Reflections

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Imaan Javeed is a medical student at the University of Toronto.

 

Warming up my dinner in the microwave, I habitually open the YouTube app to see what's going on in the world. Before the microwave can finish whirring, though, it suddenly occurs to me: do I even like this stuff?

I’m talking, of course, about politics.

I must, right? For a pill I take religiously every day, multiple times a day, which occupies an embarrassingly large chunk of my attention, you'd think it would be something I at least enjoy. The thing is, though, for me, it doesn't feel like a choice. It's not voluntary, nor is it just a hobby or a game. It's an obligation.

I would be lying, of course, if I told you it didn't give me that addictive rush, complete with the Netflix-like drama and cliffhangers that keep a person coming back for more. I fall down social media and news media rabbit holes as I ravenously devour new social, political and economic studies, polling, data, investigative work, news, and even opinion pieces. I get excited about participating, happy when my team is winning and frustrated when they're losing.

However, while it's easy to use trite analogies, the politics of today is anything but a game. Human lives are at stake each and every day. As abstract and unlikely as it sounds, even small acts of activism can help alleviate some of their suffering, bring them justice and make their lives easier. At the same time, our silence can do the opposite.

As future physicians, whose job it will (hopefully) be to care for the sick and vulnerable, and who take an oath to work for the greater societal good, knowing where to throw our political weight and understanding the power structures that operate to affect countless aspects of people's lives is a hefty yet important responsibility to carry.

Yet carry it we must – and while we're at it, help others to carry it as well. To remain disengaged or apathetic plays into the hands of those few in the system who work tirelessly (knowingly or unknowingly) in ways un-aligned with the public interest. If we're not present and ready to throw out the people who either aren’t working for us or simply aren’t the best candidates for the job, it serves as permission for them to keep doing what they're doing. Likewise, if we like the way things are going, we should show and up and make that known, or risk it changing under our noses. Our democracy relies on public accountability: accountability, that is, to you and your patients.

It's not enough to stick our privileged heads in the sand and refuse to engage, or engage with an air of entitled self-interest. Silence and blinders are statements in and of themselves. In a democratic society, these are choices we cannot escape with disengagement.

Nor is it enough to narrow our engagement to that which can be labelled as "healthcare related," like on topics of pharmacare, mental health, and MD remuneration. We may have the most expertise here, and valid opinions on the issues, but it would be short-sighted to stop at this.

Virchow once famously said that “politics is nothing else but medicine on a large scale.” It's true – a persons health is inseparable from the rest of their life. Their wages, working conditions, education, housing, food, stigma, discrimination and more all play roles. Broader issues like wealth inequality and climate change are also linked to health outcomes in countless ways, both subtle and overt, in Canada and around the world. Indeed, sometimes we become so focused on individual impacts on the people in our offices (ex: how disease presentation may be affected by social and environmental determinants) that we lose sight of the patients we may never meet face-to-face (ex: populations displaced by increasingly-harsh weather events or wars, or those prioritizing finding family housing over their health). Much like in clinical decision making, insular mindsets can deter us from taking properly-informed, well-nuanced stances on social issues. And especially as people of privilege, we have the opportunity to sway the people around us. This is key, as the medicine of politics is one that must be administered by a collective – both the choice of treatment and its dosage is controlled by collections of much smaller units.

Furthermore, for a truly holistic view, as citizens of a relatively wealthy, privileged, and influential nation, in order to give the global community we serve our full support, we must fight for the well-being of our patients not only here but beyond our borders, starting by staking clear stances on fundamental human rights. Our scope should include everyone -- from the workers struggling to pay rent in Toronto, to the rural Indigenous family without access to clean water, to the starving child in Yemen who has known nothing but war. We should feel a responsibility towards anyone who's life and health could be affected by our actions, no matter how far down the line.

I know it can be overwhelming to think about. Luckily, not everyone needs to become a politics junkie overnight. Start small. Have informal conversations with knowledgeable people, read and watch the news, maybe even get your friends involved to learn together. I understand that no one can do everything at once. The days are long and exhausting. However, it's worth asking ourselves at the end of the day: are we simply perpetuating what doesn't work, or are we doing our best to take part in changing it?

Making my tiny contribution to greater societal change is what I signed up for as a doctor-to-be. Politics is an inseparable part of that.

So, maybe I do like it. Maybe just a little.

Kacper Niburski is a medical student in the Class of 2021 at McGill University. He is also the CMAJ student humanities blog editor. Follow his writing instagram: @_kenkan.

 

 

a voice
from mine,
to yours 

a nose
poor plumbing
when frozen

freckles
little her
left holding
onto summer  ...continue reading

Due to the sensitivity of the post, the author wished to publish the following piece anonymously. 

Dear potential Referee,

My name is Jane Doe, medical student and residency applicant. So nice to meet you. You are the 30th new staff that I have worked with in the past 15 months and among the over 100 physicians and residents who I’ve met and had to prove myself to across many disciplines and hospitals in our fair country.

So excited to be working with you, to learn from you and to incorporate some of the approaches and expertise that you have into my slowly forming future practice. Look at all that I know how to do! Please appreciate all the additional readings I have done. Did you notice that I’m wearing a perfectly professional outfit with properly groomed hair? I’m actually living out of a suitcase and couch surfing in a city I have never been to that I paid hundreds of dollars to come to just so that I could have the opportunity to spend the day with you today. ...continue reading

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Dan Small is a medical anthropologist and lecturer at the University of British Columbia.

 

Since 2018, British Columbia has been pursuing legal action against pharmaceutical companies for their involvement in the opioid crisis. Within the wider context of North America, there have been over 2600 such lawsuits against the pharmaceutical companies including Purdue, Johnston and Johnson, Teva Pharmaceutical and Endo International. The Purdue pharmaceutical company, the maker of OxyContin, has recently filed for bankruptcy in response to the lawsuits. I believe a suitable strategy for examining the wider variables that have contributed to the opioid crisis: a Royal Commission. This is needed in order to widen public scrutiny beyond the role of pharmaceutical companies to include investigation of the overarching causes of Canada’s overdose epidemic.

...continue reading

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Maureen Topps is the Executive Director and CEO of the Medical Council of Canada.

 

Nothing matters more in my role than helping Canadian and international medical graduates succeed as they prepare to practice medicine in Canada. But what does success look like and how do we measure it?

...continue reading

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Marika Warren is an Assistant Professor in the Department of Bioethics, Dalhousie University.

 

In early July The College of Physicians and Surgeons of British Columbia dismissed a complaint against Dr. Ellen Wiebe made by the Louis Brier Home and Hospital, an Orthodox Jewish long term care facility. Dr. Wiebe had provided medical assistance in dying (MAiD) to a patient who resided in Louis Brier who had requested it. She thereby contravened the Home's policy. Cases such as these are increasingly likely as the policies of institutions exercising conscientious objection conflict with both patients’ interests in accessing MAiD (and other services) and providers’ interests in practicing with integrity. One way to resolve such conflicts would be to recognize a claim to conscientious provision of health care services that parallels the claims of individuals and organizations to conscientious objection. ...continue reading

Iris Gorfinkel is a General Practitioner, and Founder and Principal Investigator at PrimeHealth Clinical Research in Toronto, Ontario.

 

Medical documentation in primary care is a balancing act between promoting timely connection with patients and reducing clerical demands placed on physicians. Clinical notes contain increasingly less by way of narrative. They are often made up of time-saving digitized checklists of symptoms, physical findings, and treatments. Or the progress note may be a copy-and-pasted template. Both checklists and templates lessen the need for clinician typing and offer detailed notes within a few clicks.

Prior to the electronic medical record (EMR), hand-written or dictated notes would often relate a patient’s experience by quoting patients' descriptions of their symptoms. With the arrival of the EMR, doctors, most of whom had little typing experience, were abruptly confronted with having to type detailed patient encounters. The degree to which a clinician must type has since been correlated with physician burnout, which has risen sharply in conjunction with EMR utilization. ...continue reading

Sarina Lalla is a medical student in class of 2020 at McMaster University.

 

 

 

When I was on an emergency medicine rotation, I asked for a room to tell a patient news about an X-ray. I was told that this was not a common practice given the scarcity of private rooms. It was advised that I inform them in the waiting room where other strangers sat nearby. I was also told to present cases to staff in small spaces in earshot of patients. This was unsettling to me, and pushed me to reflect on confidentiality and privacy breaches in the ED.

Canadian EDs are well-known to be overcrowded. With limited resources and a high patient volume, the space of a department is used to house a maximum of patients. Sometimes thin curtains are separating patients, or nothing is separating them at all. Often, they are placed in hallways and close to workstations where healthcare staff outside of their circle of care are working. ...continue reading

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Akina Fay is a medical student in the Class of 2020 at McGill University.

 

 

 

Days after my fourteenth birthday, I was diagnosed with a rare brain malformation and underwent emergency brain surgery to prevent my spinal cord from dissecting.

Days after my seventeenth birthday, my mother was diagnosed with a rare form of incurable cancer.

At the age of twenty, I started medical school and began to piece together the pathophysiological processes that lead to our illnesses.

At the age of twenty-two, my mother died in my arms after a grueling year of hospitalizations, pain and suffering.

...continue reading

CMAJ’s Holiday Reading is back! CMAJ Blogs will host the popular Holiday Reading series online in December 2019.

We’re seeking witty, offbeat, whimsical stories grounded in medicine. Have ideas? Email blogs@cmaj.ca 

Need inspiration? Check out some popular stories from previous years:

Pooh has an addiction issue: holiday reading

Limitations

Diving into the ice bucket challenge