CMA HEALTH SUMMIT

Session 1 - Canada’s Universal Health Care System – Myth or Reality?

Scenario: 
Six panelists take part in a virtual discussion at the CMA Health Summit session on May 18, 2021 about universal health care. Visuals vary between all six panelists on screen at once, to each panelist appearing full screen when describing the breakout session they attended. Moderator Althia Raj, CMA President Dr. Ann Collins, keynote speakers Dr. Nadine Caron and Dr. Danielle Martin, Globe and Mail health columnist André Picard and patient advocate Sudi Barre appear in the video.

Althia Raj
Moderator

There are five main themes or questions covered in the breakout sessions. Everyone on this panel attended one of the five sessions, and I wanted to end the Summit by asking them to summarize what they heard. Sudi, let's start with you. Your session explored how to achieve patient-partnered care. What were some of the barriers and solutions discussed?

Sudi Barre
Patient advocate

Thank you Althia. Some of the barriers discussed were patient partnership not being valued in the past and they're not really part of the trajectory and process of recovery for the patient's care, as well as hospital information often being fee-for-service based. And the example of the mechanic was given: the mechanic fixes the car, but the car belongs to the owner, which is the patient, so records should belong to the patient. In terms of the benefits and wonderful things that we see here, is that telehealth has been expedited through COVID pandemic, COVID virtual care has become mobilized and I do not think that will be going away. Managing the complexity of our mental health care, in terms of that community-based approach is also one of the ways that it has been seen to be very beneficial.

Althia: Andre, your group tried to identify the biggest gaps in health care and how to overhaul Medicare to address them. Can you share an example or two with us?

André Picard
Health columnist, The Globe and Mail

I think we had sort of consensus, we had a good mix of group of physicians: retired, practicing; patients, union reps, so a good cross-section. But there was kind of unanimity that the biggest gaps are actually in social supports rather than in medicine. So, a real desire to address the social determinants of health, everything from childcare through to income supports, etc. So that was the interesting part. A lot of discussion was about the public has to speak up, has to demand more of its politicians. And the final thing is people talked about how there's a lot of fear in the public, the public wants change, but they're fearful that the change won't be for the better and that kind of holds us back from getting the change that we really need. So, a rich discussion in our group.

Althia: Nadine, the theme of your session was how to better serve racialized and vulnerable populations in our health care system. What were some of the bold ideas discussed?

Dr. Nadine Caron
Surgical oncologist

Oh, we had a great discussion. Thanks, Althia. First of all was diving into racialized and vulnerable groups, what does that mean? And we had some examples in terms of new immigrants, refugees, if we had more time, I'm sure we would have dove into entities like Indigenous populations and other racialized groups in Canada and what we're responsible for when someone living in Canada walks through the doors of one of our health care institutions. Language was an important one, in terms of vulnerable populations that don't speak the language when they walk in and they don't speak English or French, depending on where you are in Canada. But also, there was a point of bringing in medical terminology, and the fact that you can speak English and be in downtown Vancouver or Calgary or Edmonton, but there's this language called ‘medicine.’ We dived in a little bit before we ran out of time in terms of virtual health care. The big word that came out of there is choice. People want the ability to have a choice long after COVID is over, in terms of the benefits of when they only need a virtual follow-up with a family doc or specialist, but they need the choice to be able to have a real face-to-face conversation when the challenges are there and they need that extra support. It was a great conversation. Lots of take home for the CMA to work on.

Althia: Thank you, Nadine. Danielle, your group analyzed the strengths and weaknesses exposed by the pandemic and how we can learn from these to build a better system. What were some of the key points from that discussion?

Dr. Danielle Martin
Exec. VP, Women’s College Hospital

Well, I want to begin by saying how impressed I was with the diversity of our group. We had people from and including generational diversity, all the way from medical students to folks who've been in practice for 40 years. With respect to virtual care, there was a hot debate in our group about has the pendulum swung too far, and have we gone past the limits of what can reasonably be expected to be high quality care when we're conducting so much of medicine in the virtual space. And yet, at the same time, that there are ways that virtual care can really be used to enhance equity and enhance access. So, what does the future responsible, high quality, as Nadine says, patient-driven version of virtual care look like and how does that fit into the system of the future, was one theme. And the second theme was around aging. A lot of talk about the tremendous failures in long-term care, we quickly went into questions of care delivery models, regulation, quality standards, equity of wages and collective bargaining, and thinking beyond long-term care into retirement homes and home care and supporting aging in the home. And so really trying to zoom out from the long-term care conversation to understand that it really is a conversation about aging more broadly that we need to have. It was a great conversation.

Althia: Thank you, Danielle. And finally, Ann. Your session focused on the innovative approaches in health care during the pandemic and how to ensure that spirit of innovation continues.

Dr. Ann Collins
CMA president

Certainly virtual care has captured everybody's attention. And I think it's safe to say that that's across Canada, and that's where we spent most of our discussion time. Innovation needs to continue in looking at building better platforms to deliver good access to mental health care, for example; educational platforms for our learners, who kind of got caught a bit in the middle of this pandemic and the eruption of virtual care. With respect to how you keep innovation or how you continue with innovation and that spirit of innovation, the theme seemed to be that if you meet patients where they are, and if you meet them in their communities and ask what their community needs, that that will very often lead to innovation. Sometimes it's not just looking for innovation, it's looking at and recognizing and acknowledging what we already have. And the example that was used was that part of the contributing factor to the collapse of long-term care in Ontario for example, was not recognizing the critical importance of informal caregivers and what they do to keep seniors supported, not just in their homes, but in long-term care facilities as well. A good discussion, but virtual care has captured everybody's attention.

Althia: Sounds like it. Thank you, Ann. So many great ideas and insights from the breakout sessions. It sounds like you all had very rich discussions.

Session 2 - Lessons learned from COVID-19: How do we close Canada’s health gap?

Scenario: 
Four panelists take part in a virtual discussion at the CMA Health Summit session on June 17, 2021 about health equity. Visuals vary between each panelist appearing full screen and an image of all four on screen at once. Keynote speaker Dr. Jane Philpott, panelists Dr. Naheed Dosani and patient advocate Nicole Nickerson and CMA President-elect Dr. Katharine Smart appear in the video.

Dr. Jane Philpott
Dean, Faculty of Health Sciences, Queen’s University

The worst outcomes of this pandemic have been felt by those who have been least able to speak up, or at least, least likely to be heard and taken seriously. We have watched the real-time impact of ableism ageism, racism, and other structures of oppression. But, we have also had a glimpse of what's possible when those structures are challenged and when the barriers are broken down. One of the most powerful lessons I observed, in a positive way, was the protective influence of Indigenous ways of knowing and doing.

Chief Don Maracle of the Tyendinaga Mohawks of the Bay of Quinte made smart public health decisions based on the wisdom of their culture, right from the start. He made sure that elders were told to stay home. He arranged for meal deliveries in a system to check in on older people. He told me that the top priority of their culture was the protection of elders. What was the result? In a population of 5,000 people there have been only 11 cases of COVID and only one death. Imagine if we had that kind of care of older people in the rest of our culture.

Dr. Naheed Dosani 
Palliative care physician

We need to switch our mode of thinking. We have a tendency in health care, and particularly in medicine, as Jane has mentioned, to kind of be paternalistic about things, and we really need to switch that and flip that on its head. We need to stop asking people, ‘what's wrong with you?’ and ask people, ‘what happened to you?’ or ‘what matters to you?’ We need to stop looking at a deficits-based approach to care and start looking at people's strengths, and not like, ‘where are you now? Where do you want to be tomorrow.’ Focus more on healing, not prescribing medicines. And I think it's a total paradigm shift towards community healing, and I truly think that the power lies in community. I mean, I work in hospital too and I know hospitals are important, but I think there's a general trend in this conversation is we need to invest in community, not just dollars and cents, but our resources, our time. And when I say invest in community, it means co-design with the very people who use our health care systems.

Nicole Nickerson
Patient advocate

I myself have recently witnessed the sad exclusion of a caregiver input and care due to hospital visitation restrictions with my grandmother. My nanny Scott is 84 years old and was completely independent. She went to emergency with dizziness and nausea. She had to be taken by family to other hospitals due to a lack of ambulances, where she was told she had cancer in her lungs which spread to her brain, while she was completely alone as no family members were allowed in. I must question where the humanity is in that. On the other side of my family tree during COVID, my nanny Hartman has gone from a stoic, vodka-drinking self-advocate to a very confused and frail woman in long term care. I know that this rapid decline could have been tempered by family visitation and its evidence-based need for ongoing social stimulation for those with dementia. The PSW and nursing staff cannot do this work alone. And many long term care residents like my nanny do not have the capacity to have independent virtual visitations with their loved ones. The results are incredibly sad personal disclosures of wanting to die because her quality of life is well below what she envisioned for her senior years. Caregivers are more than visitors.

Dr. Katharine Smart
CMA president-elect

Thank you to all the panelists. I think it's been really powerful and I think we're hearing a lot about how to really achieve health equity we have to redefine what health care is. And I think we heard a lot of great thoughts about how health is much more than just what happens in a doctor's office or in a hospital. It's about community, money, power politics, partnerships, access, paternalism and breaking down silos. So, I'm looking forward to hearing more about this.