Dr. Joshua Tepper is a family physician and the President and Chief Executive Officer of Health Quality Ontario, the provincial adviser on health care quality
Recently, members of the health care community and the public at large mourned the loss of neurologist Dr. Oliver Sacks. My grandfather, also a neurologist, sent me one of Dr. Sacks’s books when I first expressed an interest in applying to medical school. I have since enjoyed many of his other written works.
Earlier this summer, the health care community also lost another tremendous leader, Dr. David Sackett, the father of evidence-based medicine. On my first day of medical school, I remember receiving one of his books too, and to this day it remains a fixture on my bookshelf as a resource.
It may seem odd to bring these two doctors together, because they held such divergent views of the clinical world. Sacks was applauded for elevating the case study and the patient story into a literary work of art – he wascalled, in an article in the New York TImes, “a kind of poet laureate of contemporary medicine.” Conversely, Sackett stressed the importance of good data, relying on the delicate and detailed systematic processes of clinical trials to drive clinical practice. But I’d argue that in the world of quality improvement, these two luminaries, who saw the power of both storytelling and data, strike a perfect ying and yang balance.
We need both data and narrative if we want a fighting chance to transform the quality of health care we deliver each day. I’ve seen first-hand how the reports at Health Quality Ontario, where I work as the president and CEO, have been enriched through the combination of statistics and stories. If we were to rely upon one without the other, we would only see half the person or half the condition. Take our most recent report on the variation of antipsychotic medication use cross Ontario: We integrated hard data with patient stories from those whose loved ones had benefitted from the drugs and others who saw improvement after discontinuing their use. In this way we provided the whole picture, while also drawing attention to an area in need of quality improvement.
More and more, we are realizing the power of the patient perspective, while still recognizing the value of good data to strengthen each individual voice.
Sacks understood that opportunities to learn did not fade after medical school and found new sources of education through conversations with patients. He was arguably one of the first to talk about people and the diseases they had – not the other way around. By personalizing illness as an individual experience, he encouraged placing the patient at the centre of care.
In one of his many books, The Man Who Mistook His Wife for a Hat and Other Clinical Tales, Sacks offers this pearl: “In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.”
For every Sacks, we need a Sackett. Sackett was one of the first to challenge traditional medicine and ask for the why behind how a treatment was determined to be a best practice. By asking why, he compelled people around him to always look for better evidence – not just more evidence. Sackett developed systematic reviews and meta-analyses in order to avoid data overload and to ensure the data used was both relevant and valid. We are all deeply indebted to him for the questions he asked and the structures he established to carefully guide us toward the best possible answers.
Like Sacks, Sackett believed we should always keep learning. He said, “Half of what you’ll learn in medical school will be shown to be either dead wrong or out of date within five years of graduation. The trouble is that nobody can tell you which half – so the important thing to learn is how to learn on your own.”
I hope as we all continue learning and gaining wisdom about anatomy and life, we will remember Sacks and Sackett and seek inspiration from their efforts.