Toronto physician has big ideas on how to improve health care
“I think people are tired of having negative conversations about health care. I think they are ready for constructive and positive conversations and I must say that right now Saskatchewan seems like the most fertile place in the country for the implementation of big ideas.” - Dr. Danielle Martin
Dr. Danielle Martin, the well-known physician advocate and author of Better Now: Six Big Ideas to Improve Health Care for All Canadians, recently visited Saskatoon as part of her national book tour. Her book has been attracting attention across a spectrum of readers and is a mix of plain, but compelling storytelling with a generous dollop of data and academic rigour. Dr. Martin’s six ideas to improve Canadian health care include: ensuring all Canadians have regular access to a family doctor or other primary care provider; bringing prescription drugs under medicare; reducing unnecessary tests and interventions; reorganizing health-care delivery to reduce wait times and improve quality; implementing a basic income system to alleviate poverty; and scaling up local innovations at a national level.
Dr. Martin’s use of stories, including a painful one drawn from her own family, has the effect of demonstrating her six ideas, rather than dryly explicating them. Her message is also grounded in the sense that Canadians value health care and the principle of equity that underpins it. She believes that physicians such as herself have greater role to play in making the system work better for all Canadians.
“Medicare is a work in progress,” Dr. Martin writes in her book, “but it’s a work worthy of our greatest efforts. It represents a promise to be the kind of country we can be proud of. “ Her book, she says, “explains what I think needs to be done to deliver on that promise.”
Just before she presented to a large audience at the Roxy Theatre in downtown Saskatoon, the Saskatchewan Medical Association had an opportunity to sit down with Dr. Martin to talk about her book and the reaction it’s receiving.
Please note this interview was edited slightly for length and clarity.
SMA: How did you arrive at these particular six ideas?
DM: What I was really seeking to do was to put forward a group of ideas that are supported by evidence. That was very important to me. Although the book is written for a lay audience, I wanted it to be rigorously researched. And the ideas also had to be grounded in values. I focused on ideas that would promote equity, in addition to improving access, and the patient experience in the health-care system. I wanted the ideas to stand alone, but also, as a group, to represent the totality of a person’s journey through the health-care system.
Starting with the social determinants of health, with big idea five, which relates to the guaranteed annual income, through primary care, improving access to speciality care, reorganization in hospitals and end of life care, all the way through, each of these ideas would be useful in the health-care system, but as a package, they span the entirety of a person’s journey through the system. There’s no magic here to these six, there are lots of terrific ideas that are out there being discussed, but I do think as a package, and on the basis on my own understanding of the evidence, and my own perception of the gaps in the Canadian health-care system, these are my best picks.
SMA: What are some of the challenges to implementing these ideas?
DM: By far our greatest asset is the support, is the sense of fairness, that underpins our health-care system, and that’s a tremendous base on which to build because when it comes to health care, we all speak the same values-language. This is not something we should take for granted. It’s not actually uniform across developed nations and we need only look south of the border to see what happens when people don’t have that shared common sense of values on which to start. There are lots of challenges, and one of the big ones, which I relate in the book, called big idea six, looks at the absence of effective tools and mechanisms to help spread innovations across the system.
Many of the problems we have in the Canadian health-care system have been solved somewhere in Canada. In some community, hospital or primary care group, chances are we have figured our way around each of the major health-care challenges, whether it's access to team-based primary care, or whether it's rapid access to speciality services or reductions in cost, without negatively impacting people’s experiences, or infection rates.
So for many of our problems, there has a been solution tried and tested in some part if the country. The problem we have had is bringing those solutions up to scale so that every community can have access to them. That’s probably our biggest challenge. In the book, I talk about ensuring we bring physicians into leadership and governance structures inside health care, so that they can be part of building and implementing solutions. If we succeed at this, they will see themselves as being part of a system that they have changed for the better. This is why I am so excited to hear what is happening in Saskatchewan around health system redesign. My impression is that this work is truly a co-operative effort among physicians and government, and hopefully communities and patients too. This bodes really well for the ability for Saskatchewan to implement solutions across the entire province, rather than through a more fragmented approach through pilot projects, which we often see in the Canadian health-care system.
SMA: Do you see differences in the reception of the book among audiences (general public, specialized health-care managers, patients etc.)?
DM: What I tried to achieve with the book, through the use of narrative and story, is that every reader would see themselves in it, whether they were a nurse, a family member or a politician. The idea was that no matter who you were, the range of stories in the book would speak to your experience. The reaction would be, “I know exactly what she means when she says that.” My sense is that people are responding to the book that way. Of course everybody’s got a favourite story, and everyone has one they disagree with, and that’s great, that’s a healthy conversation to be having. I wouldn’t say that patients, policy providers or policy makers are all aligning across particular lines. I think people’s reception to the different ideas is more determined by their personal experiences and characteristics.
SMA: What surprised you the most as you were writing this book, or after having finished it?
DM: The sheer amount of personal feedback that I have received from people since the book came out has led me to reflect on what it is I should be doing with these reactions. In the beginning, I hoped people would read the book, that they would learn something from it, and that it would make them think. But what I’m getting is people reaching out and sharing their personal stories with me, which is very touching. I now have quite a repository of people’s experiences in the system, some good, some bad. Some readers are asking for help and are reaching out for assistance with navigating the system. Others say they were struck by this or that aspect of the book and now want to help. That was particularly surprising, and I am now in the process of figuring out what is an adequate and appropriate response to these offers. I don’t have the infrastructure in place currently to build a movement around these ideas, but the reception suggests there are people out there who would be willing to participate in one. We are going to have to collectively figure out how to channel their energy.
SMA: Are you optimistic about health system redesign? What are you seeing in other places?
DM: I’m seeing tremendous innovation and optimism across the country. When I was in B.C., people were really excited to talk about innovations in family practice, where collaborative care models between family doctors and specialists have dramatically reduced wait times, and virtual care models have enabled telephone consults between patients and doctors. There is excitement around reducing wait times and improving efficiency. I am en-route to Halifax and Fredericton next, where there is currently a lot of work happening on the kind of system redesign that’s just getting started here in Saskatchewan. This is work focused on trying to improve integration between primary care, hospitals and home care in the context of an aging population. There is great stuff happening all over the country, and the question now is how can we build on this positive energy and momentum? I think people are tired of having negative conversations about health care. I think they are ready for constructive and positive conversations and I must say that right now Saskatchewan seems like the most fertile place in the country for the implementation of big ideas like these.
About the Danielle Martin
Danielle Martin is a family physician in Toronto and vice-president, Medical Affairs and Health System Solutions, at Women’s College Hospital. Her book, Better Now: Six big ideas to improve health care for all Canadians, was released by Penguin Random House in January, 2017. For more on her book tour watch here and follow @docdanielle on Twitter.