Four questions answered in HealthyDebate.ca

1) Parents who don’t want to have their children immunized are…

…as deserving of our care as anyone else. Of course, we ought to emphasize the personal and public benefits of vaccines. Several patients in my practice initially opted against vaccinations. Usually, this was due to fear from inaccurate stories shared online and in popular press. Over time, I earned their trust. As the family’s main physician, I was able to have authentic conversations that addressed their fears. I was able to understand their concerns, and give them my best advice. They usually ended up following it. Their children got the vaccinations they needed to stay healthy before entering school. Each time, I did not approach the topic through condescension or coercion. I valued the love they had for their children, and I was a partner in their child’s care. It took time. The work paid off in a meaningful, robust, and enduring doctor-patient relationship.

2) There is increasing concern about physician burnout. How would you help the physician community? 

I am mindful that physician burnout is a serious problem today. It leads to loss of empathy and fatigue, errors and poorer quality of care. The causes of burnout are varied and complex. We throw blame at hospitals, paperwork, patients, compensation, technology, responsibility. None of them alone are enough. Neither is it merely a matter of personal resilience. The pressure of our work weighs on us daily in the administration of medicine, but also in clinical care itself. When patients experience loss, death, grief, injury, suffering or barriers to access, we feel it too. These losses are especially difficult when related to systems issues such as overcrowding, poverty, or wait times. We cannot give up empathy, but rather we must use it to inspire change in the system.

But how?

First, we create a safe space. I promote a culture of honest conversation and open feeling. Burnout is not a sign of weakness. We must encourage doctors to reach out, recognizing symptoms in themselves. Formal and informal support networks should abound. Relief comes with time for reflection and self-care.  I will support communities of interest to keep specific passions alive, driving meaning in our work. We need to remember and recreate that awe of our first weeks of medical school, reconnecting with the human part of medicine to find joy.  Advocacy fights burnout. Joining together in a common cause of improving our cherished health system will buoy us up.  I would bring innovation and creativity to CMA, making us stronger. There is much that is good to build upon.

Can CMA Association fix every problem? Not all.  But as a collective voice for 85,000 physicians it has tremendous influence. We need a bold modern leader to head it. This is what I bring to the table in running!

3) The greatest benefits and downsides to the increasing emphasis on patient-centredness are …

The benefit of increasing emphasis on patient-centredness is obvious:  improvement in health outcomes we see when patients are true partners in decisions made in their care.  It is impossible for doctors to know everything their patients value, think and feel.  Taking a patient-centred approach ensures there is no guessing what is right for the patient. It creates space for meaningful conversations about difficult choices.  It brings humanism to the person sitting in front of us who we want to help with our experience and knowledge. When as physicians we put aside things we want for our patients, and instead act on what they want, even when we don’t completely agree, we build a stronger bond and sense of trust.  This creates an enduring relationship that is good for both of us.

There is only one downside to an emphasis on patient-centred care.  This is that it is has become so easy to say that its losing its meaning.  Many institutions say they focus on patients, but far few can actually demonstrate how. Does it take more time? Overall, no.  In the long-term patients become more independent and care for themselves better when partners, and this will save us time.  Does it fly in the face of evidence?  On the contrary.  There is increasing proof that patient partnerships produce far better outcomes and adherence to treatment plans.  Does it challenge the old paradigm of paternalistic care?  Absolutely.  But with training about care co-design, and data that shows improvement it is impossible to argue that this is isn’t the right thing to do.

It is possible for the CMA to move toward a patient centred approach and still represent the thoughts and feelings of its physician members.  This will take Bold Leadership.  I believe in this work and will fight to see that it happens in a way that is good for all of us.

4) When it comes to the federal government’s proposed tax changes on incorporated businesses, I feel physicians….. 

I feel that physicians were unfairly vilified in the press over the tax change issue.  The media and government highlighted legal tax deferral opportunities afforded physicians through medical practice corporations as being evidence of greed.  But there is a more honest story. Physicians pay significant taxes both before and after take home pay.  For instance, we are zero rated for HST.  Therefore, doctors must pay HST on purchases but cannot recoup it from our patients as retailers scan from their customers.  Many doctors are in a high tax bracket and pay consistently, in line with other professionals.  Physicians in Ontario were offered incorporation as an alternative to fee increases in a PSA negotiation over a decade ago.  This uploaded a cost from the province to the federal government, perhaps unfairly.

I believe that physicians should pay their fair share of tax as part of a socialized democracy.  I also believe that we do. We should not be given extra advantages, but neither should we be unfairly singled out.

I want to see significant tax reform happen in Canada.  The world has changed significantly in the decades since this was last done, and the tax system has become far too complex.  But large-scale change cannot be done with 75 days of consultation.  It will take a few years of significant work to simplify and provide fairness in our tax structure.  CMA can hold the federal government accountable as it is one of the most influential voices on Parliament Hill.

I am not afraid to have these tough conversations.  I am bold enough to stand up and make our collective opinion heard and to promote fairness. I believe in innovating and modernizing, and know that a good solution can be found.  More details are in my recent online post at http://larsen4cma.com/the-small-business-tax-issue/ . Have a look.

 

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