UofT MDs tell us what needs to change in the system

By Trevor Young

trevor-youngOur medical system is good overall. It works. But we’re at a moment when the possibilities of medicine and society’s expectations of us are sky-high, and we face the challenges of complex chronic disease and an aging population. And despite incredible advances in treatment – or maybe because of them – today’s healthcare can sometimes lack the human touch. In the winter issue of the Faculty of Medicine’s magazine, UofTMed, we asked our experts what needs to change in medicine.

Some highlights:

Bring back the human touch
We can get so wrapped up in the technological advances that we sometimes forget about the person in front of us. We’ve made great strides to personalize medicine but we need to go further and humanize it as well.

When I have patients in front of me, they’re a mystery; it’s my job to investigate. I want to understand what their ambitions are, what their strengths and fears are. I want to really know who they are. This allows me to develop their treatment plan to not only keep them healthy but to help them thrive.

Of course technology is an incredibly powerful tool in healthcare. But it is most powerful when coupled with a human-centred approach.

– Dr. Arno Kumagai, Vice-Chair, Education and FM Hill Chair in Humanism Education in the Department of Medicine.

Map our diversity
The thing I would like to see change most in medicine is to really start to address diversity and disparities in healthcare. Canada is becoming more diverse and our research practices need to reflect that. We need to start collecting race and ethnic data to show where some groups are having more health issues than others.

For example, we know that black and Southeast Asian Canadians have a higher risk of diabetes and heart disease. These are areas where we need to have a patient-centred approach and tailor our medicine for these populations.

The first step is to collect race and ethnic information in a healthcare setting. There are ways to link health information if you’re an immigrant, but for people like myself who were born here, that’s not going to come up in the health data.

There’s no systemic process to collect this information in Canada, whether it’s race, ethnicity or sexual orientation. We know that there will be health disparities but we can’t adequately address those unless we’re measuring it.

And we can do this. It’s being done in the United States and the United Kingdom, so we don’t have to reinvent the wheel.

– Dr. Onye Nnorom, Lecturer and Associate Program Director of the Residency Program in Public Health and Preventive Medicine.

Start calculating the risks of risk aversion
In my lab, we sequence genomes every day looking for the cause of rare disorders. In our search for, say, genes linked to autism, we increasingly bump into a mutation that causes something else like cancer.

Because of the fear of these “incidental findings” some research and clinical labs intentionally use “old” technologies or approaches so they don’t see all the genes in the genome, or at least only see the gene they want to see. I never feel good discarding those genome-wide results, especially if there are medical interventions available. Here, and with other breakthrough technologies, who’s calculating the risk of doing nothing?

– Stephen Scherer, Professor of Molecular Genetics, Director, McLaughlin Centre, Senior Scientist, The Hospital for Sick Children.

Rethink chronic disease and get out of the hospital
We need a whole suite of new services that can support people living with chronic illness closer to home and in the community, giving them a better outcome at lower cost. Instead of treating those things as surprises every time, we should proactively be trying to help people figure out where else they can go other than the hospital.

– Dr. Danielle Martin, Vice-President of Medical Affairs and Health System Solutions at Women’s College Hospital and a U of T professor in Family and Community Medicine

Questions, questions
Why are only hospitals high-tech? Why can’t clinics be? Why do you need to go to a hospital for an MRI? It might be cheaper in the community.

– Dr. Chaim Bell, Staff Physician at Toronto’s Mount Sinai Hospital and U of T professor of medicine.

Trevor Young is Dean of the University of Toronto Faculty of Medicine. Excerpted from the winter issue of UofT Med Magazine at http://uoftmedmagazine.utoronto.ca/

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