The Politician and Doctor: The Interface

1
The Politician and DoctorThe Interface

• REACH Conference
• 
  
  
• Carolyn Bennett, M.D.,M.P.
• November 30,2007

2
Confessions

• Patient as Partner womens health model
• Womens College Hospital, Toronto
• Non Quo Sed Quo Modo .
• Not what we do, but how
• Feminist Theory..
• inclusive decision-making better results
• Complexity Theory and Politics
• For every complex problem, there is a simple
  solution thats WRONG !!

3
(No Transcript)
4
Whats a Doc Like Me Doing in a Place Like
Parliament Hill? the evolution of an MD/MP

• Fight for Womens College Hospital
• Frustration with public policy
• Frustration with medical leadership
• M.P./M.D. parallel
• Coach through system
• Doctor on Call

5
MDs in politics a good idea

• Ask people whats wrong listen
• Opening a chart and helping people through a
  system
• Very few issues of public policy that havent
  been through our office
• Small business loans
• Child custody access
• Young offenders
• Of course health determinants
• Poverty,Violence,Environment
• rather be working - PWD

6
Politics in Canada has always been the art of
making the necessary possible.
Peter C. Newman
Deciding what s necessary is political
7
Good public policy is developed when the
policy-makers can keep in their minds eye the
people affected.
Jane Jacobs
8
Quiz

• Who is your MP
• Who is your MPP
• Who is the Health Minister, party critics
• Have you ever written/called/emailed an elected
  representative
• Did you vote in the last election
• Do you belong to a political party
• Have you ever helped in an election

9
(No Transcript)
10
Underestimating our power. Well- meaning
fatalism. What can we do?
Michael Ignatieff
11
Three mistakes
1. Stop talking like victims 2.
Stop assuming we all agree 3. Stop
underestimating our strength.
Michael Ignatieff
12
Feel our strength. We cant go back to some
nostalgic paradise in the past.
Michael Ignatieff
13
Power is not real. It is an illusion maintained
by the belief of the powerless that others hold
it.
Elizabeth May Environmental Activist
14
Context

• Silos of Government
• Jurisdictional gridlock
• Governments prefer solutions
• Coalition of unusual suspects - compelling
• Public policy usually follows public opinion
• Climate of investment

15
Players

• Canadians
• Patient
• Advocate
• Citizen
• Government
• Professionals

16
Making a Difference

• NGOs
• Professional Organizations
• Media
• Electoral Politics

17
Spin off - passions

• Role of citizen elected representative
• Democracy between elections
• E-democracy
• Accountability Transparency
• Persons with Disabilities

18
CYNICISM
19
Stephen ColemanProfessor of e-democracy Oxford
UniversityPeople dont want to govern they
want to be heard. Civic efficacyTwo-way
accountability
20
225

• Knowledgeable Stakeholders
• Committed Politicians
• Better Public Policy

21
H.L.Mencken

• For every complex human problem there is a neat
  simple solution, its just that its wrong.

22

• Em PHA sis on the wrong syl LAB le

23
Attitude

• Fleeing the medical model.
• Embracing the medicine wheel

24
Blame Hippocrates?
25
Medical Model

• Tyranny of the acute
• Repair shop
• Top-down cult of efficiency
• Central command and control

26
Affirm Hygeia
HYGEIA Goddess of Health
27
Public Health 101
28
1.Do you think we should have a

• A) strong fence at the top of the cliff
• B) state of the art fleet of ambulances and
  paramedics waiting at the bottom ?

29
2. Would you prefer

• A) Clean air
• B) Enough puffers and respirators
• for all

30
3. Would you prefer that wait-times were reduced
by

• A) a falls program to reduce preventable hip
  fractures
• B) private orthopaedic hospitals and more
  surgeons

31
4.Should we invest in

• A) early learning, child care, literacy, the
  early identification of learning disabilities and
  bullying programmes
• B) increase the budget for young offenders
  incarceration

32
5.Should we

• A) assume that the 'grey tsunami' will bankrupt
  our health care system
• B) include our aging population in the planning
  of strategies to keep them well

33
6. Is the best approach to food security

• A) food banks and vouchers
• B) Income security, affordable housing, community
  gardens and community kitchens and a national
  food policy

34
7. Pick the one that is NOT correct

• Pandemic Preparedness should focus on
• Tamiflu for all
• Working with the vets to keep avian flu a disease
  of birds
• Making sure people wash their hands especially
  the doctors and nurses
• Research on vaccines
• Community care plans for our most vulnerable

35
8.Governments should boast about

• how much they spent on the sickness care system
• the health of their citizens, leaving no-one
  behind

36
teachable moments

• 2003
• Canada 44 died of SARS
• France14,000 died in the heat wave
• 2005..Katrina, Kasheshewan

37
Beyond borders. SARS as a teachable moment

• Beyond silos
• Departments
• Disciplines
• Beyond jurisdictional squabbling
• Naylor report 4 Cs
• Collaboration
• cooperation,
• communication
• clarity of who does what and when
• Germs dont respect borders
• Neither do the social contagions
• Nor the humanitarian imperatives

38
Social Determinants of Health vsChoose
Health(modifiable risks)
39
(No Transcript)
40
The Causes of the Causes

• Versus
• The Causes

41
Sir Michael Marmot

• The worst thing for a physician is to patch
  people up and send them straight back into the
  situation that made them sick in the first place.
• Evidence is not enough. There has to be the
  desire, the political will for change. Given that
  will - a big given but I am an optimist - the
  evidence of what works will be a great help.

42
The mobilization of shameIrwin Cotler

Management 101 If its measured it gets
noticed, if its noticed it gets done
43
We are not tinkers, who patch and mend what is
broken. We must be watchmen, guardians of the
life and health of our generation, so that
stronger and more able generations may come
after. Dr. Elizabeth Blackwell, first woman
physician North America Wanless Report UK
2003commissisoned by Gordon Brown