“We look for medicine to be an orderly field of knowledge and procedure. But it is not. It is an imperfect science, an enterprise of constantly changing knowledge, uncertain information, fallible individuals, and at the same time lives on the line. There is science in what we do, yes, but also habit, intuition, and sometimes plain old guessing. The gap between what we know and what we aim for persists. And this gap complicates everything we do.” ~ Atul Gawande, Complications: A Surgeon’s Notes on an Imperfect Science
Healthcare, the system and all its pieces, is a perpetual focus for media, politics and society as a whole. Rightfully so. In Canada, it makes up a huge proportion of both the federal and provincial budgets and public spending in general. Healthcare professionals are working under greater scrutiny as the expenditures continue to increase in an era of innovation and technology. Our newest generation of physicians are faced with increasing complexity given the capacity of technology in medicine, and at the same time having to maneuver barriers in patient encounters such as data entry in Electronic Medical Records (EMRs).
At this pivotal point in time where all sides are stretched, patients are in a position to be at the forefront of their own healthcare and be active participants potentially easing the other factors in the equation. Despite our challenges, I have hope for the triad in healthcare – patients, physicians and our system.
Hope for patients
Outgoing Alberta Medical Association president Carl Nohr is an advocate for integrated healthcare, and perfectly captures my hope for patients in his final message, Thoughts at the end of the year, on September 23rd, 2016.
“I have a vision of a high-value, integrated system that is so obviously centered around the patient that we don’t even need to use that term anymore. We will be working with patients under the terms of the social contract to co-create care that they value, in ways that they find convenient and acceptable. Health care is something we used to do to patients. Now it is something we do for patients. The next step is to make health care something we do with patients. When this is done, we will have achieved integration around the patient.”
Hope for physicians
My hope for my fellow physicians is that even though we are facing challenges of accountability, affordability and availability, that we will be able to remember what is at the heart of medicine – caring for fellow humans in their time of need and suffering. Although it may feel that our value is based on measurements, our true value is ‘time’ – taking the time to talk with patients, understand their concerns, collaborate with others and overall to decide what is best for the patient.
As physicians, we are truly privileged with our role in society, but unfortunately, it can sometimes become clouded by the politics of medicine. My hope in turn is that my physician colleagues remember we are humans first, each with our own personal and professional challenges, not infallible, but for the most part doing our ‘best’.
Hope for our system
My hope is that with efforts such as Choosing Wisely, a campaign to avoid unnecessary treatments, tests and procedures, we can relieve some of the burden on our system and how healthcare is delivered. This campaign is aimed at both patients and providers, encouraging thoughtful consideration of the concept ‘just because we can, doesn’t mean we should’.
Our advancements in healthcare each and every year are tremendous but with that comes the risk of overusing and overspending. Focusing on what will be beneficial, what will be done with the information and whether it will make a difference in patient care, will hopefully pave the way for better access for those who truly need it.
Hope for all of us
In summary, I want to share with you this poem by Victoria Safford, The Gates of Hope, that illustrates what hope for all of us means…
You may also want to listen to a delightful version of this read by Parker Palmer.