The host of White Coat, Black Art gives us his unique perspective on where the health care system is going—and what we can do to fix it
As a doctor, you’re in a unique position—you get to interact with patients one-on-one, but you also have a bird’s-eye view of the health care system thanks to your show.
It’s true. Through the stories we’ve covered on the show, I’ve been exposed to more aspects of health care than almost any of my colleagues, and I would not be a physician doing what I’m doing today if I didn’t have this second career. It has greatly accelerated my understanding of the patient experience, and of the issues that the medical system is facing. These are challenging times. But interesting times, too. If you’re a doctor, you really have to have your eye on the future.
What are some positive changes that you’d like to see become more ubiquitous?
I think the idea of introducing peer support workers to health care is very important. A role that is missing in most hospitals is someone who advises, councils, and gives support to patients in emerg who have just been admitted with mental health issues. The idea behind peer support counselling is very simple: there is no one who understands what you’re going through in the middle of mental health crisis better than someone who has also been through a crisis. And, like most simple ideas, it’s very effective. I wouldn’t know about peer support workers if we hadn’t done a show about them.
What area of medicine do you foresee undergoing the most dramatic change?
Family physicians are undergoing a seismic shift. With more and more diagnosis tools and information becoming available to the general public, what role are they going to play going forward? A navigator of the system? A manager of chronic complex issues? Will they be team leaders instead of solo practitioners? The truth is, job security in medicine is becoming increasingly difficult to find. I worry about all the orthopaedic surgeons who are finishing their residencies and have to do an endless series of fellowships to stay relevant, all while searching for a job. An era of unemployment, or sub-employment, means that fellows can be easily exploited.
What is changing the most, in terms of how physicians navigate their careers?
There’s an assumption – particularly among specialists – that they can come out of residencies with a fellowship, land in a practice, have the O.R. time they need, and find that dream job in the exact right urban setting. That simply isn’t the case anymore. Income security is also becoming an urgent issue. And there is still, I’m sorry to say, bullying, harassment, and lack of opportunity. All these antiquated notions would have you believe that the system is 98-percent good and whole and coherent, and not in need of a serious shake-up. But, as those outdated notions are disproven, things are changing.
What do you think is catalyzing that change?
More women than men are now entering med school, and soon, hopefully, will be entering positions of power. There may be a tipping point coming soon, a major change in the culture of medicine. Younger physicians have a greater willingness to question the status quo—the question I would pose to this new generation is: will you continue to do that, or will you be silenced?
If you could snap your fingers and change one thing about how we practice medicine today, what would it be?
I’d create a system that identified complex patients instantly and seamlessly —it's something that would take the stress off of family physicians and specialists. We need to be able to quickly identify the needs of these complex patients (who are most often seniors)—they’re the ones who turn a 10-minute visit into an hour-long appointment. If you could create a system that could deal with them, that would have a huge ripple effect. Complexity is the one of the biggest issues we have.
If I had twosnaps, the second thing I’d do would be to create a concierge position, someone who could tell staff what they should be doing from moment to moment and take some of the decision-making stuff off their shoulders.
What’s the most important piece of advice you could give a young student or physician who is just about to take the leap into the world of medicine?
The most important piece of advice I can give: if you have a tendency to blame yourself for mistakes, if you’re a perfectionistic and have a hard time meeting your own high standard—give yourself a break. If you want to be kind to others, be kind to yourself. If you want to empathize with others, the first person you have to empathize with is yourself. Treating yourself as a vessel filled up with good stuff to give to other people is a recipe for burnout. What you actually need is a recipe for continuous regeneration—and you can only achieve that by taking care of yourself, forgiving yourself for mistakes, and treating yourself well. That should be the golden rule of medicine: if you don’t nurture yourself, you can’t nurture others.
Dr. Brian Goldman
Dr. Brian Goldman is a veteran ER physician and award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.