Don’t fight history and don’t fight the future—Create it and shape it

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In his powerful and provocative keynote address on November 8, 2013, Canadian health policy expert Steven Lewis stressed that the future of Canada’s health care system depends on family medicine meeting the vast unmet needs of complex care.
Lewis, a health policy and research consultant based in Saskatoon and an adjunct professor of health policy at Simon Fraser University, had a strong message for family physicians: “Don’t fight history and don’t fight the future. Create the future and shape it… The best thing about family medicine currently is that it is increasingly starting to look at people more holistically, and there is, I believe, an emerging trend back to generalism.”

It is time for family physicians to embrace their unique knowledge and experience, to continue their “heroic” work fighting chronic disease, and for family medicine to transform to undertake its critical and pivotal role in health care delivery in the years ahead, he suggested. To fulfill its potential, family medicine will have to transform itself in the classroom, in the community, and in the workplace, he recommended.

Lewis also warned attendees that the time has come for a thorough and creative review of current rewards and penalties in physician remuneration systems across the country.

“I think the way that medical remuneration works, and particularly the way that fee for service plays out over and over again, is probably morally corrosive,” he said during interview. “It encourages—subtley—physicians to do the wrong thing. Just as badly, it discourages physicians from doing the right thing. I think it encourages over servicing and the wrong kind of service, and I think it discourages the cognitive work of looking after people who have really complex needs.”

He discussed too the goals of better team work, shorter wait times, more effective division of labour among health professionals, better use of electronic health records and data, better investment in primary care, better investment in keeping people in the community rather than hospital, and encouraging patients’ efforts to self-manage.

“We are way too proud of Medicare as an icon in Canada,” stated Lewis. “We’ve become extremely complacent…. We’ve thought for too long that the solution is to buy our way out of the problem.

It is also important that in future Canada’s family physicians look at the issues surrounding autonomy. They need to join their local health care system in order to “own” the system’s problems, and to be front and centre, not arms-length, he suggested.

“Steven Lewis’ talk was truly inspiring said newly installed CFPC president Kathy Lawrence. “A lot of what he was saying really echoed, and I thought was really meaningful. I think that in many ways what Mr Lewis was saying supported what we have already thought and we need to work towards implementing.”

Following Mr Lewis’ address, the floor was opened for a question and answer session, which drew much participation from the audience. Mr Lewis received a standing ovation for his provocative address.

By Barbara Kermode-Scott