June 2024 What I’m Thinking About

Is a Physician What We Need?

 

Graham MacDonald, BA, MA, PhD

Post-Doctoral Researcher
Humber River Health
University of Toronto

Brett Schrewe, MDCM, MA, PhD, FRCPC

Assistant Professor, Department of Pediatrics
Island Medical Program, Faculty of Medicine
University of British Columbia

 

Date: Tuesday, June 18, 2024

Time: 12:00pm to 1:30pm

Hybrid: Life Sciences Centre 1312 CMR & Zoom*

Zoom Details: For connection details, please email ches.communications@ubc.ca.

Abstract

Nearly 50 years ago, Arthur Kleinman (1978) argued for the importance of understanding health, illness, and healing in society as social and cultural systems. Systems of health care and education, then, reflect to some degree the values, norms, and implicit assumptions of the societies of which they are a constitutive part. Yet these relationships become natural parts of our social landscape to the point that we take them for granted. Who, after all, would even ask if our society would need physicians?

Yet here we are. This talk is not to argue for the removal of physicians from the health care system, but more properly, to ask whether and to what degree they are formed through education and training to deliver the kinds of health care that Canadians need. Further, as physician burnout and health system overload loom, what can reasonably be expected of physicians when key determinants of health are beyond their control and influence?

There are a variety of issues that unfold from this premise, on levels of medical education, policy development, patient and public engagement, and health care system design. The question goes from curiosity to problematic when, for example, we consider that the key education policy framework in Canadian medical education claims its fundamental purpose is “meeting societal needs” …but has only consulted eight members of the public in the last 25 years (Abbott et al., 2014). When, for example, “evidence from Canadian literature suggests that the health care system accounts for only 25 percent of health outcomes, regardless of the level of funding it receives (AMFC, 2010, p. 21)”. When, for example, training for societal-level advocacy and systemically addressing the effects of the social determinants of health on the lives of our fellow citizens is no longer compulsory in Canadian medical education (Sherbino et al., 2014). When, for example, there are welcome shifts to incorporate “patient and public engagement” into medical education, yet attention remains on the former, while the latter—a major stakeholder in a system through which one of its major social rights may be delivered—is left by the wayside (Schrewe, 2023).

What is to be done? As we dig through the rubble of the pandemic, grapple with workforce shortages, and look to build a healthier Canada from coast to coast to coast going forward, we must ask the following questions: if the Canadian physician is to rise to these challenges, then what kind of physician must they become, and what kind of relationship to the public does this imply?

This talk will explore whether, how, and to what degree medical education programs and leaders may think about re-conceptualizing the relationship of physicians to societal problems of health and illness such that the physicians of tomorrow are equipped with the capabilities to not just provide high-quality individual clinical care, but identify and work towards addressing the broader asymmetries and inequities that constrain the realization of a just society and the Canada that we always should have had.

 

Biography – Graham MacDonald

Graham is post-doctoral researcher at the University of Toronto and Humber River Health studying patient engagement in drug and medical device regulation for chronic pain. In late 2023 he completed his doctorate at UBC’s Rehabilitation Sciences where he examined the theories and practices of patient engagement in research through a critical sociological lens. Graham is trained in social sciences with a background in political economy (MA, 2014) and political science (BA, 2011) and specializes in qualitative research. For the past decade he has done research primarily in the fields of health services and medical education.

Biography – Brett Schrewe

Brett showed up at CHES in the summer of 2010 for a clinical educator fellowship and never really left. He now lives, works, and is raising his two daughters on southern Vancouver Island, on the ancestral and traditional territory of the W̱SÁNEĆ people, land governed by the South Saanich Treaty of 7 February 1852. He works clinically as a consultant general pediatrician and academically as an education scientist based in the UBC Island Medical Program and Department of Pediatrics. He uses historical and critical approaches to consider how medical education shapes who physicians can be and become, and whether and to what degree training is aligned with the health care needs of 21st century Canadian society.


Accredited by UBC CPD

The Division of Continuing Professional Development, University of British Columbia Faculty of Medicine (UBC CPD) is fully accredited by the Continuing Medical Education Accreditation Committee (CACME) to provide CPD credits for physicians. This one-credit-per-hour Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by UBC CPD for up to 15 Mainpro+® credits. Each physician should claim only those credits accrued through participation in the activity. CFPC Session ID: 200716-001.

RCPSC ACCREDITATION: The CHES Cutting Edge Speaker Series is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada.