Trevor’s Take On: Parallels between the US election and Medicine

Dina Baras Messenger, Trevor's Take On

I am still reeling in response to the US election, trying to understand what it means (how did it happen?) and what the impact will be on Canada and the rest of the world.

One article I read suggested that, during the campaign, the media took Mr. Trump literally but not seriously, while his supporters took him seriously but not literally.

Others have opined that we are now in the post-truth world, where facts or evidence become much less relevant, perhaps irrelevant, and are replaced by personally-chosen opinion and revisionist history: “I don’t care what the facts are. I choose to believe differently”.

In medicine, such a shift in thinking would be a disaster.

But we must be prepared to react and respond, as it is likely some of that behavior and thinking will leak across the border. How will we (the health system, not just doctors) address the need to increase childhood immunization rates? To reduce pollution? To address global warming? Recently we’ve heard that Mr. Trump has an open mind on some of these questions. That is better than a closed mind, I suppose, but it begs the question where his mind has been for the past 10 years, what he’s been reading and who he’s been listening to.

What is also becoming ever more apparent is the enormous set of conflicts of interest Mr. Trump’s business interests create in his impending role as President and Commander-in-Chief. In my experience, people are readily able to identify potential conflicts in others, but not very good at identifying conflicts of interest in themselves. Rather than putting his business interests into a blind trust, Mr. Trump has indicated he will turn over the running of his businesses to his children. I am sure Dad and the kids never talk, so that should alleviate any issues…Why is this important? The question the American people may have to ask themselves is: is this decision in the American interest or in Mr. Trump’s business interests? What if the two interests are not aligned?

Are there parallels in medicine? I think so.

Are we truly able to interpret the evidence behind new devices, drugs and treatments? Do we critically evaluate what we do (and what we offer patients) against current evidence? Do we abandon treatments, drugs and technologies shown not to have benefit? Do we delay adopting new and innovative techniques until there is evidence to support their adoption? Or, in the absence of evidence, do we attempt to produce the evidence?

How prone are we to recognize or act on conflicts of interest? How many of us think that drug detailing by pharmaceutical representatives has no impact on our prescribing choices? Can we see that some conflicting interests are non-financial – examples include prestige and secondary benefits?

How willing are we to step up and speak out against behaviors that are unacceptable – swearing at co-workers, denigrating colleagues, laughing at patients’ misfortunes, threatening when we don’t get our way?

Recently I had the opportunity to hear a very experienced lawyer/politician express her views about the Trump election. In part, her message was that words matter and that, as a civil society, we need to stand up and object (and correct) when words are used in ways that violate our sense of fairness, of right and wrong, and our desire to have an inclusive society.

I believe the same is true in our profession. Words and actions matter. There is no better time to stand up and object (and correct) when we see and hear things that are unprofessional, hurtful and untrue. Thankfully, we are guided by mores and ethics, including by a shared sense of purpose. The problems we face in health care in Alberta and in medicine specifically are our collective problems; we don’t need a disruptive figure (a misogynistic, xenophobic, racist, philandering and groping figure at that) to force change. We can make the changes ourselves, while remaining professional as we do so.

Offering Thanks

The December meeting of Council will be Jim Stone’s final act as the President of the Council and chair, as his six years on Council comes to an end.

I have had the good fortune to work with a stellar group of Council presidents, and Jim has been one of the best. Not only has he been incredibly supportive to me and our team at the College, he has been a true consensus-builder at Council and, when necessary, the moral center for Council.

Jim has dedicated many extra hours and days to the College, which, considering his other roles as cardiologist/clinician and cardiovascular SCN medical director, is more than we could reasonably ask. While we will continue to benefit from Dr. Stone’s experience and expertise on the Governance Committee (where the past-president plays a role), I will miss his leadership at Council and his counsel and friendship to me.

To all of you, I hope the holiday season brings you time with family, time to recharge and reflect, and time to be thankful for the blessings we all have as Albertans and Canadians.

Trevor Theman