Addressing complex patient care

March 28, 2018 | Author: Dr. Andrew Padmos

Dear colleagues,

There are some things we know:

  • new technologies (such as artificial intelligence) are impacting the medical profession, patients and how care is delivered;
  • scopes of practice are evolving and innovative models of collaborative care are increasingly important to meet complex patient needs;
  • barriers in access to specialist care remain an issue; and
  • important changes lie ahead to support the ongoing evolution of continuing professional development.

Each year, we host the Royal College-National Specialty Societies (NSS) Specialty Medicine Summit. This year it was held on March 21, 2018. This summit is a valuable touch base and opportunity to dialogue on challenges we all face and solutions we should lead.

A summary of our discussion is shared below. Dr. Wong and Dr. La Roche, two presenters, have also shared their presentation slides.

Where do we go from here?

Council established a new working group, last month, to examine the impact of digital technology on medical education and health care. It is being chaired by Dr. Richard Reznick, FRCSC, dean of the Faculty of Health Sciences at Queen’s University. This group will report back to Council next year, at which time we’ll determine next steps.

Specific to our ongoing work with the NSS, we will keep the channels of communication open, continue to champion knowledge and data-sharing and pursue more opportunities for collaboration to address some of these issues. We will also hold a larger event in 2019 with a broader array of stakeholders to define solutions to pressing specialty care issues.

If we all continue to work together, I think it’s possible that this summit can be the place for the profession to build consensus and leadership for high quality specialty care.

How are you/your hospital/your teaching centre, tackling some of these practice realities? In what areas or on which issues are you in most need of educational or advocacy support?


Andrew Padmos, BA, MD, FRCPC, FACP
Chief Executive Officer

Discussion (Summary points)

Collaboration and scope of practice

  • We’re seeing more and more patients with multiple, complex conditions being treated in multiple and complex systems of care.
  • We need to encourage more knowledge-sharing (innovations) and sharing of evidence to support and spread change.
  • We need “the roots and the rain” to advance new models. We also need the right people around the table to feed and sustain them.
  • We need to make the case for change to funders, administrators/system managers and other physicians.
  • We need to better teach physicians (both those in training and those in practice) how to advocate.

DOWNLOAD THE PRESENTATION SLIDES: “Cross-Specialty Collaboration: What, Why and How,” Dr. Camilla Wong, St. Michael’s Hospital

Impact of technology

  • We have technology available to us that we’re not using fully or effectively.
  • Industry is going ahead and outpacing the medical profession, especially where there is money to be made.
  • Governments need medical leadership to inform choices related to return on investment, impact, privacy and ethics, etc.
  • We must consider whether we are protecting the role of the physician in the face of technology, harnessing technology to improve access to care, or both.
  • The revolution is here – we can’t stick our heads in the sand.

Breaking down barriers to access

  • Access is a problem (e.g. cancelled or postponed treatments, therapies or surgeries; displacing patients; discontinuity of care; excessive wait-times; service disparities between rural and urban environments, etc.)
  • There is a current misalignment between resources and needs (e.g. workforce, access to practice resources, etc.)
  • Funding models don’t support best models of care.
  • We already have some solutions (e.g. collaborative models of care in Ophthalmology) but we need to
    • monitor scopes of practice,
    • prepare physicians for evidence-informed advocacy — better explain why we need more resources,
    • be accountable to patients, to one another and to funders.

DOWNLOAD THE PRESENTATION SLIDES: “Where can fellows find alliances to improve access to specialty services?” Dr. Robert La Roche, Professor, Ophthalmology and Visual Sciences, Division of Pediatric Ophthalmology and Strabismus, Dalhousie

General themes (not previously mentioned)

  • There is broad recognition that the medical profession has a leadership role to play in each of these areas (advocacy was a common theme).
  • We need to continue to collect and champion data for evidence-informed advocacy.
  • Not all topics affect all disciplines equally or in the same ways (e.g. the impact of technology on high-tech disciplines versus low-tech/high-touch disciplines).


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F. S. Dominique | March 28, 2018
Never mind teaching us how to advocate. You should teach yourself how to advocate. Canada is second to last in quality and access according to the Commonwealth fund.
Dr. Andrew Padmos | April 18, 2018
Hi Dr. Dominique, thank you for your comment. Actually, I wasn’t suggesting that the Royal College teach anyone or itself advocacy techniques but rather asking if you, as a Fellow of the Royal College, need support in respect of the practice realities we all face. Perhaps we could arrange a telephone call to discuss challenges and solutions to improve Canada’s health system performance. Let me know if you’d like to arrange a call. Best wishes, Andrew
Louis Hugo Francescutti | March 28, 2018
Never heard from Richard, I am still interested in helping out Louis Hugo Francescutti Physician & Storyteller 780-932-7187 >
Dr. Andrew Padmos | April 18, 2018
Hello Louis, Richard is away on sabbatical until July, so the terms of reference and membership of the Task Force has yet to be finalized. I’ll keep you posted. Keep well, best wishes, Andrew