Dr. Danielle Martin knows her inspiration for changing the health-care system inside and out.
‘Abida’ was in her early 60s when she first became a patient of Martin, MD’03, in 2006. She had immigrated to Canada years earlier, the product of an arranged marriage to a negative, demanding and verbally abusive husband.
“She was a complex patient,” Martin said. “A long list of problems – chronic lung disease, bowel issues, mini strokes, recurring set of vague symptoms like chest pain, pelvic pain, memory loss and frequent headaches. She was practically a full-time patient.”
That is all you learned from her chart. As they got to know each other, it became clear the grind of a difficult home life invariably would exacerbate and inflame her symptoms.
“Her many specialists were great and gave attention to her maladies. They were looking out for Abida’s heart, Abida’s lungs and Abida’s hips – but who was looking out for Abida?” said Martin, who recently returned to her alma mater for the 50th-anniversary celebration of the Department of Family Medicine.
A professor in the Department of Family and Community Medicine, the Institute of Health Policy, Management and Evaluation and the School of Public Policy & Governance at the University of Toronto, Martin spoke of the need for a stronger relationship between the physician and the patient.
Her new book, Better Now: Six Big Ideas to Improve Health Care for All Canadians, attempts to tap into the passion she knows so many million Canadians feel for their health-care system and, in doing so, create a drive for improvement in the system.
“Although we have much to be proud of, there is a tremendous amount of work that remains to be done,” she said.
“By getting to know Abida over these last 12 years, I am totally confident I have been able to give her better care than she would have had if we didn’t have that decades-worth of trust building between us. Over that time, I have been able to work much more effectively with her many specialists, increasingly getting advice directly from them. The take-away from Abida is, relationships have a direct, and often sizeable, impact on health and wellness.”
A physician in the Family Practice Health Centre at Toronto’s at Women’s College Hospital, where she is the vice-president of Medical Affairs & Health System Solutions, Martin is also a national media commentator on the health issues that hit closest to home for many Canadian families.
“Every single Canadian should have access to not only a family physician, or a primary-care provider, but a person with whom they have a relationship,” she said, adding she initially expected that comment would precipitate a collective “rolling of the eyes across the country” when she first brought it up.
“But I was wrong. Travelling across the country, this is the one idea that captivates people the most, more than pharmacare, more than spreading scale of innovation, more than reducing unnecessary tests and procedures. This (relationship) resonates with people.”
Referring to Ian McWhinney, the first professor and Chair of Western’s Family Medicine program, Martin added the primary role of the family physician is to “walk the territory with the patients.”
“The territory not only of disease, but their personal experience of illness. In that act of accompaniment, there is a special magic that can occur,” she said. “The relationship is prior to the content. We know people before we know what their illnesses will be.”
But then comes the question: How does a physician, in an already over-stressed health-care system, find the time to build a real relationship with their patients?
“Small investments in this relationship bank, over time, accrue interest,” Martin said. “You don’t have to have a deep conversation every time. Every single interaction, whether it’s to discuss a disintegrating marriage or a wart on the sole of your foot, has to be seen as an opportunity to strengthen that relationship.
“If we are successful in building that relationship over time, the patient will feel heard and seen, will have enhanced self-efficacy, in respect to their own health, and will need less time in our office and less time in other parts of the health-care system.”
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WHAT’S THE BIG IDEA?
As a family doctor, Dr. Danielle Martin, MD’03, sees the cracks and challenges in our health-care system every day. A passionate believer in the value of fairness that underpins the Canadian health-care system, she is on a mission to improve medicare in ways that will benefit all. In Better Now: Six Big Ideas to Improve Health Care For All Canadians, Martin shows how bold fixes are both achievable and affordable to improve health care for all.
Big Idea 1: Ensure relationship-based primary health care for every Canadian;
Big Idea 2: Bring prescription drugs under Medicare;
Big Idea 3: Reduce unnecessary tests and interventions;
Big Idea 4: Reorganize health care delivery to reduce wait times and improve quality;
Big Idea 5: Implement a basic income guarantee;
Big Idea 6: Scale up successful solutions across the country.