An Interview with Dr. Danielle Martin, MD CCFP FCFP MPP of Medical Affairs & Health System Solutions
(Image Credit to University of Toronto)
You are a family doctor, with unique insights into the Canadian health care system. Your new book, Better Now: Six Big Ideas to Improve Health Care for All Canadians, poses, as per the title, six big ideas to improve the Canadian health care system. What inspired you to write this book?
Each chapter in the book was named after a patient in my practice who I was inspired by and this is a book about their stories. I think that when people pick up a copy of Better Now, they will see themselves in the stories, or a friend or a family member. Many of us have had similar experiences in the doctor’s office, or we know of someone who has. As a family doctor, I see the challenges my patients face because of problems in the system. These problems often feel outside the control of both individual patients and providers. But as someone who studies health system issues, I know that a lot of those problems can be fixed, and importantly we can fix them in ways that build on the value of fairness that is so important to Canadians. I felt a book was a good way to give voice to these issues and to try to get people like my patients and your readers more engaged in pushing for improvements.
Big idea 1 is the return to relationships. What does this mean for Canadian health care?
We know that around 85% of Canadians have a family doctor, so that’s a great place to start. But having a good relationship with your doctor comes next. This relationship should be one where there is open communication, so that we as doctors have the chance to really understand what patients need when they come in to see us. In my book, I say that the notion of being seen by “someone who knows you” is central to primary care. The best place to integrate all your health needs is a place where, like the bar in Cheers, everybody knows your name. So, for example, if you come in to see me for a cold, I would help you with that, but while you were there, we might also sit and talk about other concerns you may be having, discuss your family history with a disease, talk about screening and what we need to better manage your health. This relationship can also help to guard against overtreatment or over-doctoring. For example, in my book, I talk about my patient Abida and how we’ve worked to reduce the number of medications she takes and the specialists she meets with over the years, to her benefit. We’ve also tried to limit the number of times she goes in to the emergency room by making sure that she sees me more often, vs. other healthcare providers who many not know about as much about her health history.
Big idea 2 is a nation with a drug problem. What is our drug problem in Canada? What is the remedy or the solution for it?
We know that one in five Canadian households report that someone in that household is not taking their medicine out of concerns about costs. We need a public drug plan that covers all Canadians and does not have high co-payments so that patients can afford to take their life-saving medications. A strong national pharmacare program would solve our access problems and save Canadians billions of dollars. If done right, a pharmacare program could also help to reduce overmedication and inappropriate prescribing – problems that affect too many Canadians, especially seniors. Canadians believe in the principle that access to health care should be based on need, not ability to pay. That principle needs to be extended beyond doctors and hospitals to include universal access to a publicly-funded formulary of essential medicines.
Big idea 5 is a basic income for basic health. That is important to BIEN. It is, specifically, a basic income guarantee. What is the specific definition of a basic income guarantee in big idea 5? How would this impact the Canadian health care system?
A basic income guarantee means that if your income falls below a certain level, you would be topped up to a level sufficient to meet your basic needs. It’s a departure from our current social assistance program in two ways:
- A basic income would ensure that everyone in Canada has income above the “poverty line.”
- It would work through the tax system and be easier to administer with the only eligibility requirement being a person’s income. Who you live with or whether you were searching for work or attending a training program wouldn’t be factored into whether you are eligible to receive support.
Medicine isn’t the only thing that makes us healthy. If you can’t afford good food, your rent or safe housing, it’s harder to be healthy, so we need a basic income for basic health. By ensuring that everyone has access to a basic income, we can improve health and decrease costs in the health care system by reducing or eliminating poverty. For example, in Manitoba in the 1970s, a small income top-up for people in poverty reduced hospitalizations by 8.5%. If we could find a drug as effective as that, we would put it in the water supply!
About the Author
Danielle Martin is a family physician in Toronto and Vice President, Medical Affairs and Health System Solutions at Women’s College Hospital. Her book, Better Now: Six Big Ideas to Improve Health Care for All Canadians, was released by Penguin Random House in January 2017. For more information on her current book tour watch here and follow @docdanielle on Twitter.