Looking at the role of physician health advocacy in the Canadian healthcare system

Andrea Jones

The Merriam-Webster dictionary defines an advocate as ‘one who supports or promotes the interests of another’.(1) Advocacy for social justice is a long–running theme throughout the history of medicine. In 1847, Rudolph Virchow described physicians as ‘natural attorneys for the poor’, who can take the lead on improving health through first improving economic and social conditions.(2) This type of advocacy described by Virchow—social activism for the betterment of health—remains a core component of practice in Canada’s current medical profession.(3) However, with the evolution of more complex, integrated healthcare systems and changing health needs, the role of Canadian physicians as health advocates has and will continue to undergo re–evaluation and redefinition.(4, 5, 6) This news article will briefly review current definitions of physician health advocacy and possible ways that physicians can advocate for health within the context of Canadian healthcare.

While authors in academic literature recognize that health advocacy in modern medicine needs conceptual clarification,(4, 5, 6) there appears to be general consensus that it consists of activities intended to benefit the health of individuals and populations.(3, 4, 5)  In a recent journal article published in Academic Medicine, the role of physicians as health advocates is explored in the context of the CanMEDS framework.(4) Here the authors divide health advocacy into two distinct activities: agency and activism. They elaborate that through agency, physicians can assist individual patients in navigating healthcare systems and accessing appropriate resources, while activism addresses the broader health issues and their determinants in populations and communities.(4)

Since the inception of the 1982 Canadian Health Act, universal access and coverage for hospital, physician, and surgical-dental services have been afforded to all Canadians. While the general intention of the act is clear, universal access and coverage can be affected by policy made at the level of the healthcare system and decisions made during the process of healthcare delivery. At the delivery level, access to healthcare can vary according to individual patient characteristics such as gender or level of health-literacy. For example, when all other clinical considerations are equal, physicians are more likely to recommend men for total knee arthroplasty than women.(7) In consideration of health literacy, if a patient is unaware that certain treatment options exist, they essentially do not have access to these treatments unless properly consulted and counselled. In such situations, physicians can work with patients and other healthcare professionals to ensure that patients have the resources and information necessary to make the best treatment decisions. Likewise, physicians can also be sensitive to biases that may exist in their own decision–making processes and make an effort to ensure that access to care is determined by health need and not other irrelevant patient characteristics.

At the policy level, there remains grey area as to whether controversial services such as in vitro fertilization or medical marijuana should be included under provincial health insurance plans. In addition to this, healthcare systems often struggle with achieving actualization of timely universal access (e.g. long wait times for surgeries).(8) While finite resources limit the extent of services that can be covered and the expediency with which they are delivered, there remains room for physician advocacy to inform and shape future decision–making for resource allocation. Physicians can engage in such efforts individually or collectively as groups. Suggestions for individual physicians to become involved in activism include public education of healthcare issues through mainstream media, speaking at public events, and communication with executive and legislative officials. In particular, the Canadian Medical Association (CMA) is an example of a professional association with an advocacy mandate. Collectively they advocate for improved healthcare through research intended to inform healthcare policy, submissions to government outlining their stance on healthcare issues, and advocacy skills training for CMA members.

In summary, physician health advocacy includes actions of agency and activism. In regards to healthcare systems, physicians can act as agents of individual patients as well as activists on a systemic level. Discussions around the role of physicians as health advocates are likely to continue. While the central focus of physician health advocacy efforts should continue to be the health of individuals and populations, there remains a need to further develop best practices for health advocacy training as well as structures and processes to support physicians’ health advocacy efforts.(9, 10) As a growing field of interest and action, health advocacy is becoming an increasingly important means of providing quality care to patients, improving healthcare systems, and ensuring fair and equitable access to healthcare resources.

REFERENCES
  1. Merriam-Webster’s Collegiate Dictionary. [Internet]. 11th ed. MA: Merriam-Webster, Inc. Advocate [cited 2014 Oct 19]. Available from: http://www.merriam-webster.com
  2. Silver GA. Virchow, the heroic model in medicine: health policy by accolade. Am J Public Health. 1987;77(1):8288.
  3. Royal College of Physicians and Surgeons of Canada: CanMEDS 2005 Framework [Internet]. 2005 [cited 2014 Dec 7]. Available from: http://www.royalcollege.ca/portal/page/portal/rc/common/documents/canmeds/framework/the_7_canmeds_roles_e.pdf
  4. Dobson S, Voyer S, Reghr G. Perspective: agency and activism: rethinking health advocacy in the medical profession. Acad Med. 2012;87(9):11614.
  5. Hubinette MM, Ajjawi R, Dharamsi S. Family physician preceptors’ conceptualizations of health advocacy: implications for medical education. Acad Med. 2014;89(11):15029.
  6. Hubinette M, Dobson S, Voyer S, Regehr G. “We” not “I”: health advocacy is a team sport. Med Educ. 2012;48(9):895901.
  7. Borkhoff CM, Hawker GA, Kreder HJ, Glazier RH, Mahomed NN, Wright JG. The effect of patients’ sex on physicians’ recommendations for total knee arthroplasty. CMAJ. 2008;178(6):6817.
  8. Wait Time Alliance. Time to close the gap: report card on wait times in Canada [Internet]. 2014 [updated 2014 June; cited 2014 Dec 7]. Available from: http://www.waittimealliance.ca/wp-content/uploads/2014/06/FINAL-EN-WTA-Report-Card.pdf
  9. Verma S, Flynn L, Seguin R. Faculty’s and residents’ perceptions of teaching and evaluating the role of health advocate: a study at one Canadian university. Acad Med. 2005;80(1):103108.
  10. Cowell JW, McBrien-Morrison C, Flemons W. Physician advocacy, physician engagement – two sides of the same coin. Qmentum Quarterly. 2012;4(3):2629.