What I didn’t learn in medical school
Sometimes doctors can’t fix what makes their patients sick in the first place.
I began medical school optimistic about what becoming a physician meant I could do for my future patients. Naively, I presumed my career would involve treating patients’ illnesses so they could return to lead full and fulfilling lives. Yet for the one in seven Canadians living in poverty, it is often difficult for doctors to achieve this goal.
Take Christina, a 64-year old woman with diabetes, who came to me with new-onset numbness in her fingers and toes (a serious and progressive consequence of poorly controlled diabetes). As she struggled to leave on her walker, her prescription fell out of her purse. When I retrieved it for her, she mentioned that it hardly mattered because she would not have enough money to purchase the medication anyway.
Then there was Andrew, a 36-year old man who had been physically assaulted while panhandling. He had a prosthetic hip from a work accident that had left him with a pronounced limp, a chronic disability and no job. While I could screen Andrew for fractures and neurologic deficits, I could do nothing for his unemployment or his inability to find safe shelter at night.
These are but two of many encounters I have had that starkly contrast the values of social medicine I have learned in medical school. What good is it to treat illness if we can only send our patients back to the conditions that helped make them sick to begin with?
Healthcare is just a small part of what determines our well-being. In fact, our health is strongly influenced by factors such as income, our working environment and affordable housing, over which neither patients nor medical doctors have much control. This is why Canada needs better public policy that safeguards the global health of all Canadians.
As the ninth richest country in the world, we have managed to ignore the erosion of social assistance and the rise in income inequality that has taken place over the last decades. While we are one of the countries consistently spending the most on healthcare, we don’t do a very good job of providing a social safety net for the growing numbers of Canadians who are living paycheck to paycheck or are under or unemployed. We are also one of the few OECD countries without a national housing and homelessness strategy, which the United Nations Committee on Economic, Social and Cultural Rights considers a “national emergency.”
For a nation that once prided itself on being ranked “the best country in which to live,” we have a lot to do before warranting the title once again.
It does not have to be this way. Public policy decisions, including those that determine the allocation of tax revenue, strongly influence health outcomes. These decisions need to be critically re-examined, particularly when most Canadians have demonstrated their support for policies that improve conditions for the most vulnerable.
In 2009, a Nanos research poll reported that most Canadians strongly supported the public health system and strengthening publicly funded healthcare. In 2014, a poll by the Broadbent Institute found that 77 per cent of Canadians recognize the widening income gap as a serious issue for the country, while 71 per cent believe this gap undermines Canadian values. The same poll found that most Canadians are in favor of increasing taxes to fund public programs that will reduce the impacts of income inequality.
This means that Canadians are far ahead of their governments in supporting solutions to close the gap between the rich and poor, and, often at the same time, the healthy and unhealthy.
Canada’s current public policies could better meet both the health needs and social values of its citizens. As a soon-to-be physician I hope to practice medicine in a nation where income is not an obstacle to good health, and where polices and legislation are accountable to Canadians’ priority of health for all.
Vivian Tam is a second year medical student at the Michael G. Degroote School of Medicine at McMaster University.
Elizabeth Lee-Ford Jones is an expert advisor with EvidenceNetwork.ca, and Professor of Paediatrics at The Hospital for Sick Children and the University of Toronto.