A special message for Residents & Medical Students

Did you know that residents can vote in the Doctors of BC election? Did you know that residents can directly influence the future direction of the medical profession and healthcare in BC by exercising their right to vote?

Over the past few years, I have been absolutely amazed by the resilience and fortitude of our future colleagues, the residents and medical students of BC. They are coming into our profession when we have all been consumed by not one but multiple pandemics, a heat dome, an atmospheric river and more.  

You have spent time on the frontlines in the hospital where you are immersed with incredible stress, fear, and exhaustion caring for critically ill patients. During that time you also had to make very difficult decisions on how to provide care without the patient’s family or support networks around. 

This has been interspersed with periods of guilt and helplessness. With you feeling trapped on the sidelines, sheltered in your homes, facing hours and days of nothing specific to do.  Worrying about colleagues, loved ones, and your own lost opportunities to learn, what you need to learn, before becoming independent attendings. 

But despite all these challenges, when many would have said it was improbable during a pandemic,  you are all learning, growing and inspiring so many of us.

Medicine is the quest for the improbable. The improbable solution to disease, the improbable surgical solution, the improbable recovery after a critical illness. All of you work hard to learn an improbable amount of knowledge to offer patients the care they need, when they need it.

Diversity, Equity, Inclusion, Justice. 

We continue to see the cracks of our society laid bare by the pandemic: the disparities in our healthcare and social support system, the vulnerabilities of those with housing insecurity and crowded living situations. The unequal access and treatment of care of indigenous people and people of colour. The devastating news of residential schools. We can’t pretend any longer that this is news. What happened to BIPOC and Indigenous peoples has been happening over and over for decades in almost every community in every corner of this country.  

We can’t simply say that these patients are making decisions “against medical advice”, when medical advice led so many to forced sterilizations, endless waiting on waitlists or perhaps even having significant healthcare issues minimized or ignored. 

I remember a story of an elder, indigenous patient I once had that told me of her fearful memories of authority and healthcare. She needed to have an urgent surgery and while we were getting her ready for the OR, we quickly drew our initials on her abdomen as we all do every day as part of the surgical checklist. She shut down emotionally and we proceeded with the surgery knowing she was anxious about the procedure. It was not until she had recovered and came back for her postop visit that she shared with one of our wonderful residents how she felt at that moment.  Vulnerable, terrified, alone and ashamed. In our quest for standardized care, we had turned her into another number. It brought her back to her residential school days and she felt like she had no power over her body or her life. 

We need to do better. We need to learn about our patient’s lives and cultures and goals of care and respect all of this. We need to advocate for each and every one of them to be treated fairly and justly. And we need to go farther and advocate for not only the individual but also for the system to change so that history does not repeat itself.

Just & Equitable Access

Every month, every year, there is another novel, innovative development in the world of medicine. We find new and novel ways to make the improbable reality. Yet, how often do we think about equitable access to these innovations for all patients, or how many people will actually be affected by this next great thing? 

There is now ample evidence that patients in higher socioeconomic statuses and with higher levels of education are the first to access innovative care, while those in lower SES and lower levels of education are the first to submit to Phase 1 and Phase 2 trials. Is this aspect of innovation just? Is it appropriate? Think about all the time you will spend learning the new surgical technique, or the new application of a technique you had learned before. Do any of us spend that much time thinking about what percentage of patients have access to the current standard of care? Or whether we can deliver it in a timely way? Or what can we change in the system to make timely access a reality?

Only 60-70% of patients globally have access to standard of care oncologic care. And before, we say well that's not our problem in Canada, let's remember that < 40% of patients get adjuvant chemotherapy within 8 weeks of their surgery. The more income you have in Canada, the likelier you are to get early intervention for your cancer. The more rural you are, the less likely to have access to standard of care treatments. 

Why not make resolving this issue, the focus of your innovation, the focus of your next great thing?

Planetary Health

Given the irrefutable relationship between the environment and individual health, we must accept that our duty of care extends not only to our current population, but also to future generations and to the planet. Health care is currently responsible for nearly 5% of global greenhouse gas emissions, equivalent to the fifth highest emitting country. 

The best way of delivering planetary healthcare bases itself on 3 significantly important principles: reducing demand for healthcare by promoting healthy living and disease prevention, ensuring that patients get the most appropriate care and decreasing emissions from our day to day work. It is only by considering and embedding sustainability and environmental accountability into our day to day work will we be able to make a difference

What do YOU want to fix?

If each of us thinks about how we want to seize this moment, which improbable outcome do we want to make real and where and what we want to advocate, how can we not make a difference? If we are lead by your enthusiasm, your drive and your commitment, everything is possible.

Have no doubt, as practicing physicians, every one of you carries enormous power. You are soon to enter a world desperate for your voice and your expertise.  In a fractious world, remember that physicians are still trusted by upwards of 90% of Canadians. What you say, how you live, what you stand for matters. Almost everything that is wrong in the structure of our society ultimately leads back to impacting the health of its citizens. 

The enormity of this responsibility can feel almost paralyzing at times, and solving it improbable, if not impossible.  But this is absolutely something every one of you has the talent and the skill to do. And if you don’t individually, you do as a collective. 

Draw on your strengths, alone and together to latch onto whatever piece of this world that inspires you the most to change and transform the world around us.

I hope that you will choose to join me and the Doctors of BC to help make the improbable a reality and make the world a better place for generations to come.