Physician health and well-being in the spotlight: CCPH 2023

Representatives of a battered and stressed medical profession gathered in Montreal and virtually last week for the 7^th annual Canadian Conference on Physician Health (CCPH) – the first such meeting in four years.

Acknowledging the tremendous pressures facing physicians today, the 450 delegates in attendance – the largest ever at such a meeting – heard about the wide variety of initiatives underway to address physician health and well-being both at the individual and at the system level.

“Medicine has changed. The world around us has changed but we are all here to discuss important issues,” said Dr. Jeff Blackmer, chief medical officer and executive vice president of global health for the Canadian Medical Association (CMA), which hosted the meeting. “Many of us are stretched so incredibly then (and) have been targets of harassment and bullying at work and in training programs,” CMA President Dr. Kathleen Ross added.

Later in the meeting, Dr. Ross released a statement referring specifically to the current conflict in the Middle East. “The Hamas-Israel conflict is causing significant tensions for Jewish and Palestinian physicians, with many experiencing antisemitism, racism, Islamophobia and other forms of aggression,” the statement noted.

The impact of the COVID-19 pandemic and its hugely negative impact on physicians was also referenced repeatedly. “COVID is not over it has a lingering presence. It has altered our ability to offer quality patient care … and we will never recover,” said opening keynote speaker, Dr. Jane Lemaire, co-director of WellDoc Alberta.

What emerged very clearly this year was the recognition of how interlinked the well-being of physicians is with the healthcare system as a whole and the health of the patients of which they care. “We are caught in a vicious cycle of work overload, burnout and attrition of the health workforce which has critical population health and health system impacts,” said Dr. Ivy Bourgeault, leader of the Canadian Health Workforce Network.

At one point in the meeting, an emergency physician from Montreal rose to ask why it was so hard to persuade people that good physician health translates into better patient outcomes.

Dr. Edward Spilg, an associate professor of medicine at the University of Ottawa noted that a decade ago individual resilience was identified as the way physicians could best deal with wellbeing issues. Now, he said, there is a recognition that system-level interventions are essential. Dr. Lemaire said a multi-pronged approach to culture change is required to improve physician well-being and the healthcare system must support such a change.

While much of the focus of the meeting was on these system-level approaches, some sessions also dealt with how individual doctors could deal with the stress of medical practice today. In a keynote address, Dr. Kristen Neff, a clinical psychologist at the University of Texas, Austin advocated self-compassion consisting of “kindness, mindfulness and common humanity”.  In another session, Collingwood family physician Dr. Caroline Bowman who has been diagnosed with MS discussed shame resilience as a missing component of physician wellness.

A focus on improving the well-being of medical learners and the environment of academic medicine came from two sessions discussing the Okanagan Charter, an international framework to support well-being at academic centres. Deans of all 17 Canadian medical schools have committed to following the charter, said Dr. Melanie Lewis, chief wellness officer at the University of Alberta.  But she added only 12 of the 17 schools (soon to be 13) have formally adopted the charter to date and she is the only person to currently hold the position of chief wellness officer at a medical school.

The ambivalence with which many physicians view practising medicine today was encapsulated in a plenary session at the conclusion of the conference where speakers engaged in a formal debate on whether there are still compelling reasons to practise despite the challenges involved.

Manitoba physician and best-selling author Dr. Jillian Horton who moderated the debate noted both that “we leave jobs we love because they have become undo-able,” and that “most of us are here because we are looking for reasons to continue to do what we do no matter how difficult is.”

“The healthcare system values efficiency over patient care and values data over relationships. The painful reality is very little money and very little decision-making effort goes into our well-being,” said Dr. Julie Maggi, director of faculty wellness at the Temerty School of Medicine, University of Toronto, one of the two physicians charged with arguing the futility of continuing to practise.

Tasked with arguing in favour of continuing to practise, Dr. Saleem Razeck, professor of pediatrics at the University of British Columbia talked about the satisfaction of being a physician even with “a full bladder, empty stomach and dry mouth.”

“We are at the precipice of greatness,” said his debating colleague Dr. Andrew Ajisebutu, a neurosurgery resident at the University of Manitoba, in noting all the current advances in medicine. “At times the job does suck, but the profession does not.”

(Image: Dr. Jillian Horton moderates final plenary at CCPH 2023)

Sept. 8, 2023: Social media and medicine update

Ottawa during the spring smoke event

Gather around and warm yourself by the glimmering sparks of evidence-based science in the ruined infrastructure of the platform previously known as Twitter as we provide the 2023 version of the professional use of social media by physicians and in medical education.

Well, things might not be quite that bad, but for the first time in 11 years of speaking to first year medical students at uOttawa I was not telling them that use of social media can definitely be of benefit to them professionally and that the platform previously known as Twitter is their best option.

To quote Mark Carrigan, a lecturer at the University of Manchester: “I believe Twitter can now be a dangerous place for many academics, particularly if they are from minoritized groups.”

While some of us have been hanging on grimly to our presence on X (the platform previously known as Twitter), hoping the situation will change for the better rather than continue to get constantly worse, many prominent physicians, patient advocates and others have fled X for other platforms such as Mastodon or threads. And things seem to be getting worse.

Earlier this week, moderators of one of the only remaining compelling and inclusive medical and healthcare tweetchats #hcldr announced that it would be winding down. Medical and health tweetchats of distinction have been discontinued but in this case the situation seemed sadder. As one of the #hcldr co-hosts Joe Babaian (along with Colin Hung) wrote in a blog announcing the move: “We all know what a hugely different place Twitter is … The vehicle is damaged.”

In my presentation to uOttawa students I discussed the many ways Twitter (now X) has declined over the last couple of years and how many alternatives have arisen in an attempt to replace it. However, as others have pointed out these alternatives have not successfully filled the void for those interested in medicine or healthcare, especially academics.

“We’re in a situation now where it’s not clear that any of the alternatives (to Twitter) will become the alternative. We’re entering a more fragmented landscape where the path to visibility and promotion is going to involve maintaining a presence across a whole range of platforms,” Carrigan wrote, adding that this will require a relatively sophisticated understanding of the platforms and a strategy for using scheduling software. “Any lingering sense of Twitter as a democratising space where academic hierarchies can be levelled, further falls apart under those conditions.”

His views were echoed more forcefully by Professor Inger Mewburn, director of researcher development at The Australian National University who wrote a blog titled: The enshittification of academic social media.

“Telling academics they can achieve career success by using today’s algorithmic-driven platforms is like telling Millennials they could afford to buy a house by eating less avocado on toast,” he wrote in the July 10 blog. “It’s a cruel lie because social media is a shit way to share your work now. Basically, it’s no longer true that you can build a substantial audience by doing Good Work and telling people about it. Today you can talk about your research on social media platforms all you want, but hardly anyone will hear you unless you pay cash money because Algorithms.

Mewburn closed his blog with tips for academics and students and some of these aren’t half bad such as noting social media can be social and a good place to have fun and chat with people and that you should always “own” your own content rather than just produce it on social media platforms. He also urged teachers not to use social media as tools in their classrooms as it may exposure students to the toxic elements that now seem to define much of the social media landscape.

In the face of all of this doom many continue to maintain that X and social media platforms are in general are vitally important places for physicians and others to maintain a presence if only to challenge the politically motivated misinformation about medical and health issues that continues to cost people lives. As Dr. Teresa Chan, the inaugural dean of the medical school at Metropolitan University in Toronto told me earlier this summer: We need to be on social media because the world is on social media. We have to learn to fight misinformation – not be part of it!”

Tim Caulfield, Canada Research Chair in Health Law and Policy and a leading debunker of health misinformation had a similar message for those attending the Canadian Medical Association Health Summit in Ottawa in August. After tracing the leading role social media has had in spreading life threatening falsehoods, he told physicians they had a critical role to play in challenging this information.

X may now be a lousy place to network with your colleagues and associates and grow academic credibility by sharing links to your studies. But if you are of an altruistic bent and believe that advocating for science-based knowledge is important it might be worth hanging in there until the entire platform shatters under mismanagement or falls off a flat earth.

It’s a medical practice, Jim – but not as we know it

Image: Dr. Kaveh Safavi

Artificial intelligence (AI) – whether old school AI algorithms using “big data” or new normative models using large language models (such as chat GPT) – is already fundamentally changing how some Canadian physicians work and will impact the very nature of medical practice itself.

But whether changing approaches to diagnosis and management augmented by AI are actually going to make practice more satisfying and combat the smoldering fires of burnout driven by increasing demands placed on physicians is still very much an unknown.

As with any conferences focusing on health technology right now, recent Canadian health care conferences such as the major e-Health conference held in Toronto last week had the role of AI has a major topic of discussion.

Speakers at both #ehealth2023 and the CADTH annual symposium that preceded it in Ottawa provided tangible examples of how major Canadian healthcare institutions are already using AI to improve care delivery. But arguably the most provocative and thought-provoking presentation was the opening plenary at e-Health from Dr. Kaveh Safavi, senior managing director of global health for Accenture.

In discussing the future of healthcare and the potential roles for AI, Dr. Safavi noted “we are fundamentally changing the nature of how we do work, and it will be different in half a decade or a decade for now.” Using technology to replace tasks in healthcare will mean redistributing remaining tasks and essentially changing the healthcare workforce to a combination of “fixed and adaptive workers”, he said.

Dr. Safavi also challenged the widely held believe that using AI to help relieve physicians and nurses of the administrative burdens they currently face will allow them to focus on more complex tasks and make reduce burnout. Doctors complain bitterly about doing administrative tasks but complain even more when these tasks are being taken away because it means they must work at peak capacity continuously, he said.

Interestingly at the very same conference other speakers maintained that allowing physicians to focus on patient care and deal with complex cases and patient care would do exactly what Dr. Safavi said it will not – namely improve physician well-being and reduce burnout.

For AI to be used productively in healthcare, Dr. Safavi said, practitioners will need to know how to ask the right questions of the AI tools and interact with them. A panel discussion focused specifically on the role of AI in healthcare at e-Health agreed that medical schools needed to integrate effective use of AI into medical education.

“When we think about how we train clinicians today and you look at medical schools and nursing schools, I think we’re a little behind the curve,” said Aloha McBride, global health sector leader with EY Consultants, adding basic training about AI needs to be incorporated into undergraduate and postgraduate curricula.

“Clinicians especially need to be able to understand why it is that this particular algorithm is presenting them with this particular recommendation. And probably more importantly, they need to be able to explain it to their patients.”

Another speaker on the same panel, Rachel Dunscombe, former CEO of the National Health Service (NHS) Digital Academy said that within the NHS in the UK, senior clinical leaders are already being provided with such training.

As noted, speakers at both e-Health and the CADTH meetings showed how AI is already being integrated into care delivery at major Toronto hospitals.

In the closing session at CADTH, Dr. Muhammad Mamdani, vice president of data science and advanced analytics at Unity Health Toronto said much of healthcare is data driven and AI can assist in using data better for diagnosis, prognosis and treatment. He described how a predictive AI algorithm is being used at Unity Health to monitor internal medicine patients to assess risk and that this is reducing mortality rates.

At e-Health, Dr. Bradly Wouters, executive vice president of science and research at the University Health Network in Toronto described how clinicians at Princess Margaret Cancer Centre are implementing use of an AI algorithm to quickly and accurately develop a treatment plan for use of radiation therapy.

Other examples were also given about the impact of combining big data with machine-learning to develop clinical support tools.

(This is part 1 of a 2-part series dealing with discussions of AI at e-Health. The second part will discuss how AI could best benefit community-based family physicians)

 

ICAM, I saw, I conquered: The International Congress on Academic Medicine (#ICAM2023)

They scheduled plenary sessions on ableism, humanism and the concept of One Health that links the health of humans, animals and the planet itself.

Then, they had patients sharing the podium.

Those who organized the first International Congress on Academic Medicine (ICAM) just completed in Quebec City intended it to be many things, but what it certainly was not was the type of medical education conference that Drs. William Osler or William Flexner would have imagined.

With more than 1500 delegates attending and another 100 tuning in virtually, the conference can be viewed as a success for the Association of Faculties of Medicine of Canada and its president and CEO Dr. Geny Moineau who initiated the idea.

With most of the luminaries of medical education in attendance and dozens of closed meetings hosted by several Canadian medical education organizations and focused on the business of medical education, the conference did bear many of the hallmarks of a traditional #meded gathering.

But it was during the plenary sessions dealing with the critical issues facing medicine today that the conference really came through. And many of the themes touched on in plenary such as the prevalence of racism in medicine and medical education and the urgent need to address EDI seemed to filter through many of the other breakout sessions.

The role for having patient participation in medical conferences has long been problematic for both patients and physicians with charges of tokenism being brought on one side and clinicians lamenting the loss of a space where they can network with just their peers on the other.

At ICAM, the organizers committed wholeheartedly to the self-assessed Patients Included charter for medical conferences which calls for patients to be meaningfully involved in all aspects of a conference from planning to presenting. At ICAM this approach resulted in a rich exchange of information and views perhaps best incapsulated in the closing plenary session where Dr. Brian Hodges, chief medical officer at the University Health Network in Toronto and president of the Royal College of Physicians and Surgeons of Canada engaged in conversation with patient partner and advocate Cecilia Amoakohene.

“Some of the best learnings we have had this week have come from patients,” said Dr. Moineau in her closing remarks.

For many, some of the remarks made at plenaries cannot have been comfortable as Canadian medical schools were blasted for failing to deal with many issues from ableism to the wellbeing of medical learners to adequately training learners to deal with the realities of medical practice today.

In terms of living up to the international part of its title, the conference had delegates from 44 countries and speakers from around the world dealing with global topics. Perhaps the most important issue facing Canada and other countries in healthcare today – the crisis in health human resources – had its own plenary with a strong global focus.

With a conference this diverse and ambitious it’s hard to assess whether it will do anything other than reinforce views of those who attended or who watched the plenaries virtually. But it certainly checked a lot of boxes. And the opportunity to hear CMA President Dr. Alika Lafontaine’s masterful, concise assessment of how we got to the muddle we are in today with respect to the Canadian healthcare system or Cecilia Amoakohene discussing why she feels she must dress well when going to the emergency room to try and counter racist views made it time well spent.

(Image: Patient advocate Cecilia Amoakohene in conversation with Dr. Brian Hodges)