Physicians as leaders at a time of change

On 31 May I began my term as president of Doctors of BC, a year-long journey to represent you, my colleagues, during a time of continued change that presents many challenges. This column, my first in this publication, is written in the style that I will continue with as your president—speaking honestly and from the heart.

With more than 34 years’ experience as a family doctor in Victoria, I believe that medicine is the best job on Earth. I never have to wonder why I go to work each morning; I know that I am contributing to the well-being of my patients, their families, and society as a whole. Being a doctor is truly a privilege. And I see these beliefs mirrored by my colleagues as well, which is why I feel so privileged to represent our profession as your president over the coming year.

But the world is changing rapidly. Health care budgets are being squeezed, the population is aging and caring for our aging patients is more complex, and patients are seeking treatment from a number of different providers in a number of different locations. How do we ensure that we continue to be not only relevant, but pivotal, in patient care into the future?

We need to be leaders. We need to be innovators. And, we need to stand for quality care.

I believe the influence our profession enjoys is completely dependent on the esteem in which we are held by our patients, our health care partners, and the public. So how do we provide quality care to our patients? How do we do so in a way that they understand? In a way that leaves them with a positive experience and a feeling of confidence in the trust that they have given us? And how do we do so in a cost-effective way that better ensures the sustainability of our system as a whole?

First, we must work at the system level to engage with our government, health authorities, and allied professional colleagues to help arrange care in a way that makes sense. Through the last decade’s experience of the collaborative committees—the General Practice Services Committee, Specialist Services Committee, Shared Care Committee, and the Joint Standing Committee on Rural Issues—we have learned that collaboration with quality patient care as a focus has improved the level of patient care and the morale of our colleagues who participate in that care, as well as our street cred with our partners.

In the coming year I will be working with our Board and CEO to help physicians engage with health authorities, administrators, and managers to exert a meaningful difference on decisions being made in the health care system that affect patients and doctors, to see that the renaissance that has affected community family practice spreads across the profession. This step will see the greatest new investment by Doctors of BC.

I will need your help. In my coming President’s Tour I will make it a priority to meet with facility-based specialists and physicians, to listen and to talk so that we will have a common and united goal—to become more influential in making change to benefit our patients, our health care system, and our profession. I am asking that you come to those meetings, if possible, and make your voices heard. And I will take your thoughts and opinions back to better inform our association, the health authorities, the ministry, and the public.

Second, we must commit to quality care at the micro level. I believe that each of us is a leader in our own right. Each of us has the ability to make meaningful change. Not all of us want to work at the system level, but each practising physician can and should be a leader in quality with each individual patient interaction. Think provincially, act locally. Physician leadership and innovation is more important now than ever before.

Medicine is no longer a one-way conversation. Patients want to get involved, they need to get involved, they deserve to get involved. Today patients are far more educated about their own conditions, they are far more empowered, and they have access to far more information. They’re demanding to be full partners in their care, and they should be. I will be championing the physician’s role as a provider of not only excellence in patient care but also of the best patient experience. I believe the future of our profession depends upon it.

Third and finally, we need to focus on doctors as innovators, particularly in the arena of information technology. We need to be leaders and innovators in how to protect and organize information, and how to share it with patients, with our colleagues, and with other providers.

Information technology has the potential to vastly improve patient care while simplifying management of that care. When I did my internship in New Zealand 35 years ago, the name of the prescribed medication was not printed on the vial because it was considered unnecessary to tell the patient what they were taking! Those days are gone, and rightly so. Today patients can access their lab results online and, having gathered information using the Internet, are often well informed when they arrive in the office. Those rows upon rows of manila files that used to line the walls of our offices are fast disappearing as we convert to electronic medical records. I see a day in the near future when doctors and other providers use an e-referral process to converse electronically and directly with each other’s EMRs, regardless of the vendor. I see two-way communication between health authorities and community doctors that allows transmission of clinical information. I see a day when all doctors use e-prescribing, solving many current medication problems and resulting in the demise of the traditional Rx pad.

Although information technology has the potential to improve patient care and our workflow, we need physician leaders and innovators actively participating in this process to ensure it does so, and to ensure technology serves patient care and not the reverse.

Not all of this is going to be achieved during my year as your president. But my father used to tell me, “Always do your best to leave something better than when you found it.”

To get there, I am willing to listen to you, to work with you, and to advocate for the kind of supports we will need from government and health authorities.

It’s all about working together. I look forward to working with you.
—William Cavers, MD
President, Doctors of BC

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Dr Bill Cavers wants to hear from you. E-mail him at president@doctorsofbc.ca with your thoughts and ideas.