the remote far North did not have the bandwidth to be able to connect and the new Canadians did not have the means to get technology.

Our healthcare is broken. We fall back on the patterns that you know we are in. For the short term, if we disrupt health care, it’s going to be painful. But we need to do that to build a system that’s not broken.

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Balogiannis: This podcast is brought to you by the Ontario Medical Association and is edited and produced by Jodi Crawford Productions. To learn more about the Ontario Medical Association, please visit oma.org.

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