The general council of the Canadian Medical Association bills itself as the “Parliament of Canadian Medicine.”
It’s no wonder: The policy meeting has taken place annually since 1867. The first president of the CMA, Sir Charles Tupper, went on to briefly become Prime Minister.
Suffice to say that physicians have always been politically astute and connected, so they have had – and insisted on having – a profound influence on public policy.
Canadian doctors were, through the CMA, early and vocal proponents of mass vaccination – both before and after the smallpox epidemic of 1885. They pushed for licensing and regulation (or, more precisely, self-regulation) of physicians at a time when quacks and charlatans selling health services were commonplace.
The first large-scale public debates about universal health insurance happened at the CMA general council, around the time of World War I, when tens of thousands of young men came back maimed and disabled, and an influenza pandemic swept the world.
Later, CMA general council would embrace public hospital insurance and fiercely debate the merits of physician insurance. (In the early days, many doctors were opposed to medicare because of suggestions they become salaried civil servants.)
The CMA, through its general council, was among the first groups to call for a ban on smoking and for the decriminalization of birth control and abortion.
In recent years, debate has been dominated by the so-called public-private question, namely how much of Canadian’s health care needs should be covered by public insurance as opposed to private insurance and, of course, the role of physicians (and public policy more generally) in tackling perpetual challenges like wait lists.
Of late, the rhetoric that became a hallmark of CMA general council has cooled a lot, as physician leaders seem to have settled on a middle-of-the-road “transformation” agenda that calls for better access to prescription drugs, home care and long-term care, and holds that the limits of medicare need to be debated publicly.
But, at this year’s general council meeting in Yellowknife, Canada’s physician leaders became downright philosophical.
The theme of the meeting was socio-economic determinants of health, the factors – such as income, education, housing, environment – that are known as the “causes of the causes of poor health.”
That phrase was coined by Sir Michael Marmot, a professor of epidemiology and public health at University College, London, and keynote speaker at the CMA conference.
Sir Michael enraptured the meeting with his data-laden talk on the health impacts of inequality, and his stark admonitions that poverty in the midst of plenty (as is the case in Canada) is a “stain on our societies” and that “social injustice is killing on a grand scale.”
Some were surprised that physicians would entertain and embrace what is sometimes perceived as a “leftie” message, but the reality is that doctors see the consequences of inequality every day in their practices, whether in urban or rural settings, emergency rooms or family practices. With few exceptions, the poorer you are, the unhealthier you are, and the more health services you consume.
It is clear that if we hope to rein in health costs, we will be unable to do so without investing more smartly in education, in social services and health promotion, especially in sectors of society where poverty is endemic, such as among aboriginals, refugees, those with disabilities, frail seniors, and minimum-wage workers.
This rethinking of priorities is not navel-gazing but a necessary readjustment of priorities.
That is the message that Dr. John Haggie, a surgeon in Gander, Newfoundland, and outgoing president of the CMA, delivered eloquently in his valedictory address.
“Self-examination of how we practice our profession is in order,” he said in pleading with his colleagues to appreciate the art, not just the science, of medicine, and to embrace anew the elemental importance of the physician-patient relationship.
“A few decades ago, cutting-edge medicine was all going to be technical, reliant on ever-bigger, better and more expensive gizmos,” Dr. Haggie said. “What we’re looking at now is the era of low-intensity health care, not the big glamorous investments, not the multi-million-dollar machines and the very expensive procedures, but small incremental amounts of money invested in community point of care, where it makes a difference.”
Dr. Haggie’s was a timely reminder of what really matters in our technology-obsessed times: Talking to patients, listening to them, and establishing physical contact in a way that cements the therapy.
Dr. Anna Reid, an emergency-room doctor in Yellowknife and the new CMA president, had a similar message. She spoke of the need for physicians to speak out against “persistent and pernicious inequities.”
She also shared highly personal stories of her parents’ health care experiences in the past year – of a father with dementia and a mother with aggressive cancer – to underscore the point that, beyond all the policy debates, it is the quality of care at the bedside that really matters.
Dr. Reid stated, wistfully, that too many physicians have “strayed from the essence of what it is to be a healer” and “lost our identity as physicians.”
In short, it was a call for Canada’s doctors – and Canada’s health and welfare system more generally – to get back to basics.
We can only hope that the CMA’s legendary ability to influence public policy will bear fruit.