Treating Canada's Health Care System

Summary

In a TVO interview, Dr. Danielle Martin, a family doctor and advocate for universal health care, discusses her book 'Better Now: Six Big Ideas to Improve Health Care for All Canadians.' She addresses the Canadian health care system's challenges, including wait times, the need for a national pharmacare plan, and the importance of primary care relationships. Martin emphasizes the potential of reorganizing resources and the role of social determinants of health, such as a guaranteed annual income, in improving health outcomes. She calls for collaboration within the medical profession to innovate and scale successful health care models.

Takeaways

• 📚 Dr. Danielle Martin's book, 'Better Now: Six Big Ideas to Improve Health Care for All Canadians,' offers insights and suggestions for improving Canada's health care system.
• 🌟 Dr. Martin is a respected voice in health care, having testified before a U.S. Senate subcommittee and being a family doctor and VP of Medical Affairs at Women's College Hospital in Toronto.
• 🗣️ The interview highlights the importance of wait times in health care and how they can be managed more effectively within the single-payer system.
• 💊 Dr. Martin advocates for a national pharmacare plan in Canada, emphasizing the need for prescription drug coverage as part of the universal health care system.
• 🤔 She raises the issue of overprescription and overtreatment in the health care system, suggesting that sometimes doing less can be beneficial for patient health.
• 👵 The conversation touches on the challenges faced by elderly patients, such as the 'revolving door' of hospital admissions and the lack of support for care in the home.
• 💼 Dr. Martin discusses the role of primary care providers and the need for better relationships between them, their patients, and the broader health care system.
• 🏥 The script addresses the idea that the health care system is not just about funding but also about the reorganization and effective use of existing resources.
• 🏛️ The interviewee shares her personal story of her grandfather's experience with the health care system before Medicare, which influenced her views on health care access and affordability.
• 🤝 Dr. Martin calls for collaboration between physicians, government, and patients to improve the health care system, rather than relying solely on competition.
• 💡 The importance of considering social determinants of health, such as income and poverty, is emphasized as a critical factor in improving overall health outcomes.

Q & A

Who is Dr. Danielle Martin and what is her role in the health care system?

Dr. Danielle Martin is a family doctor, an activist for universal health care, and the Vice-President of Medical Affairs and Health System Solutions at Women's College Hospital in Toronto. She has testified before a committee of the U.S. Congress and has written a book titled 'Better Now: Six Big Ideas to Improve Health Care for All Canadians'.

What is the significance of Dr. Martin's testimony before the U.S. Congress?

Dr. Martin's testimony was significant because she was invited to speak about the Canadian health care system as part of a panel discussing international health care systems with universal coverage. Her insights and experiences provided a unique perspective on how the U.S. could learn from Canada's approach to health care.

What are the 'Six Big Ideas' mentioned in Dr. Martin's book to improve health care in Canada?

The transcript does not provide explicit details about all six big ideas, but it does mention several, including improving relationships within the health care system, implementing a national pharmacare plan, avoiding unnecessary medical interventions, reorganizing resources, considering social determinants of health like guaranteed annual income, and fostering a culture of collaboration and innovation within the medical profession.

Why is a national pharmacare plan considered essential according to Dr. Martin?

Dr. Martin considers a national pharmacare plan essential because one in five Canadian households reports that someone is not taking their medication as prescribed due to cost concerns. She argues that Canada is the only developed country with a universal health care system that doesn't include prescription drugs, which is shameful and detrimental to health outcomes.

What is the issue with wait times in the Canadian health care system as discussed by Dr. Martin?

Dr. Martin discusses that while there are established benchmarks for reasonable wait times in Canada, the system can be reorganized to be more effective. She uses the analogy of security lines to illustrate that sometimes the issue is not the amount of resources but how they are organized and managed.

What is the role of a family doctor or primary health care provider in the Canadian health care system according to Dr. Martin?

According to Dr. Martin, a family doctor or primary health care provider plays a crucial role in maintaining a long-term relationship with patients, understanding their overall health and life circumstances, and acting as a 'quarterback' to coordinate their care within the health care system.

How does Dr. Martin address the concern of overprescription and overtreatment in the health care system?

Dr. Martin acknowledges the issue of overprescription, overtreatment, and overtesting in the health care system, which can lead to patient harm. She advocates for a more disciplined approach, where medical professionals should consider whether interventions are known to improve health or if they may cause harm.

What is the impact of poverty on health according to Dr. Martin's views in the transcript?

Dr. Martin emphasizes that poverty is a significant determinant of health, with illness significantly concentrated among low-income individuals. She suggests that improving access to income and resources through measures like a guaranteed annual income could have a profound effect on health.

What is Dr. Martin's perspective on the role of competition in the health care system?

Dr. Martin believes that collaboration, rather than competition, is necessary for scaling successful health care programs and improving the system overall. She argues that the medical profession needs to take on the responsibility of partnering with government to make the health care system better.

How does Dr. Martin view the relationship between government and physicians in Ontario regarding health care improvements?

Dr. Martin expresses concern over the toxic relationship between the government and physicians in Ontario, which she believes hinders health system improvement. She calls for a new definition of professionalism within the medical community, emphasizing the need for doctors to participate in solving system issues.

What is the significance of the story of Susan, the 75-year-old woman, in the context of the health care system's issues?

The story of Susan illustrates the problem of the 'revolving door' of health care, where patients, especially older ones with chronic conditions, are repeatedly admitted and discharged from hospitals without receiving the appropriate care. Susan's case highlights the need for better organization of resources and a focus on patient goals and preferences.

Outlines

00:00

📚 Introduction to Dr. Danielle Martin's Advocacy

Dr. Danielle Martin, a prominent advocate for universal health care, is introduced by Steve as a guest who has testified before a U.S. Senate committee. She is a family doctor, Vice-President of Medical Affairs and Health System Solutions at Women's College Hospital in Toronto, and author of 'Better Now: Six Big Ideas to Improve Health Care for All Canadians.' The conversation begins with Steve referencing her viral testimony on wait times in Canadian health care and her experience with the U.S. health care debate.

47:39

🏥 Testimony on U.S. Health Care and Canadian System

Dr. Martin discusses her appearance before the U.S. Senate subcommittee, chaired by Bernie Sanders, to share insights on the Canadian health care system. She emphasizes the importance of a balanced perspective, acknowledging the strengths and areas for improvement in Canada's health care. The exchange highlights her role in the political theatre of health care debates and the significant reaction from Canadians, showing their pride in their health care system.

52:45

💔 Personal Impact of Health Care Costs

Dr. Martin shares a personal story about her Egyptian-born grandfather who suffered a heart attack shortly after immigrating to Canada. The medical expenses led to financial devastation for her family, influencing her beliefs about the necessity of health care based on need rather than ability to pay. This story underscores her passion for health care reform and her commitment to a sustainable health care system.

57:46

🤝 The Importance of Relationships in Health Care

The conversation shifts to focus on the critical role of relationships within the health care system. Dr. Martin emphasizes the importance of a strong relationship between Canadians and their primary health care providers, as well as the connection between primary care offices and the broader health care system. She argues that high-functioning primary care is the foundation of a high-performing health care system.

02:46

💔 Challenges in Accessing Primary Care

Dr. Martin acknowledges the difficulties many Canadians face in accessing primary care, such as the inability to see a family doctor promptly. She contrasts this with the rise of walk-in clinics, which provide episodic care without building lasting relationships, and argues for the need to improve primary care to support high-quality health care delivery.

07:50

💊 The Need for a National Pharmacare Plan

Dr. Martin discusses the issue of medication affordability, noting that one in five Canadian households report not taking prescribed medication due to cost concerns. She advocates for a national pharmacare plan that would integrate prescription drug coverage under the umbrella of Medicare, arguing that it would save billions and improve health outcomes by ensuring consistent access to necessary medications.

13:00

🚫 The Risks of Over-Treatment in Health Care

The discussion turns to the problem of over-prescription, over-testing, and overtreatment in the health care system. Dr. Martin warns of the potential harm caused by excessive medical interventions, especially for seniors, and calls for a more disciplined approach to health care delivery. She encourages a focus on evidence-based practices that genuinely improve health, rather than simply responding to patient demands or fear of litigation.

🛑 Reorganizing Health Care Resources

Dr. Martin shares the tragic story of Susan, an elderly woman who experienced the revolving door of health care, leading to a series of hospital admissions and discharges without proper support. This case illustrates the need to reorganize health care resources to provide the right kind of care, such as support for seniors to remain at home and timely transition to rehabilitation facilities.

💰 The Myth of Starving Health Care System

Dr. Martin challenges the common belief that the health care system is starved for funding, arguing that money is not always the solution and that better organization of existing resources is crucial. She provides examples of how specialists and family doctors can collaborate to reduce wait times and improve care, emphasizing the need for systemic change rather than simply throwing more money at the problem.

🌐 Innovative Solutions for Health Care Delivery

The conversation explores innovative solutions such as virtual consultations and telephone advice from specialists, which can reduce wait times and improve access to care. Dr. Martin highlights the importance of thinking differently about health care delivery and leveraging technology to enhance the efficiency and effectiveness of the health care system.

🤝 The Role of Doctors in System Improvement

Dr. Martin stresses the need for doctors to take on the responsibility of improving the health care system, recognizing that solving system issues is part of their professional role. She discusses the current toxic relationship between the government and physicians in Ontario and calls for a new definition of professionalism that includes collective responsibility for system improvement.

💡 The Power of Guaranteed Annual Income

The interview concludes with a discussion on the potential impact of a guaranteed annual income on health care. Dr. Martin argues that addressing poverty through a guaranteed income could have a profound effect on health, citing the Mincome experiment in Manitoba that reduced hospitalizations. She emphasizes the importance of considering social determinants of health in any comprehensive health care strategy.

Keywords

💡Universal Health Care

Universal health care refers to a system where all residents have access to health services regardless of their ability to pay. In the video, Dr. Danielle Martin is an advocate for this system, as she discusses her activism and her experiences testifying about it before a U.S. Senate committee. She emphasizes the importance of access to health care based on need rather than ability to pay, which is a core principle of universal health care.

💡Wait Times

Wait times in health care refer to the period a patient must wait to receive treatment or consultation after a referral. Dr. Martin discusses this issue, noting that while Canada has established benchmarks for reasonable wait times, there are ways to improve the system within the single-payer framework. She uses the analogy of security lines to illustrate that sometimes the issue is not the amount of resources but the organization of them.

💡Primary Health Care Provider

A primary health care provider is typically the first point of contact between a patient and the health care system, often a family doctor. In the script, Dr. Martin emphasizes the importance of a strong relationship between Canadians and their primary health care providers, arguing that this relationship can significantly contribute to health improvement and is a cornerstone of a sustainable health care system.

💡Pharmacare

Pharmacare refers to a proposed national program to provide coverage for prescription medications. Dr. Martin argues that a national pharmacare plan is essential because many Canadians are not taking their medications as prescribed due to cost concerns. She points out that Canada is the only developed country with a universal health care system that does not include prescription drugs, which she finds shameful.

💡Overprescribing

Overprescribing occurs when health care providers give patients more medication than necessary or prescribe medications that may not be beneficial. Dr. Martin mentions that overprescribing, along with overtesting and overtreatment, is prevalent in the health care system, leading to potential harm for patients, such as increased risks of falls and hospitalizations.

💡Health Care Reorganization

Health care reorganization involves restructuring the way health care resources are deployed to improve efficiency and patient outcomes. Dr. Martin discusses the need to reorganize health care resources to ensure they are used in a more logical and rational manner, rather than simply increasing funding, which may not necessarily improve the system.

💡Social Determinants of Health

Social determinants of health are the conditions in which people are born, grow, live, work, and age. These circumstances have a significant impact on health. Dr. Martin highlights income as the number one determinant of health, noting that a guaranteed annual income could have a profound effect on health outcomes by reducing poverty and improving access to resources.

💡Professionalism in Medicine

Professionalism in medicine refers to the standards, qualities, and responsibilities that physicians are expected to uphold. Dr. Martin calls for a redefinition of professionalism among doctors, emphasizing that they should take on the responsibility of not only treating individual patients but also participating in solving system-wide issues to improve health care overall.

💡Mental Health Services

Mental health services encompass a range of treatments and support for individuals experiencing mental health issues. Dr. Martin points out that improving access to mental health services could be achieved through better organization and utilization of existing resources, such as team-based care, virtual consultations, and telephone consultations, rather than simply increasing funding.

💡Health System Improvement

Health system improvement refers to efforts to enhance the quality, efficiency, and effectiveness of health care delivery. Dr. Martin stresses that health system improvement requires collaboration between physicians and government, as well as a willingness to challenge the status quo and adopt new approaches to care delivery.

💡Guaranteed Annual Income

A guaranteed annual income is a government program that provides citizens with a minimum level of income regardless of employment status. Dr. Martin discusses the potential health benefits of such a program, citing a historical experiment in Manitoba that showed a reduction in hospitalizations when people had access to a minimum income.

Highlights

Dr. Danielle Martin discusses her testimony before a U.S. Senate subcommittee on the Canadian health care system.

She emphasizes the importance of reorganizing the health care system to improve wait times and patient experiences.

Dr. Martin shares her book 'Better Now: Six Big Ideas to Improve Health Care for All Canadians', outlining her vision for health care reform.

The interview covers the significance of primary care and its role in a high-functioning health care system.

Dr. Martin addresses the issue of Canadians not taking prescribed medication due to cost concerns, advocating for a national pharmacare plan.

She argues that a national pharmacare plan would save billions and ensure medication access for all Canadians.

Dr. Martin highlights the problem of overprescription, overtreatment, and the harm caused by unnecessary medical interventions.

The interview touches on the role of culture in health care delivery and the need for systemic change within the medical profession.

Dr. Martin discusses the potential impact of a guaranteed annual income on health outcomes and reducing hospitalizations.

She refutes the notion that a single-payer system stifles innovation, citing the need for collaboration over competition.

Dr. Martin calls for a redefinition of professionalism among doctors to include solving systemic issues within health care.

The importance of improving relationships within health care, between patients and providers, is underscored.

Dr. Martin shares her family's personal experience with the health care system, highlighting the need for a system based on need, not ability to pay.

The interview delves into the challenges of accessing primary care and the rise of walk-in clinics as a result.

Dr. Martin discusses the concept of 'doing less' in health care, questioning the necessity of certain tests and procedures.

She addresses the fear of litigation among doctors and how it influences medical decision-making and test ordering.

The conversation includes the idea of reorganizing resources within health care to better meet patient needs and preferences.

Transcripts

>> Steve: WE'VE HAD A LOT OF GUESTS ON THIS PROGRAM OVER THE YEARS WHO'VE WEIGHED IN WITH

THEIR VIEWS ON HOW TO IMPROVE ONTARIO'S HEALTH CARE SYSTEM.

BUT TO THE BEST OF MY KNOWLEDGE, ONLY ONE HAS EVER TESTIFIED BEFORE A COMMITTEE OF THE U.S.

CONGRESS.

DR. DANIELLE MARTIN HAS LONG BEEN AN ACTIVIST FOR UNIVERSAL HEALTH CARE.

SHE'S A FAMILY DOCTOR AND ALSO VICE-PRESIDENT OF MEDICAL AFFAIRS AND HEALTH SYSTEM

SOLUTIONS AT WOMEN'S COLLEGE HOSPITAL IN TORONTO.

SHE HAS PUT HER EXPERIENCES AND IDEAS FOR REFORM IN A NEW BOOK CALLED: "BETTER NOW: SIX BIG

IDEAS TO IMPROVE HEALTH CARE FOR ALL CANADIANS."

AND WE WELCOME DR. DANIELLE MARTIN BACK TO TVO.

nice to see you again.

>> Dr. Danielle Martin: NICE TO SEE YOU.

>> Steve: YOU'RE NOT GOING TO BE SHOCKED WITH WHAT I WANT TO START WITH HERE.

PEOPLE KNOW YOU.

>> Dr. Danielle Martin: THE SENATE.

>> Steve: GOT IT.

PEOPLE KNOW YOU FOR A BUNCH OF REASONS BUT I SUSPECT FOR THIS REASON ABOVE ALL ELSE.

ROLL CLIP, PLEASE.

>> WHAT LENGTH OF TIME DO YOU CONSIDER TO BE EQUITABLE WHEN WAITING FOR CARE?

>> WELL, IN FACT, THE WAIT TIME LINES IN CANADA, SIR, HAS ESTABLISHED BENCHMARKS ACROSS A

VARIETY OF DIFFERENT DIAGNOSES FOR WHAT'S A REASONABLE PERIOD TO WAIT.

WHAT WE FOUND IS THAT ACTUALLY, WORKING WITHIN THE SINGLE PAYER SYSTEM WE CAN REORGANIZE THINGS.

I WAITED MORE THAN 30 MINUTES AT THE SECURITY LINE BEFORE I GOT IN THIS BUILDING.

I NOTICED ACROSS THE HALL THERE WAS A SECOND ENTRY POINT WITH NO LINEUP WHATSOEVER.

SOMETIMES IT'S NOT ACTUALLY ABOUT THE AMOUNT OF RESOURCES THAT YOU HAVE BUT RATHER ABOUT

HOW YOU ORGANIZE PEOPLE IN ORDER TO USE YOUR QUEUES MOST EFFECTIVELY.

THAT'S WHAT WE'RE TRYING TO DO.

WHEN YOU TRY TO ADDRESS WAIT TIMES, YOU SHOULD DO IT IN WAYS THAT BENEFIT EVERYONE, NOT JUST

PEOPLE WHO CAN PAY.

>> ON AN AVERAGE HOW MANY CANADIANS DIE ON A WAITING LIST?

>> I DON'T KNOW.

THERE ARE 34,000 IN AMERICA WHO DIE WAITING BECAUSE THEY DON'T HAVE INSURANCE AT ALL.

>> Steve: THAT WAS VERY SHARP, THAT WHOLE WAITING THING.

HOW DID YOU END UP BEFORE THAT COMMITTEE ANYWAY?

>> Dr. Danielle Martin: THE CHAIRMAN OF THAT U.S. SENATE SUB COMMITTEE WAS ONE BERNIE

SANDERS, INDEPENDENT SENATOR FROM VERMONT, WHO IS KNOWN FOR MANY MORE THINGS NOW.

AT THE TIME HE WAS CHAIRING THAT SUB COMMITTEE.

AND HE WAS ORGANIZING A PANEL ABOUT WHAT THE U.S. CAN LEARN FROM INTERNATIONAL HEALTH CARE

SYSTEMS THAT HAVE UNIVERSAL COVERAGE.

SO THEY ORGANIZED A PANEL AND I WAS INVITED TO SPEAK ABOUT THE CANADIAN HEALTH CARE SYSTEM, I

HAVE EXPERTISE IN THAT AREA, AND THEY CALLED ME UP AND I HAD SOME PRE-VETTING THAT TOOK PLACE.

I MEAN, IT'S A PRETTY INVOLVED PROCESS.

AND THEN I CAME TO BE SEATED AT THAT PANEL TABLE THAT YOU SAW AND THERE WAS SOMEBODY SPEAKING

ABOUT FRANCE AND SOMEONE ABOUT DENMARK AND SOMEONE ABOUT TAIWAN, ET CETERA, AND I WAS

THERE TO TALK ABOUT WHAT THE U.S. CAN LEARN FROM CANADA, WHICH IS ALWAYS A TRICKY PLACE

TO FIND YOURSELF BECAUSE YOU WANT TO PUT YOUR BEST FOOT FORWARD AND TALK ABOUT THE

THINGS THAT MAKE YOU PROUD ABOUT YOUR COUNTRY, BUT I THINK IN MY CASE, I ALSO WANTED VERY MUCH TO

BE BALANCED IN TERMS OF THE PERSPECTIVE THAT I PUT FORWARD.

I DIDN'T JUST WANT TO SAY, OH, EVERYTHING'S PERFECT.

I WANTED TO ACKNOWLEDGE WHERE WE CAN DO BETTER.

>> Steve: RIGHT.

I DO RECALL AT THE TIME, THERE WERE A LOT OF PEOPLE WHO SAW THIS CLIP -- IT DID GO VIRAL AND

THEY WERE SORT OF SAYING, YOU GO, GIRL, WELL DONE.

WHAT DID THE AMERICAN SENATOR WHO YOU WERE AFTER THERE, WHAT WAS HIS REACTION?

>> Dr. Danielle Martin: HE JUST SHOOK MY HAND AND LEFT AT THE END.

I DON'T THINK -- YOU KNOW, I WASN'T REALLY THERE THINKING THAT I WAS GOING TO CHANGE

ANYBODY'S MIND ABOUT HOW THE HEALTH CARE DEBATE SHOULD GO IN THE U.S. AND I DON'T THINK HE

EXPECTED TO HAVE HIS MIND CHANGED.

YOU KNOW, THAT WAS A BIT OF POLITICAL THEATRE.

I TALK ABOUT IT IN THE BOOK, YOU KNOW, HOW I HAD TO BE PRETTY CAREFUL WITH MYSELF ABOUT

UNDERSTANDING WHAT ROLE WAS I BEING ASKED TO PLAY.

AND THESE GUYS WERE NOT REALLY TALKING TO ME, THEY WERE TALKING OVER ME TO THEIR PUBLIC AND I

WAS PLAYING AN ASSIGNED ROLE.

BUT WHAT I DID DO IS TOUCHED A NERVE IN CANADA THAT I WAS TOTALLY UNPREPARED FOR, AND A

HUGE AMOUNT OF REACTION THAT I HAD, PEOPLE WHO REACHED OUT TO ME, CANADIANS LIVING ALL OVER

THE WORLD, ALL OVER THE COUNTRY, HANDWRITTEN NOTES, eMAILS FROM PEOPLE, MEDIA COVERAGE.

IT SAID TO ME THAT CANADIANS ARE STILL REALLY PROUD OF MEDICARE AND CONSISTENTLY IN POLL AFTER

POLL WILL SAY IT'S OUR GREATEST NATIONAL ACCOMPLISHMENT.

>> Steve: HAVING SAID THAT, THERE ARE PROBLEMS -- >> Dr. Danielle Martin: THERE

ARE HUGE PROBLEMS.

>> Steve: AND YOU OUTLINE THEM IN THE BOOK.

>> Dr. Danielle Martin: EXACTLY.

>> Steve: I WANT TO TAKE YOU BACK MANY DECADES AND I WANT YOU TO TELL US ABOUT YOUR

EGYPTIAN-BORN GRANDFATHER AND WHY HIS STORY KIND OF, YOU KNOW, I THINK ALERTED A PASSION INSIDE

YOU THAT LED TO MAYBE WHERE YOU ARE TODAY.

>> Dr. Danielle Martin: SURE.

YOU KNOW, IT'S A STORY THAT ACTUALLY PREDATES MY BIRTH.

SO MY GRANDPARENTS CAME TO CANADA IN THE EARLY '50s FROM CAIRO IN A BIT OF A RUSH.

THEY HAD THREE GENERATIONS ON THE SHIP TO PIER 21 IN HALIFAX.

MY MOM STILL REMEMBERS THAT JOURNEY.

SHE WAS A LITTLE GIRL AT THE TIME.

AND WITHIN 18 MONTHS OF ARRIVING IN MONTRéAL, MY HEALTHY, STRAPPING 40-SOMETHING

GRANDFATHER HAD A TOTALLY UNEXPECTED HEART ATTACK, AND MY FAMILY WAS PLUNGED INTO

ESSENTIALLY A DECADE OF HORRIBLE MEDICAL EXPERIENCES IN THE DAYS OF CANADIAN MEDICINE BEFORE

MEDICARE, AND BY THE TIME MY GRANDFATHER DIED IN HIS EARLY 50s, THEY WERE NOT JUST SORT

OF DESTROYED FROM A HEALTH PERSPECTIVE BUT FINANCIALLY COMPLETELY DESTROYED.

AND MY MOM STILL TALKS ABOUT THAT EXPERIENCE IN THAT IT'S HER BELIEF THAT THE FINANCIAL

DEVASTATION AND THE WAY THEY HAD TO BORROW MONEY FROM FAMILY MEMBERS AND FRIENDS AND THE

MARKS THAT LEFT ON THOSE RELATIONSHIPS THAT NEVER REALLY HEALED, THAT IT WAS THAT THAT

ACTUALLY, IN HER VIEW, RUINED THEIR FAMILY.

I GREW UP WITH THAT STORY.

IT'S NOT THE SUM TOTAL OF WHO I AM OR WHY I BELIEVE EVERYTHING I BELIEVE, BUT IT CERTAINLY HAD AN

INFLUENCE ON ME, AND IT CERTAINLY LED TO MY BELIEF THAT -- AND I THINK THIS IS A

BELIEF SHARED BY MOST CANADIANS -- THAT ACCESS TO HEALTH CARE IS SOMETHING THAT

SHOULD BE BASED ON NEED, NOT ABILITY TO PAY.

AND THAT IS A DRIVING FORCE, IT'S BEEN A DRIVING FORCE IN MY CAREER FOR SURE.

>> Steve: YET HERE WE ARE WITH SIX BIG IDEAS YOU THINK WE NEED TO LOOK AT TO IMPROVE HEALTH

CARE IN CANADA.

LET'S GET INTO THEM.

THE FIRST, YOU SAY, AND THIS SOUNDS LIKE NOTHING TO DO WITH HEALTH CARE AT ALL:

RELATIONSHIPS.

>> Dr. Danielle Martin: RIGHT.

>> Steve: HOW IS IMPROVING RELATIONSHIPS WITHIN HEALTH CARE GOING TO IMPROVE HEALTH CARE?

>> Dr. Danielle Martin: SO I'M TALKING ABOUT TWO VERY SPECIFIC RELATIONSHIPS.

THE FIRST IS THE RELATIONSHIP BETWEEN EVERY CANADIAN AND THEIR PRIMARY HEALTH CARE PROVIDER.

USUALLY THEIR FAMILY DOCTOR.

I TALK A LOT IN THE BOOK ABOUT HOW THAT RELATIONSHIP CAN BENEFIT PEOPLE'S HEALTH.

THAT RELATIONSHIP OVER TIME, BETWEEN YOU AND SOMEONE WHO COMES TO KNOW YOU, WHO

UNDERSTANDS YOUR UPS AND DOWNS, YOUR BROADER LIFE, NOT JUST ONE PART OF YOUR BODY OR ANOTHER

PART OF YOUR BODY, BUT THE WHOLE OF YOU, HOW THAT CAN CONTRIBUTE TO IMPROVEMENT IN HEALTH OVER

TIME AND HOW IT CAN ALSO MAKE THE HEALTH CARE SYSTEM SUSTAINABLE.

BUT SECONDLY IS THE RELATIONSHIP BETWEEN THAT PERSON'S PRIMARY CARE OFFICE AND THE REST OF THE

HEALTH CARE SYSTEM.

SO AS A FAMILY DOCTOR MYSELF, WHEN I SEE PATIENTS WHO NEED SPECIALTY CARE OR WHO HAVE BEEN

GOING IN AND OUT OF THE HOSPITAL OR WHO NEED CARE IN THE COMMUNITY OR AT HOME, IT'S MY

JOB TO SORT OF BE THE QUARTERBACK FOR THE WHOLE OF THAT PERSON'S JOURNEY THROUGH

THE HEALTH CARE SYSTEM, AND WHEN THOSE RELATIONSHIPS ARE FUNCTIONING WELL, THE

RELATIONSHIP BETWEEN THE PATIENT AND THEIR PROVIDER AND THE RELATIONSHIP BETWEEN THE

PROVIDER AND THE REST OF THE SYSTEM, EVERYTHING ELSE WORKS, AND ALL HIGH-PERFORMING HEALTH

CARE SYSTEMS ARE BUILT AROUND THAT CORE OF HIGH-FUNCTIONING PRIMARY CARE.

>> Steve: THE FLIP SIDE OF THAT, OF COURSE, IS IF YOU CAN'T GET IN TO SEE A FAMILY DOCTOR IN

A SYSTEM WHERE EVERYTHING IS BUILT AROUND THAT ORIGINAL RELATIONSHIP, WE'VE GOT HUGE

PROBLEMS.

>> Dr. Danielle Martin: THAT'S RIGHT.

SO I THINK THAT WE HAVE A LOT OF WORK TO DO IN THAT AREA.

WE KNOW, FOR EXAMPLE, AND I TALK ABOUT THIS, THAT IN CANADA FEWER THAN 50% OF CANADIANS WILL SAY

THAT THEY CAN GET IN TO SEE THEIR FAMILY PHYSICIAN ON THE SAME DAY OR NEXT DAY WHEN THEY

CALL WITH AN URGENT PROBLEM, WHICH IS HOW WE'VE SEEN, JUST AS AN EXAMPLE, CERTAINLY IN URBAN

CENTRES, THE RISE OF THE WALK-IN CLINIC.

A CONVENIENT FORM OF CARE, WHICH I UNDERSTAND WHY PEOPLE USE IT, BUT ACTUALLY QUITE THE OPPOSITE

OF WHAT WE WOULD CONSIDER TO BE RELATIONSHIP-BASED PRIMARY CARE, VERY EPISODIC, NO RELATIONSHIP,

NO ONGOING CHART, NO COMMUNICATION BACK, AND NOT THE KIND OF MODEL THAT REALLY I

THINK SUPPORTS HIGH-QUALITY HEALTH CARE.

AND SO IN THE ABSENCE OF THOSE RELATIONSHIPS, WE SEE THAT KIND OF BREAKDOWN.

IT'S MY VIEW THAT WE NEED TO UP OUR GAME IN PRIMARY CARE.

I SAY THAT AS A FAMILY DOCTOR.

AND I THINK THAT THERE'S A LOT OF WORK THAT WE CAN DO AND IT'S ABSOLUTELY DOABLE, IS PART OF

THE POINT I'M TRYING TO MAKE.

IT'S NOT MAGIC.

WE DON'T NEED THOUSANDS MORE DOCTORS, WE DON'T NEED A TON MORE MONEY IN THE SYSTEM, WE

JUST NEED TO ORGANIZE A LITTLE BETTER WHAT WE'RE DOING.

>> Steve: PHARMACARE, ANOTHER OF YOUR IDEAS.

WHY IS A NATIONAL PHARMACARE PLAN, IN YOUR VIEW, ESSENTIAL?

>> Dr. Danielle Martin: FOR THIS VERY SIMPLE REASON THAT ONE IN FIVE CANADIAN HOUSEHOLDS

REPORTS THAT SOMEONE IN THAT HOUSEHOLD IS NOT TAKING THEIR MEDICATION AS PRESCRIBED BECAUSE

OF CONCERNS ABOUT COSTS.

SO CANADA IS NOW OFFICIALLY THE ONLY COUNTRY IN THE DEVELOPED WORLD WITH A UNIVERSAL HEALTH

CARE SYSTEM THAT DOESN'T INCLUDE PRESCRIPTION DRUGS, AND I THINK THAT THAT IS SHAMEFUL, FRANKLY.

IN AN AGE WHERE WE'RE TRYING TO MOVE HEALTH CARE OUT OF THE HOSPITAL, TO KEEP PEOPLE WELL IN

THE HOME, IT'S ABSURD THAT A PERSON WHO IS ADMITTED TO THE HOSPITAL COULD HAVE ACCESS TO

ALL OF THE CARE THEY NEED, INCLUDING ALL OF THE MEDICATIONS AND THE INSTANT THAT THAT PERSON

SETS FOOT OUTSIDE THE HOSPITAL ON THE SIDEWALK WITH A PRESCRIPTION IN THEIR HAND,

THEY'RE ON THEIR OWN.

WE'RE NOW IN A SITUATION WHERE WE'RE PAYING FOR COMPLICATIONS OF CHRONIC ILLNESS, FOR HOSPITAL

ADMISSIONS AND EMERGENCY DEPARTMENT VISITS FOR PEOPLE WHO WOULD BE SO MUCH BETTER OFF, AND

THEIR HEALTH WOULD BE SO MUCH BETTER TAKEN CARE OF, IF THEY COULD AFFORD TO TAKE THEIR

MEDICINE.

>> Steve: TELL ME THIS.

IF YOU TAKE PEOPLE WHO HAVE A PHARMA PLAN AT WORK OR THEY'RE OVER 65 --

>> Dr. Danielle Martin: IN ONTARIO.

>> Steve: IN ONTARIO.

OR IF THEY'RE A LOW INCOME PERSON AND THEREFORE THEY GET DRUG BENEFITS AS A RESULT OF

THAT, THAT'S GOT TO BE A HUGE PERCENTAGE OF THE PEOPLE IN THE PROVINCE OF ONTARIO.

NO?

>> Dr. Danielle Martin: I THINK IT PROBABLY IS IN THE PROVINCE OF ONTARIO.

THE PROBLEM IS THAT EVEN IN SOME OF THOSE PUBLIC PLANS, AND IN SOME OF THE PRIVATE PLANS, THE

CO-PAYMENTS AND THE DEDUCTIBLES FOR SOME PEOPLE ARE A BARRIER.

I HAVE A PATIENT IN MY PRACTICE, I CALL HER JULIE IN THE BOOK, WHO RECEIVED A COUPLE OF YEARS

AGO NOW A DIAGNOSIS OF M.S., MULTIPLE SCLEROSIS, AND HER MEDICATIONS COST $25,000 A YEAR.

WELL, SHE'S GOT A WORK PLAN THAT COVERS -- IN FACT, SHE IS ACTUALLY SELF EMPLOYED, BUT HER

HUSBAND HAS A PLAN THAT COVERS 80% OF THE COST OF HER MEDICINES.

BUT THAT 20% IS THOUSANDS OF DOLLARS EVERY YEAR FOREVER THAT THEY HAVE TO TRY TO FIND.

AND SO SOMETIMES EVEN HAVING COVERAGE -- >> Steve: NOT ENOUGH.

>> Dr. Danielle Martin: -- DOESN'T MEAN THAT IT'S NECESSARILY ENOUGH.

>> Steve: A NATIONAL PHARMACARE PLAN WOULD DO WHAT THEN?

>> Dr. Danielle Martin: IT WOULD ESSENTIALLY BRING MEDICINES UNDER MEDICARE.

FOR THOSE MEDICATIONS THAT THERE IS GOOD MEDICAL EVIDENCE TO SUPPORT THEIR USE, NOT

EVERYTHING FOR EVERYONE ALL THE TIME BUT A LIST OF WHAT'S CALLED A NATIONAL FORMULARY OR

SUPPORTED BY MEDICAL EVIDENCE, WHEN YOU GO TO THE DRUGSTORE YOU SHOULD PRESENT YOUR HEALTH CARD

AND THEY SHOULD GIVE YOU YOUR MEDICINE AND YOU SHOULD GO HOME AND TAKE IT.

>> Steve: COULD WE DO THIS IN CANADA?

>> Dr. Danielle Martin: WE COULD DO IT AND IT WOULD SAVE US BILLIONS OF DOLLARS IN THE

PRIVATE SECTOR BECAUSE EMPLOYER-BASED HEALTH PLANS ARE EXTREMELY EXPENSIVE AND PEOPLE

ARE PAYING A LOT OUT OF POCKET.

ONE OF THE THINGS I WONDER ABOUT, YOU KNOW, IN THIS ONGOING DISPUTE BETWEEN THE PROVINCES

AND THE FEDERAL GOVERNMENT ABOUT, ARE WE GOING TO HAVE A HEALTH ACCORD AND IF WE'RE GOING

TO HAVE A HEALTH ACCORD, WHAT'S GOING TO BE IN THE HEALTH ACCORD, THE DISCUSSION OF

PHARMACARE SEEMS TO HAVE FALLEN OFF THE SIDE OF THE TABLE.

I WOULD LIKE TO SEE THAT REIGNITED.

I THINK IT IS SO OBVIOUSLY THE UNFINISHED BUSINESS OF OUR HEALTH CARE SYSTEM.

>> Steve: ANOTHER OF YOUR SIX BIG IDEAS, AND THIS IS A DIFFERENT KIND OF A QUOTE: DON'T

JUST DO SOMETHING.

STAND THERE.

>> Dr. Danielle Martin: THAT'S RIGHT.

>> Steve: WHICH IS THE OPPOSITE OF COURSE OF WHAT WE USUALLY SAY.

YOU ADVOCATE THAT SOMETIMES THE BEST THING TO DO FOR A PATIENT IS NOTHING.

EXPLAIN.

>> Dr. Danielle Martin: IT'S A LIGHTLY IRONIC, BECAUSE HAVING JUST SAID THAT THERE ARE MANY

PEOPLE WHO CAN'T ACCESS THE HEALTH CARE THEY NEED, I NOW TURN AROUND AND SAY THERE ARE A

LOT OF PEOPLE GETTING A LITTLE BIT TOO MUCH HEALTH CARE.

BUT IN FACT THAT'S TRUE.

AND LET'S COME BACK TO THE EXAMPLE OF MEDICATIONS.

WE KNOW IN CANADA THAT ONE IN FIVE CANADIAN SENIORS, OR ABOUT 20%, ARE BEING PRESCRIBED A

MEDICINE ON THE BEERS LIST, WHICH IS A LIST OF MEDICATION THAT SHOULD EFFECTIVELY NEVER BE

PRESCRIBED TO SENIORS BECAUSE THE RISKS OUTWEIGH THE BENEFITS.

WE HAVE A HUGE AMOUNT OF OVERPRESCRIBING, OVERTESTING, AND OVERTREATMENT THAT ARE GOING

ON IN THE HEALTH CARE SYSTEM, AND PEOPLE ARE HARMED BY IT EVERY DAY.

YOU KNOW, IN THE CASE OF SENIORS, IT INCREASES THE RISK OF FALLS, ENDING UP IN THE

HOSPITAL WITH A BROKEN HIP, PNEUMONIA, ET CETERA.

SO, YOU KNOW, THE REPERCUSSIONS ON HEALTH CAN BE VERY SERIOUS.

AS WE'RE TALKING ABOUT WHAT WE NEED TO DO TO HAVE A HIGH-QUALITY HEALTH CARE SYSTEM,

I DON'T THINK WE CAN ONLY TALK ABOUT WHAT WE NEED TO DO MORE OF.

WE ALSO NEED TO ASK OURSELVES, WHERE DO WE NEED TO BE DOING LESS.

IF SOMETHING IS KNOWN TO IMPROVE HEALTH, OF COURSE WE SHOULD DO IT AND EVERYONE SHOULD HAVE

ACCESS TO IT.

IF IT'S QUESTIONABLE OR CLEAR THAT IT DOESN'T IMPROVE HEALTH OR INDEED ACTUALLY HARMS HEALTH,

THEN WE SHOULDN'T BE DOING IT.

AND WE VERY RARELY HAVE THAT CONVERSATION THESE DAYS ABOUT HOW CAN WE DIAL IT BACK A LITTLE

BIT AND SORT OF LAY OFF PEOPLE.

FEWER INVESTIGATIONS.

FEWER IMAGING PROCEDURES.

FEWER INTERVENTIONS AND SURGERIES.

UNLESS WE KNOW THAT THOSE THINGS ARE ACTUALLY GOING TO IMPROVE THE HEALTH OF THE INDIVIDUAL.

>> Steve: I WONDER HOW MUCH THE PATIENT HAS TO ACCEPT RESPONSIBILITY FOR THAT.

I THINK WE'VE ALL HEARD STORIES OF SOMEBODY WHO SAYS, YOU KNOW, I HAVE A HEADACHE, I WANT AN

M.R.I. ON THIS TOMORROW.

>> Dr. Danielle Martin: FOR SURE.

THERE ARE NO DOUBT THAT PATIENT DEMANDS OR REQUESTS FACTOR INTO THOSE CONVERSATIONS.

I THINK WE NEED TO RECOGNIZE THAT THAT'S TRUE FOR A CERTAIN CATEGORY OF THINGS.

YOUR M.R.I. EXAMPLE BEING A REALLY GOOD ONE.

WE KNOW THAT THERE ARE HUGE NUMBERS OF CANADIANS WHO ARE SUBJECTED TO MRIs FOR LOW BACK

PAIN OR CT SCANS FOR HEADACHES WHERE THOSE THINGS WOULD CONTRIBUTE ESSENTIALLY NO USEFUL

INFORMATION TO THE MANAGEMENT OF THEIR CASE, AND IT'S POSSIBLE THAT OFTEN PEOPLE ARE ASKING FOR

THOSE INVESTIGATIONS.

ON THE OTHER HAND, VERY FEW PEOPLE WALK INTO A CANADIAN HOSPITAL AND SAY I'D LIKE A

CORONARY BYPASS.

THERE ARE SOME THINGS WHERE IT'S UP TO US AS A MEDICAL PROFESSION TO SAY, YOU KNOW, WE'RE GOING TO

BE A LITTLE BIT MORE DISCIPLINED OURSELVES.

>> Steve: THERE ARE STORIES IN THE BOOK YOU TELL ABOUT A PATIENT DEMANDING A CERTAIN KIND

OF TEST AND YOU SAY, FORGET IT, YOU DON'T NEED IT, AND THEY GET MAD AT YOU.

>> Dr. Danielle Martin: SOMETIMES THEY GET MAD.

OFTENTIMES WHAT I FIND AND THIS HAS BEEN AN INTERESTING LEARNING FOR ME IN MY PRACTICE, I GET

EMOTIONALLY GEARED UP FOR THEM TO GET ANGRY AND THE PERSON TURNS AROUND AND SAYS, OKAY,

THAT'S GREAT.

IF YOU DON'T THINK I NEED IT, THAT'S FINE.

SOMETIMES WE'RE AFRAID TO HAVE THAT CONVERSATION.

IT COMES TO BIG IDEA ONE AROUND THE RELATIONSHIP.

WHEN YOU HAVE THAT MUTUAL TRUST WITH SOMEONE AND THEY KNOW YOU HAVE THEIR BEST INTERESTS AT

HEART.

I'M NOT TRYING TO SAVE THE SYSTEM FIVE BUCKS.

I'M TRYING TO TELL YOU I DON'T THINK THIS IS OF ANY BENEFIT TO YOU.

ACTUALLY A LOT OF PEOPLE ARE HAPPY NOT TO SPEND THEIR TIME GETTING MEDICAL TESTS AND

PROCEDURES THEY DON'T NEED.

>> Steve: FOR SURE.

WHAT ABOUT THE DOCTOR WHO IS TERRIFIED HE OR SHE IS GOING TO GET SUED BY A PATIENT IF THEY

DON'T ORDER THE TEST AND COVER EVERY POSSIBLE BASE.

>> Dr. Danielle Martin: THAT'S YOUR C.Y.A., COVER YOUR ASS IN MEDICINE.

I THINK THERE'S LESS OF IT ON THIS SIDE OF THE BORDER THAN THERE IS IN THE U.S., BUT IT

DOES HAPPEN FOR SURE.

AND I THINK IT'S ONE OF THE CONTRIBUTING FACTORS IN WHAT IS A VERY COMPLEX MORASS OF, YOU

KNOW, HOW DO WE COME TO -- PEOPLE ALWAYS SAY THE MOST EXPENSIVE TOOL IN THE HEALTH

CARE SYSTEM IS THE PHYSICIAN'S PEN, RIGHT?

AND SO THAT -- WHAT LEADS ME TO TICK THAT BOX ON THE REQUISITION FORM, SOME OF IT IS WHAT DOES

THE PATIENT WANT OR EXPECT OR DEMAND OF ME, SOME OF IT IS MY FEAR OF BEING SUED, SOME OF IT

IS MY DESIRE TO GET THEM OUT OF THE OFFICE MORE QUICKLY OR WHATEVER IT IS, AND ALL OF THESE

THINGS KIND OF COME TOGETHER INTO THAT ONE SORT OF TICK BOX ACTION, AND I THINK THAT WE'RE

GOING TO NEED TO UNRAVEL SOME OF THAT IF WE WANT TO IMPROVE THE HEALTH CARE SYSTEM.

>> Steve: ANOTHER OF YOUR BIG IDEAS, AND THIS ACTUALLY HARKENS BACK TO THE PERFORMANCE YOU HAD

IN FRONT OF THE SENATE SUB COMMITTEE WHERE YOU TALKED ABOUT THE LINES OF PEOPLE, TONS IN ONE

AND NO LINEUP AT THE OTHER PLACE AS WELL.

REORGANIZING WHAT WE'VE GOT GOING RIGHT NOW.

AND TO THAT END, TELL US THE STORY THAT YOU TELL IN THE BOOK ABOUT A 75-YEAR-OLD WOMAN NAMED

SUSAN WHO ENDED UP HAVING A TERRIBLE DEMISE COURTESY OF THE HEALTH CARE SYSTEM.

>> Dr. Danielle Martin: THAT'S RIGHT.

SO SUSAN WAS AN OLDER WOMAN, A WIDOW, WHO LIVED IN THE CENTRE OF THE COUNTRY AND SHE HAD A

NUMBER OF CHRONIC MEDICAL CONDITIONS, AND SHE ENDED UP IN WHAT I CALL THE REVOLVING DOOR

OF HEALTH CARE, WHERE SO MANY CANADIANS, PARTICULARLY OLDER PEOPLE WITH CHRONIC MEDICAL

CONDITIONS END UP WHERE SHE WAS BEING ADMITTED TO THE HOSPITAL AND THEN DISCHARGED AND

READMITTED AND DISCHARGED, AND, YOU KNOW, WAITED FOR A SPOT IN A LONG-TERM CARE FACILITY FOR

WEEKS AND DURING THE TIME THAT SHE WAS WAITING, SHE BECAME FRAIL AND THEN SHE FELL OUT OF

BED IN THE HOSPITAL.

SHE BROKE HER HIP.

AND IN THE END, AFTER THREE WEEKS IN THE INTENSIVE CARE UNIT, WHICH WAS SOMETHING THAT

SHE HAD NEVER WANTED FOR HERSELF, SHE ENDED UP DYING IN THE ICU.

AND IT'S A REALLY SAD CASE.

IT'S SAD, YOU KNOW, ABOUT THAT INDIVIDUAL, BUT IT'S ALSO SAD BECAUSE EVERYONE WHO READS THAT

STORY KIND OF SAYS, OH, I KNOW -- I KNOW SOMEONE WHO HAS HAD SOME SLICE OF THAT

EXPERIENCE.

AND THE THING ABOUT SUSAN IS, SHE DIDN'T LACK FOR HEALTH CARE.

SHE GOT MORE HEALTH CARE THAN MOST OF US WOULD EVER WANT FOR OURSELVES OR OUR LOVED ONES, BUT

IT WASN'T THE RIGHT KIND OF HEALTH CARE.

WHAT SHE NEEDED WAS SUPPORT TO KEEP HER IN HER HOME.

WHAT SHE NEEDED WAS INSTANT TRANSITION, OUT OF THE HOSPITAL AFTER THAT FIRST ADMISSION INTO

A BED IN A FACILITY WHERE SHE COULD BE REHABILITATED AND GET BACK TO HER HOUSE.

WHAT SHE NEEDED WAS FOR SOMEBODY TO SIT DOWN AND SAY TO HER: WHAT ARE YOUR GOALS?

IF IT IS LOOKING LIKE WE'RE CLOSE TO THE END FOR YOU, WHERE DO YOU WANT TO DIE?

AND WE'RE SO AFRAID TO HAVE THOSE CONVERSATIONS THAT WE END UP INSTEAD PUTTING PEOPLE INTO

THESE VERY RESOURCE-INTENSIVE ENVIRONMENTS THAT ARE OF NO BENEFIT TO THEM AND THAT COST

THE SYSTEM A LOT OF MONEY.

SO REORGANIZING THOSE RESOURCES TO MAKE THEM MORE LOGICAL OR RATIONALE, NOT IN THE RATIONING

SENSE BUT IN THE RATIONAL SENSE, IN THE WAY WE DEPLOY THEM.

I THINK IT COULD TAKE US A LONG WAY.

ACTUALLY THERE'S A LOT OF RESOURCE IN THE SYSTEM, BUT WE DON'T ALWAYS ORGANIZE IT

EFFECTIVELY.

>> Steve: WE DON'T HEAR THAT STORY AT ALL.

WE HEAR ALL THE TIME -- FROM DOCTORS, FROM NURSES, FROM PATIENTS, FROM EVERYBODY

ASSOCIATED WITH THE HEALTH CARE SYSTEM -- THIS SYSTEM IS STARVED FOR FUNDING.

MIGHT BE 50 BILLION A YEAR IN ONTARIO BUT IT'S STARVED FOR FUNDING AND NEEDS MORE MONEY TO

BE BETTER.

THAT'S NOT THE CASE?

>> Dr. Danielle Martin: I THINK OUR EXPERIENCE -- LET ME START BY SAYING, OF COURSE THERE

ARE ALWAYS POCKETS OF THE SYSTEM WHERE MORE MONEY WOULD BE VERY USEFUL.

BUT I THINK WE HAVE SEEN ACTUALLY THE EXPERIENCE IN CANADA OF MONEY FLOWING AND NOT

MAKING A BIG DIFFERENCE, AND SO I THINK WE HAVE TO BE CAREFUL TO THINK THAT MONEY IS THE

SOLUTION.

VERY OFTEN IT'S THAT REORGANIZATION OF RESOURCES.

YOU KNOW, I HAVE SEEN NEW GRADUATES COMING OUT INTO THE HEALTH CARE SYSTEM AND STARTING

THEIR PRACTICES WHO ARE, YOU KNOW, DESPERATE FOR CONSULTS, SPECIALISTS WHO CAN'T FILL THEIR

AFTERNOON CLINIC AS THEY'RE TRYING TO RAMP UP THEIR PRACTICES AND, YOU KNOW, GET

ENOUGH PEOPLE IN THEIR OFFICES TO MAKE A LIVING, AT THE SAME TIME THAT THEIR MORE EXPERIENCED

COLLEAGUES HAVE A NINE-MONTH WAITING LIST FOR A FIRST CONSULTATION.

THAT'S NOT ABOUT A LACK OF RESOURCES.

THAT'S ABOUT POOR ORGANIZATION.

AND AS A REFERRING PHYSICIAN, AS A FAMILY DOC, I HAVE NO IDEA HOW LONG ANYBODY'S WAIT TIME IS OR

HOW WOULD I EVEN KNOW WHETHER I SHOULD BE SENDING MY PATIENTS TO ONE OR TO THE OTHER.

SO WHEN SPECIALISTS, AS AN EXAMPLE, COME TOGETHER IN GROUPS AND SHARE REFERRALS SO THAT YOUR

PATIENT CAN BE SEEN BY THE NEXT AVAILABLE SPECIALIST, EVEN JUST THAT ACT ALONE CAN SIGNIFICANTLY

REDUCE WAIT TIMES.

BUT IT DOES REQUIRE SOME CHANGE WITHIN THE MEDICAL PROFESSION AND IT ALSO REQUIRES A CHANGE

AMONG OUR PATIENTS, CITIZENS, AND WHAT THEIR EXPECTATION IS ABOUT, WHAT DOES IT MEAN TO BE

REFERRED?

>> Steve: I'M GOING TO COME BACK TO THAT IN A SECOND.

ON THE MONEY, I WANT TO READ THIS QUOTE FROM YOUR BOOK.

SHELDON, TOP OF PAGE 5, PLEASE.

>> Steve: I'M TRYING TO FIGURE OUT HOW WE -- YOU KNOW, ON THE FACE OF IT, IT FEELS LIKE, IF WE

SPENT TWICE AS MUCH MONEY TOMORROW AS WE DID TODAY GETTING BETTER MENTAL HEALTH SERVICES TO

PEOPLE, SURELY WE WOULD HAVE BETTER OUTCOMES AND THAT WOULD BE MONEY WELL SPENT.

IS THAT NOT THE CASE?

>> Dr. Danielle Martin: I MEAN, IT'S TRUE IF WHAT -- I GUESS YOU OUGHT TO ASK, LET'S

TAKE MENTAL HEALTH SERVICES AS AN EXAMPLE, IS THE PROBLEM WITH WAIT TIMES FOR MENTAL HEALTH

SERVICES REALLY ABOUT A LACK OF PROVIDERS, OR IF WE WERE TO EXPAND PUBLIC FUNDING SO THAT

PEOPLE COULD SEE NOT ONLY, SAY, A PSYCHIATRIST, BUT ALSO A SOCIAL WORKER OR A PSYCHOLOGIST,

IN OTHER WORDS TEAM-BASED CARE, COULD WE REDUCE THOSE WAIT TIMES USING THE SAME AMOUNT OF

RESOURCE?

IF WE WERE TO CENTRALIZE THE WAIT LISTS.

THERE'S A GREAT EXAMPLE IN HAMILTON, ONTARIO, ACTUALLY, OF PSYCHIATRISTS COMING TO A GROUP

OF FAMILY PHYSICIANS, A FAMILY HEALTH TEAM, AND PROVIDING CONSULTATIONS WHERE THE

PSYCHIATRIST JUST SITS AT A TABLE AND THE FAMILY DOC GOES THROUGH TEN CASES WITH THEM, YOU

KNOW, IN AN HOUR.

SO YOU, AS THE SPECIALIST, CAN GIVE ME THAT ADVICE.

I CAN THEN GO BACK AND IMPLEMENT IT WITH MY PATIENT AND DRAMATICALLY REDUCE THE WAIT

TIMES.

WHAT ABOUT VIRTUAL CONSULTATIONS?

e-CONSULTATIONS?

TELEPHONE CONSULTATIONS?

THERE'S SO MUCH THAT WE COULD BE DOING WITH THE RESOURCES THAT WE HAVE TO REDUCE WAITS OR IMPROVE

QUALITY WHEN IT COMES TO MENTAL HEALTH.

SOME OF THAT MAY COST MONEY OR MIGHT HAVE AN UPFRONT COST TO PUT INTO PLACE OR SOMETHING.

BUT A LOT OF IT IS JUST ABOUT THINKING DIFFERENTLY ABOUT HOW WE CAN DO THINGS, AND WE SEE

LITTLE POCKETS AND EXAMPLES OF THIS HAPPENING ALL OVER THE PLACE, LIKE THE HAMILTON EXAMPLE

THAT I JUST NAMED.

I HAD A PATIENT IN MY OFFICE LAST WEEK WHO HAD A CARDIAC ISSUE AND I WASN'T SURE WHAT TO

DO AND I JUST HAD A PHONE CONVERSATION WITH A CARDIOLOGIST BECAUSE THERE'S A BILLING CODE

NOW FOR TELEPHONE CONVERSATIONS.

A SPECIALIST CAN GIVE ADVICE TO THE FAMILY DOCTOR BY PHONE AND IN A FEW MINUTES ON THE PHONE --

SO THAT PERSON NEVER HAD TO LEAVE THEIR COUCH FOR ME TO GET THAT OPINION, ESSENTIAL ZERO

WAIT TIME.

I HAD THE ANSWER ON THE SAME DAY.

WE WERE ABLE TO MAKE THOSE ADJUSTMENTS AND MOVE ON.

>> Steve: WHAT'S PREVENTING MORE OF THAT FROM HAPPENING?

>> Dr. Danielle Martin: SO MUCH OF IT IS CULTURE.

WE ALL KIND OF GET UP TO WORK AND DO THE SAME THING TODAY THAT WE DID YESTERDAY.

AND SO, TO BE HONEST, THAT'S A BIG PART OF THE REASON WHY I WROTE THE BOOK IS TO TRY TO GET

PEOPLE DEMANDING THAT.

PHYSICIANS, PATIENTS, POLICY-MAKERS SAYING -- ACTUALLY, THERE'S NOTHING

STOPPING US FROM DOING ANY OF THIS STUFF.

THERE'S NO MASSIVE BARRIER IN OUR WAY.

WE JUST HAVE TO KIND OF GET STARTED.

>> Steve: A COUPLE OF MORE OF YOUR BIG IDEAS TO FIX HEALTH CARE.

ONTARIO IS NOW IN THE THROES OF AN EXPERIMENT ABOUT THE GUARANTEED ANNUAL INCOME.

NOT QUITE SURE HOW IT'S GOING TO ROLL OUT OR WHEN IT'S GOING TO ROLL OUT OR WHERE IT'S GOING TO

ROLL OUT, BUT THEY SAY THEY'RE GOING TO DO IT.

IF THAT HAPPENED AND IT WORKS THE WAY PEOPLE THINK IT SHOULD WORK, WHAT ARE THE IMPLICATIONS

FOR THE HEALTH CARE SYSTEM?

>> Dr. Danielle Martin: WE'VE SPENT A LOT OF TIME TALKING ABOUT HEALTH CARE, AND AS YOU

SAID, IT TAKES UP PRETTY MUCH HALF OF OUR PROVINCIAL BUDGET.

BUT ACTUALLY THIS BIG IDEA, THE GUARANTEED ANNUAL INCOME, IF IT WORKS, WOULD DO MORE FOR HEALTH

THAN ANYTHING ELSE WE BASICALLY DO IN THE HEALTH CARE SYSTEM.

INCOME IS THE NUMBER ONE DETERMINANT OF WHETHER PEOPLE WILL BE WELL OR ILL IN THEIR

LIFE TIMES.

AND SO WE KNOW THAT ILLNESSES SIGNIFICANTLY CONCENTRATE -- ILLNESS IS SIGNIFICANTLY

CONCENTRATED AMONG LOW INCOME PEOPLE AND IMPROVING PEOPLE'S ACCESS TO INCOME AND THEREFORE

THEIR ACCESS TO RESOURCES HAVE A VERY PROFOUND EFFECT ON THEIR OWN HEALTH, ON THE HEALTH OF

THEIR KIDS, AND IT'S VERY, VERY SIGNIFICANT.

SO ACTUALLY THESE, WHAT WE CALL THE SOCIAL DETERMINANTS OF HEALTH, ARE CRITICALLY

IMPORTANT, AND DOING SOMETHING TO REDUCE OR ELIMINATE POVERTY IN CANADA IS PROBABLY THE MOST

IMPORTANT THING WE COULD DO IF WE WANT TO IMPROVE THE HEALTH OF CANADIANS AND I COULDN'T WRITE A

BOOK ABOUT HEALTH WITHOUT TALKING ABOUT THAT.

>> Steve: IT'S PRETTY CLEAR, POVERTY MAKES YOU SICK.

>> Dr. Danielle Martin: ABSOLUTELY.

>> Steve: THE STRESS OF JUST GETTING THROUGH THE DAY WILL MAKE YOU SICK.

>> Dr. Danielle Martin: ABSOLUTELY.

AND THE OTHER THING THAT'S CLEAR IS THAT FOR PEOPLE WHO ARE LOW INCOME, INCREASING THEIR INCOME

EVEN BY A SMALL AMOUNT HAS A DRAMATIC EFFECT ON THEIR HEALTH.

SO THE EXPERIMENT THAT WAS DONE IN MANITOBA IN THE 1970s ON THE GUARANTEED INCOME, THE

MINCOME EXPERIMENT, PEOPLE HAD ACCESS TO A MINIMUM INCOME, IT WAS A SMALL AMOUNT OF MONEY, IN

FACT, REDUCED HOSPITALIZATIONS IN THAT COMMUNITY BY 8.5%.

I LIKE TO SAY IF SOMEBODY INVENTED A DRUG TOMORROW THAT REDUCED ALL HOSPITALIZATIONS, WE

WOULD PUT IT IN THE WATER SUPPLY.

WHY AREN'T WE TALKING ABOUT IT AS A HEALTH INTERVENTION?

>> Steve: WE HAD ELLEN FORGET WHO DID

YOU GET EVERYBODY COMPETING LIKE HELL BY -- THE ARGUMENT IS, BECAUSE YOU'RE CHAMPIONING A

SINGLE PAYOR SYSTEM, YOU ARE REDUCING ONE OF THE INCENTIVES OF COMPETITION IN OUR SOCIETY

AND THEREFORE YOU ARE DEPRIVING THE SYSTEM OF THE VERY JUICE THAT IT NEEDS IN ORDER TO

INNOVATE.

TRUE OR FALSE?

>> Dr. Danielle Martin: FALSE.

THE REASON IT'S FALSE IS -- TWO THINGS.

FIRST OF ALL, WE DON'T ACTUALLY HAVE AN INNOVATION PROBLEM IN THE CANADIAN HEALTH CARE SYSTEM.

THERE ARE SUCCESSFUL PROGRAMS, LITTLE POCKETS OF EXCELLENCE -- I LIKE TO -- SOMEBODY SAID AT

SOME POINT, ISLANDS OF EXCELLENCE IN A SEA OF MEDIOCRITY.

POCKETS WHERE

WHETHER IT'S FOR STROKE CARE OR DIABETES CARE OR MENTAL HEALTH CARE, ALL OF THESE EXAMPLES

EXIST IN CANADA.

BUT THEY EXIST IN ONE COMMUNITY IN ONE PLACE, ONE TEAM, AND SO IF YOU HAPPEN TO BE LUCKY ENOUGH

TO BE A PATIENT IN THAT PLACE, YOU'RE GETTING WORLD CLASS STANDARD OF CARE.

BUT WHAT WE'RE MISSING IS THE CAPACITY TO BRING THOSE EXAMPLES TO SCALE SO THAT EVERYONE HAS

ACCESS TO THEM.

AND ACTUALLY WHAT'S REQUIRED TO DO THAT, THAT MOVE FROM WHAT WE CALL THE PILOT PROJECT TO THE

SYSTEM SOLUTION IS COLLABORATION, NOT COMPETITION.

AND SO THAT'S WHERE WE REALLY NEED TO PUT THE INFRASTRUCTURE IN PLACE TO SAY, WHEN WE KNOW

WHAT THE BEST WAY TO DO IT IS, HOW DO WE MAKE SURE THAT EVERYBODY STARTS TO DO IT THAT

WAY?

TO SOME DEGREE THAT'S ABOUT STANDARDIZING THINGS BUT A LOT OF IT IS ABOUT SPREAD AND

LEARNING FROM WHAT WE KNOW WORKS.

>> Steve: I'VE GOT A MINUTE LEFT AND I WANT TO DO ONE MORE QUOTE FROM THE BOOK AND ONE MORE

COMMENT FROM YOU.

ALONG WITH NURSES, REHAB PROFESSIONALS, MENTAL HEALTH PROFESSIONALS ...

>> Steve: HOW DO YOU GET DOCS TO SEE THE BIGGER PICTURE?

>> Dr. Danielle Martin: I THINK THIS IS SOMETHING THAT CAN ONLY COME FROM WITHIN THE

MEDICAL PROFESSION.

IT'S NOT SOME EDICT FROM GOVERNMENT OR, YOU KNOW, ENFORCING EMPLOYMENT STATUS OR

SOMETHING ON PHYSICIANS, IT'S ABOUT DOCTORS SAYING TO OURSELVES AS A COMMUNITY OF

PROFESSIONALS, PART OF OUR JOB IS SOLVING SYSTEM ISSUES.

WE CAN'T JUST GO TO WORK EVERY DAY AND SEE ONE PATIENT AT A TIME.

WE HAVE TO PARTICIPATE IN THE TOUGH WORK OF RUNNING THE HEALTH CARE SYSTEM.

IN ONTARIO RIGHT NOW, THAT'S HARD BECAUSE, YOU KNOW, THE RELATIONSHIP, AS YOU KNOW,

STEVE, AND YOU'VE TALKED ABOUT THIS ON THE SHOW, HAS BECOME REALLY TOXIC BETWEEN GOVERNMENT

AND PHYSICIANS.

I HAVE A LOT OF SYMPATHY FOR THE ANGER THAT DOCTORS ARE FEELING IN ONTARIO RIGHT NOW.

I DON'T THINK THAT UNILATERAL ACTION ON THE PART OF A GOVERNMENT IS A GOOD IDEA.

I DON'T THINK IT CREATES THE KIND OF ENVIRONMENT WE NEED FOR HEALTH SYSTEM IMPROVEMENT, AND I

ALSO THINK PHYSICIANS NEED TO BE WILLING COLLECTIVELY TO TAKE ON THE RESPONSIBILITY OF PARTNERING

WITH GOVERNMENT TO MAKE THE HEALTH CARE SYSTEM BETTER, AND WE'VE GOT -- THAT'S GOING TO

REQUIRE A NEW DEFINITION OF WHAT IT MEANS TO BE PROFESSIONAL FOR OURSELVES AS A COMMUNITY OF

DOCTORS.

IT'S SOMETHING THAT I THINK IS CRITICALLY IMPORTANT OR WE WILL NEVER BE ABLE TO ACHIEVE ALL OF

THIS.

>> Steve: THE NAME OF THE BOOK IS "BETTER NOW: SIX BIG IDEAS TO IMPROVE HEALTH CARE FOR ALL

CANADIANS."

DR. DANIELLE MARTIN.

GOOD TO HAVE YOU AT TVO AGAIN.

>> Dr. Danielle Martin: THANK YOU, STEVE.