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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.

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Jovana Milenkovic is a PGY2 in Pediatrics at the University of Calgary.

Ready is what I was.

A week of what should have been pure relaxation on the beaches of the Caribbean, was ruined by the torment of my special sixth sense. You see what I refer to as my sixth sense, is this twist deep in my stomach that always comes before something, usually bad, is going to happen. It came before I lost my first patient during clerkship. It came before my grandfather fell and broke his hip. It continues to come as a subconscious warning to brace myself.

We arrived at the airport, ready to head back home. While checking in, a passenger became unwell and was pulled to the side by the medical team. I watched as they took out a simple blood pressure cuff, “I haven’t had to use one of those since medical school, it’s all electronic now,” I commented to my mother. The twist in my stomach tightened.

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Stephanie Choquette is a medical student in the class of 2020 at the Northern Ontario School of Medicine

 

 

 

Public health is most often understood as “...the science and art of preventing disease, prolonging life, and promoting health through the organized efforts of society”. Its scope is broad and encompasses both physical and mental health. We are often attuned to the ways these efforts are not meeting the needs of our patients, and to the public-health crises that continue to plague us (pun, intended). Fifty-six long-term drinking water advisories remain on public systems on First Nations Reserves in Canada as of September 3rd, 2019.  Although a significant reduction from previous years, this indicates that many Indigenous Canadians still lack access to clean drinking water. In Thunder Bay, an HIV outbreak affecting predominantly the homeless population was declared in June 2019 within the context of an ongoing tuberculosis outbreak. News coverage regularly includes threats to public-health programs and funding, and concerns from within the field about changes to public-health organization and infrastructure. During my Public Health and Preventive Medicine elective at the Interior Health Authority in Kelowna, B.C., I discovered that no matter how distant that fifth-floor board room might seem from the exam table in my future, public health is changing the lives of individuals for the better every day. ...continue reading

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.

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10 Comments

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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Dennis Wesley is an independent educational researcher, whose interests include STEM, the Humanities, and health sciences--especially interdisciplinary practices and methods.

 

 

Written in 1978, Sontag’s long form essay ‘Illness as Metaphor’ is poignant for its historical study of illnesses and the metaphors that are used to describe them. These metaphors, most often, have a punitive and mystified connotation. Sontag takes us through the journey of metaphors attached with tuberculosis and, more recently, cancer. Essentially, she advocates for an explanatory language that is based on medical truths rather than on the disposition of the afflicted.

As a proponent of critical theory, it might seem like Sontag is handing over an illness to the field that it belongs to- the medical. However, she presents the tendency of philosophers and the general populace to shroud an illness, about which very little is known, in colorful and distasteful figurative language. ...continue reading

In this special episode, Dr. Diane Kelsall, previous interim editor-in-chief for CMAJ, interviews Dr. Andreas Laupacis, new editor-in-chief of the Canadian Medical Association Journal.

They chat about:

  • first impressions after two days on the job
  • his vision for the journal
  • his life as the child of refugee parents
  • the state of health care today
  • his proudest accomplishments during his career up to this point
  • why he decided it was time to stop doing clinical work

If you want to get in touch with Dr. Laupacis, you can reach him at:
andreas.laupacis@cmaj.ca
or on Twitter: twitter.com/AndreasLaupacis

...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