May 1, 2023 • 42 mins
His cultural heritage and years of work on the Indigenous health strategy have given Dr. Alika Lafontaine the kind of calm courage that isn't often seen in healthcare leadership.
In this episode, Diane and Alika talk about what’s needed to make meaningful and sustainable changes to transform the Canadian healthcare system.
Learn more about Dr. Alika Lafontaine: Canadian Medical Association
Contact Dr. Diane McIntosh: DrDianeMcIntosh.com
More Episodes: Website
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
You know,
just reminding political leaders those in government,
if we don't see something soon,
people will transition from simply being hopeless to being indifferent.
Today.
I'm speaking with Dr Alika Lafontaine.
He's the president of the Canadian Medical Association,
the largest advocacy group for medical doctors in Canada.
(00:24):
It's hard to imagine anyone doesn't know who Alika is because it seems he's being interviewed weekly on the subject of health care transformation.
Despite his incredibly busy schedule,
Dr Lafontaine continues to work as an anesthetist in Grand Prairie Alberta and he's also a busy parent and an active community member.
(00:46):
I first met Alika at a health conference in Montreal in 2022.
And I was struck by his wisdom and courage and also his fresh way of thinking about problems,
particularly in our health care system.
He's all about solutions but not just actions.
He's also deeply interested in people,
how they think how they feel and also how we all need to think differently if we want different outcomes.
(01:13):
As an anesthetist,
waking people up is just as important as putting them to sleep.
And Alika's message should be a wake-up call to every Canadian crisis is an opportunity to create change.
If we act,
I was inspired by Doctor Alika Lafontaine and I hope you are too.
(01:34):
It's so great to speak to you today,
Alika.
So if you're ok,
I'm just gonna jump right in here.
You're the head of the Canadian Medical Association.
And that means you're leading Canada's largest physician advocacy group,
many Canadians.
And I will say myself included,
believe that our healthcare system is broken,
perhaps irreparably broken.
(01:55):
And maybe that's me saying,
you know,
it has to change because the status quo ain't working anymore.
But as a medical leader in your position,
what do you think?
So it is correct to say that the system is broken.
It's correct to say that the system is collapsing at a different rate depending on where you're at.
You know,
it's not collapsing everywhere,
(02:16):
but it's definitely collapsing in different places.
And it,
it's really illustrating,
I think in,
in its collapse,
the connectedness of all our different parts of the system,
you know,
primary care began to collapse in the midst of the last couple of years,
particularly with,
you know,
the pressures of the pandemic and the continual decrease in resourcing when it came to being a family physician in the community.
(02:41):
And,
and as a result that demand was still there,
it just shifted to a different part of the system.
You know,
we tried to absorb it with walking clinics,
we tried to absorb it with virtual care.
It's now being attempted to be absorbed within emergency rooms.
But that collapse of the system slowly works it way through.
We noticed in,
in different ways,
waves of the pandemic that when we had acute spikes in demand,
(03:02):
we actually shut down different services in order to reallocate those resources to provide care for people that we decided were more acute and more urgently in need of that care.
You know,
my OR s were shut down at a point in time in the pandemic.
And all those personnel went to ICU.
You know,
I went to help with,
you know,
uh rapid response airway teams.
(03:22):
And as a result,
patients didn't get the care that they needed.
And so someone inside the system,
no matter where you're working,
you're starting to see now the interrelatedness of all these different problems,
how the pressure is moving from one place to another and,
and we're buckling under it,
you know,
and I think that's where the breaking is happening.
(03:42):
Now,
I think saying that we're having deteriorating systems that are collapsing and breaking is a lot different than saying that they can't be fixed.
And I,
I think that that's really where the hopeful part of it is for me,
you know,
we,
we are finally recognizing for the first time in a very long time that we can't depend on frontline workers to shoulder the burden of change.
(04:05):
How many times has a patient come in and had a near miss.
And the only reason why they didn't end up having temporary or permanent harm is because someone within the health care team said,
well,
I'm gonna go above and beyond what I'm supposed to do and I'm just gonna do this instead,
we've reached our limit within health care to do that.
(04:27):
We,
we don't have it in us anymore.
Whether that's because of energy or whether that's time or whether that's capacity,
you know,
there,
there's lots of different reasons behind this.
But we,
we can't depend more on the goodwill of providers to provide that workaround through sacrificing themselves,
you know,
their own relationships,
their own time and their own health,
(04:48):
etc.
We,
we now have to look to the system and the system now has a very clear choice.
You know,
we choose to change what we do or we continue to deteriorate moving forward.
I'm really glad you brought up family doctors and the crisis in primary care because as a psychiatrist,
I believe that Canada is facing a massive mental health care crisis and this has been coming for a really long time.
(05:14):
But my focus personally,
from a professional perspective is on the clinicians that bear the greatest weight within mental health care delivery in this country.
And that's family doctors and increasingly nurse practitioners.
What are your thoughts about mental health care delivery or the mental health care system versus health care?
(05:34):
In general,
I think one of the challenges that mental health has always had is that it was pushed out of view of folks.
We,
we always knew that there was a crisis in mental health.
We always knew that there was insufficient access and resources to people who could provide the care that patients for.
But we pushed it out of view.
It was replaced by things like surgical wait lists.
(05:55):
It was replaced by things like emergency wait times whether or not someone had a family doc,
et cetera.
And it's now coming back in full view.
So i it's not a crisis,
that's new.
It's just a crisis that was out of view that we're finally seeing again.
I believe you're right with the inter relatedness between what's going on with primary care and obviously the special of psychiatry and you know,
(06:19):
the,
the support that we have from allied providers,
nurses,
counselors otherwise and the area of mental health and the strain of the pandemic and the weakening of that social fabric that used to provide that mental health support,
I think are,
are,
are two big parts of why we're in this crisis.
You know,
the the need for these things has never disappeared.
(06:40):
It's just they were met in different ways and with the pandemic and with things that we were required to do with social distancing,
especially in the era where we had no idea how this pathogen spread,
we were forced into a situation where we did have to push each other away while we figured things out,
you know,
that that's obviously evolved to a different place than we are right now.
(07:01):
But the inevitable fraying of the social fabric,
you know,
the fact that we don't trust each other anymore because of what's gone on in the past few years.
The fact that we don't have capacity within the health care system's great workarounds.
People in the community don't have capacity to,
you know,
carry each other's stress anymore in the same way that they did before,
you know,
we do have to refocus and rebuild that capacity.
(07:24):
And I,
I think with with capacity building,
you have to split into two parts,
there's the stabilizing of systems and then there's the growth and scale of systems and with where mental health is at specifically,
and the health care system is generally,
we're not in a scale and grow area.
We,
we have to stabilize and that's a very different approach to how you support people.
(07:51):
Then I think what we're doing right now.
Well,
I couldn't agree more that what we really need to think carefully about is what capacity building actually means.
I'm especially concerned about how we build capacity in mental health care.
So I have a sense that you're a solution oriented person,
much like myself.
So if we could just take a few moments to solve this problem,
(08:13):
I would be grateful.
I I wonder when you,
when you're thinking about and of course,
I'm coming from a mental health perspective and you've got a more broad perspective and a more broad advocacy.
But are there some key areas where you believe that the focus would be most impactful if we in,
in addressing this mental health crisis?
(08:35):
This is where the money is.
And,
and I will say I,
we can't spend our way out of this.
There are bigger,
more systemic issues that we have to tackle.
Where do you think we got to focus first?
What are the top choices here?
Unsurprisingly,
a a lot of this answer will probably come down to what the CMA is focused on right now,
which I think probably speaks to the way that we went about finding our priorities over the past few years.
(09:01):
You know,
when,
when you don't have capacity within the system,
you keep the people that you have,
you bring other people in from outside and then you change the way that you work together.
You know,
we,
we actually went through these shortages and a crisis similar to this.
I,
I think it was less intense than what we're going through today.
Um But,
you know,
mid nineties to mid two thousands,
(09:22):
we,
we had a health care worker shortage,
you know,
and how do we respond to patient care during that time?
Well,
we blurred the lines between what people did and we all started to get focused on what needed to get done.
And so when,
when we talk about team based care,
which is one of the priorities of the CMA I think that we,
we often conflate that with,
(09:44):
with cost savings.
So a lot of the focus on team based care right now is how can you switch out the person who costs the most with someone who costs less?
So a lot of times it's switching out the psychiatrist with,
you know,
someone who's a non physician or the family physician with someone who's a non physician.
I don't think the issue is necessarily,
you know,
the,
the letters behind your name,
but it's the question of what tasks need to be done and who's in the right position to have those tasks done in a way that they actually get solved the first time around.
(10:13):
You know,
there,
there's an enormous amount of redundancy when it comes to seeing patients,
particularly those with mental health.
You know,
you,
you come into a family office,
for example,
and they don't practice,
you know,
mental health interventions.
And so you get referred somewhere else,
right?
Or you go to,
you know,
a specialty provider who doesn't necessarily work within your area.
(10:36):
So that,
that's a big problem with understanding your health workforce and being able to match skills to needs.
Right?
Other times you go to the emergency room with your mental health issues,
but you don't have any idea that the psychiatrist is not on because there's only temporary coverage or you know,
folks within the emergency room don't feel comfortable providing,
(10:56):
you know,
mental health support.
And and as a result,
patients continue to go through this holding pattern of,
of going to different places for care,
never receiving it.
And then folks who can provide the care not being given the opportunity to actually connect with those patients.
You know,
so we we make it very,
very difficult for patients to navigate the system.
But we make it equally difficult for providers who can service these needs to navigate their way through the system.
(11:22):
And so being able to create environments where people can freely move through systems and go to places where their needs uh or where their,
their talents can meet needs.
You know,
that that's an extremely important part of what we're doing.
I think the third part is,
is really taking the non clinical elements that have piled up for people who are providing the clinical care and simplifying that,
(11:48):
you know,
in Alberta,
we adopted,
you know,
a pan provincial electronic medical record system not too long ago.
And to some degree,
it's,
it's been really great,
you know,
you have one place that you can get information,
etc.
But what it's also done is that in saving costs for debt input.
So example is we used to have these huge teams that would transcribe dictations,
(12:10):
right?
So you'd you'd speak into a phone,
someone else would write it up,
they check your grammar,
they send it off to the people that you need to send off to.
Now,
all that is done by the person who's at the bedside.
So you fired these transcription teams,
saved your money on that team.
But now all the work has now shifted to the person who's at the bedside.
And so I it's not been uncommon for me to have to go search through lists of contacts within the system to find a family.
(12:34):
Do I've never seen before,
you know,
or connect with a colleague in a department that I I don't regularly connect with.
And that takes,
you know,
56 minutes when I'm going through that,
you scale that across,
you know,
15 2025 patients in a day,
that's an enormous amount of time.
And so opening up that time,
I think could have an enormous impact.
And then pan national data sharing would be another place that we can unlock a lot of time,
(12:58):
how many,
how many patients are seen by one person and then seen again for the exact same problem because you can't get access to the blood work or you can't get access to imaging or a patient history,
etc.
There's a lab down in the US called IAN.
It's run by a doctor named Toan.
He's written a bunch of books on,
on quality improvement.
(13:19):
Uh One of the ones that's really relevant to the OR is the surgical checklist.
One,
but they estimate that within health care there's probably at least 30% of redundant care that occurs.
So imagine every three in 10 patients are seeing someone again for the same problem.
You know,
that's an enormous amount of capacity that we could open up.
I want to pick up on that idea that so much more is being asked of the person at the bedside.
(13:46):
I want to bring up the CMA surveys regarding physician burnout and which are just jarring.
So in 2017,
I think about 30% of physicians said they were highly burnt out or at a high level of burnout in November 2021,
it's up to 53% as a physician who has personally experienced burnout,
(14:09):
I wasn't surprised,
but I was actually quite frightened looking at that number and what the implications were for that number.
And you touched on that a little bit earlier because I've never fully recovered from my burnout.
And so I also know that too often burnout is blamed on the individual on the clinician rather than on the system that they're working in.
(14:32):
And it,
it's not that there's no responsibility for the clinician,
but that it tends to be all on the clinician and not on the system.
So as I've said,
my focus has been on family doctors and helping them to have the tools they need to support patients who have a mental illness.
What can Canadian health care system do better to support clinicians,
(14:55):
especially in this post pandemic period.
I am glad that we're,
we're talking about burnout the way that we are now.
He used to be in the realm of wellness or resiliency.
This idea that we were all rubber bands and all we had to do was regain our elasticity before going into,
you know,
the difficult situations were often found in at work when I talk about burnout,
(15:16):
I,
I think I'm a lot more blunt now,
burnout happens because you have a toxic working environment.
You can have high stress in an environment and not have it be toxic and still feel renewed.
At the end of the day,
what wears again away at clinicians that leads to burnout.
It's frustration,
helping patients navigate systems.
It's trying to fix problems that,
(15:37):
you know,
our problems,
people around you agree your problems no matter what you do,
no one wants to change.
It's having dangerous situations.
And I,
I think particularly in today's environment,
this is very true,
unsafe situations that we know violate standards of practice.
We know are things that objectively people would say you should not do things this way and being told.
(16:01):
Well,
don't make noise about it.
We,
there's nothing we can do.
This is just the reality of what we're doing.
Now.
I,
I think these are the things that,
that wear away at us and when we see patients now suffer when we see calls buckle under the weight of what it's like to carry these experiences with you.
(16:21):
I mean that that kills souls.
You walk away and you feel empty inside after.
And so what,
what do you do to solve?
Burnout?
You fix toxic working environments.
You know that that is the simple solution.
And I think that leads you to questions that we don't confront directly in a lot of the places in Canada.
You know,
we,
we need to ask like,
what is making working environments toxic?
(16:45):
Sometimes it's the volume of work.
Sometimes it's the way that we treat each other.
Sometimes it's the way that we're treated by administration or the system,
you know,
the,
the system seems very well designed to consume us.
You know,
we,
we walk into environment and it takes away every part of us.
(17:07):
You know,
I,
I,
I have colleagues who,
you know,
have requested time off for really important family events and,
and whether it's an objectively important family event,
it's relevant,
it's important to them.
You know,
they,
they feel like they need to show up and be there for,
you know,
people that,
that they love and care about and,
you know,
they're,
they're told,
well,
you can do it but you have to be back like within some ridiculous timeline,
(17:30):
you know.
Um Well,
we'll do it but only this once,
you know,
why are we making people feel bad for being human.
You know,
why are we making people feel bad for going through emotional experiences that you'd expect anyone to go through,
you know,
even things like,
you know,
depressive episodes,
etc.
You know,
the triggers of those things are often very human experiences.
(17:51):
You know,
and we have become very cold to each other in how we treat and allocate each other's time.
And if we fix toxic working environments and there's a lot of different ways we can go about doing that.
You know,
it,
it depends on the place that you work.
Um As far as the,
the solutions,
(18:11):
uh I think we'd have a much better outcome when,
when asking people about burnout and,
and seeing the effects of burnout,
you know,
when,
when people walk away from something that they've spent often more than a decade pursuing training for,
there's a really,
really deep reason for it.
You know,
people do not walk away from a career in medicine when they've spent this much time training and sacrificing all this time and effort unless they found that they just can't tolerate things anymore.
(18:42):
And,
and that's the situation I think we're at in,
in many places in Canada right now.
So you just made me feel very emotional in your response.
And I'm just so grateful to feel heard by you,
the way that you spoke just really again,
made me feel like you understood my experience.
So I'm so grateful for that.
(19:04):
And I certainly understand why you're the president of the CMA.
And I'm very happy.
I'm just wondering if you ever thought about psychiatry because I,
I gotta tell you,
I,
I feel very emotional because you just get me and what I went through and it,
that's very meaningful.
So,
and I know part of your job is supposed to get up every morning and think,
how do I advocate for Diane and all of our other colleagues?
(19:27):
That's,
that's your role.
And I,
I guess it moves into my next question around.
How do we help to engage our colleagues to accept,
to embrace,
to participate in this desperately needed change because they're exhausted because they feel overwhelmed with new technology and they feel like the systems that were,
there were put in place that are we supposed to support them and make their life easier?
(19:51):
Actually,
that hasn't been the case.
So we need change,
but it ain't gonna happen if we don't get doctors on board thoughts on how we do that.
You know,
the,
the very simple direct answer to that is,
is people have to see things happening to have hope that things will change.
So,
a big push that,
that I've been making with the CMA and it's building on work that has been done in previous years.
(20:14):
You know,
Katherine Smart did a ton of advocacy is her role as president and,
and previous presidents have,
have done the same,
you know,
just reminding political leaders those in government,
if we don't see something soon,
people will transition from simply being hopeless to being indifferent.
You know,
there,
there's this uh emotional continuum,
(20:35):
I think when it comes to change where,
you know,
things are going well,
you're kind of happy and then things start to kind of slide down.
You get the early stages of burnout,
you're now in it for a while,
you get late stages,
then you start to get hopeless that things can change,
but you're still showing up doing work trying hard and then you,
you kind of fall off this cliff where you just stop caring.
(20:57):
You know,
you say,
you know,
if administration doesn't care if colleagues don't care if government doesn't care,
why do I care?
And it's a protective mechanism,
right?
It's,
it's a way that we deal with what we're witnessing and what we're feeling in everything that's,
that's going on around us.
And so depending on where someone's at,
they,
they need to see something different.
But I,
I do think in general what we need now is to stop people from falling off that cliff of indifference.
(21:25):
We need to do something soon.
Uh Yesterday would have been the best time to do it.
But there,
there has to be a very,
very clear signal that things are changing.
We're gonna make a fundamental difference in,
you know,
the,
the way that we collect and,
and collaborate and share data or,
you know,
health,
human resources or to provide freedom for people to move from place to place without having to go through lots of red tape.
(21:50):
You know,
a signal that we're gonna move towards team based care.
We need to hire more people.
You know,
we need more people within the system to carry the burden that's in there right now.
You know,
we,
we can start with any one of these things,
but we have to do at least one right now.
And that's the urgency that's building,
I think.
And,
and if we don't do anything,
I,
I do imagine it won't be much longer before more and more of people in the system just kind of shrug their shoulders and say,
(22:16):
you know,
nothing's going to change.
And,
and I just stopped caring.
And again,
for me personally,
I was shocked that I was starting to lose my sense of compassion.
And it was the thing I loved most was seeing patients.
So I know my other colleagues are probably,
you know,
I spent 14 years in university getting to the end of my specialty.
(22:38):
And I'm imagining that my colleagues are,
well,
I have many in my practice actually who have experienced the same thing that this shock,
how could I,
how could I be here?
How did,
how did I get here?
And I think we don't,
we've lost compassion within the health care system,
but something you talk about that.
I want to ask you a little more about is this ability to listen,
(23:01):
which I think we've lost collectively our ability to pay attention,
whether it's the internet or access to 24/7 entertainment.
But you talk about the importance of listening,
especially to patients and families.
And I couldn't agree.
More paternalism and medicine has always been an issue.
And I think even more in psychiatry,
(23:24):
this issue of a lack of objective measurement so that it allows subjectivity and personal biases to at times profoundly impact patient care,
profoundly impact a patient's experience.
So do you think clinicians are getting any better on this front?
And what about for members of more vulnerable communities,
(23:45):
this loss of compassion or,
or inability to listen,
you know,
why,
why do we interrupt patients on average within the first minute of them explaining their situation when,
when we see them in,
you know,
clinical consultation,
right?
It's something that,
that I have to push back on myself on,
you know,
it's something I know we all struggle with.
(24:05):
It's because we were taught that we know the answers.
You know,
we've read through the chart,
we've seen the medications they're on,
we have collateral information.
Sometimes from other folks that have done investigations,
we've looked at vitals,
we've looked at imaging and other investigations and we haven't had a working diagnosis already.
So let's just get on with it.
You know,
because I have other people who need to see me as well.
(24:27):
And if I spend too much time with you on something that's not gonna change the outcome of what we're gonna do,
then why,
why am I spending that time?
I,
I can be much more efficient and,
you know,
spread myself around to more patients and let's have more impact,
et cetera.
So that's the thought process of,
I think uh a lot of folks who are challenged by listening to patients,
(24:48):
you know,
and I,
I'll just say again,
we've been trained to believe that when you become a diagnostician,
you know,
we,
we are trained to recognize patterns,
you know,
we're trained to look at certain things a different way.
This is why a psychiatrist who looks at one patient looks at it different than an anesthesiologist is,
you know,
we see different patterns evolving from the same clinical constellation.
(25:08):
And what I think we've realized in more recent years is sometimes solving the problem in our way isn't actually what the patient is asking for.
And in letting go of what we think our role is,
we,
we start to discover what it actually is and we actually get what we want out of the clinical encounter.
(25:35):
And I,
I am very hopeful that we're starting to see a cultural change towards this because people are realizing that what they're getting right now in medicine isn't what they want,
you know.
And if,
if we can have more conversations that help us to unpack what we're actually trying to get out of the clinical encounter,
you know,
and recognize again that it's like a,
(25:57):
it's a two way value exchange between both sides.
You know,
we,
we often talk about patient centered care.
I I think something intrinsic in patient centered care is that it's not only about what the patient is asking for you to do,
it's also what you're getting from the patient as well.
You know,
I've never sat down and talked with a group of patients about patient centered care without them expressing,
(26:20):
you know,
appreciation for,
you know,
what,
what their provider has done and how they've expressed that in different ways.
I think having those conversations helps to lead us towards,
you know,
what we really need,
which is these moments where we can sit back and reflect,
you know,
maybe what I'm doing isn't really getting me what I want and how,
how can I do things differently?
(26:41):
Aleka.
I was really fortunate to hear you speak at a health conference in Montreal and there you talked about the health care system specifically about how we need to change the way we think to adjust our mental models,
you said during your talk and I write everything down.
I was writing furiously every word that you said,
(27:02):
but I may misquote you here so you can correct me.
But what I wrote down was systems are just people.
I have a great deal of faith in people,
but I don't have a great deal of faith in systems.
What does that mean to you when,
when you think about the mental health care system and really what I'm getting at is,
do you have hope?
(27:23):
What can people do?
What can the average person do to create the change that we need?
So,
I,
I think that's a pretty accurate quote.
Yeah.
And,
and,
and specific to,
to mental health,
you know,
we we've tried to fix the human problems in our systems.
(27:43):
You know,
people not being able to see things because of bias,
people mistreating or maltreating each other for a variety of different issues through applying algorithms and you know,
standards of care and you know,
introducing technologies,
etc.
But the safety net in,
in all of that has always been the person across from who needs the help when you're struggling as a patient,
(28:04):
your safety net is the provider sitting across from you.
No matter if that's the,
you know,
specialist physician or family doc who's doing an emerge shift or,
you know,
the the nurse who sees you during triage,
you know,
that that's your safety net to make you,
you don't fall through the cracks when you have a policy in place in a hospital that you know,
(28:26):
it is causing harm for yourself as a provider or for patients that you see your safety net is the administrator,
you know that you,
you sit across to and,
and talk to.
And so systems are,
are only as good as the ability that,
that their structures have to confront the challenges that are happening right now.
And,
and you know,
whether or not they can confront the challenges based on how much,
(28:48):
how frequent and how intense crises occur.
That's the best test of a system.
You know,
our,
our health care systems were able to get through multiple waves of COVID and survive.
So that that was a good test for the system as far as,
you know,
being confronted with acute care.
But in this time of weathering,
you know,
people getting to the point of,
(29:10):
of extreme burnout,
our systems are not well designed to provide that sort of care.
And the,
the only hope that you have in the midst of a crisis is,
is for someone to sit back and say to themselves.
Well,
I see you as,
as you,
you see me as me,
you know,
we're both people,
let's figure this out together.
I,
I do have a lot of hope.
I,
I do think that at the core of people who work in health care and people who work in government,
(29:35):
you know,
but I,
I also believe that the ways that we've been unpacking these issues are outdated,
you know,
they,
they don't apply the newer um more impactful ways of looking at things that have yet to be integrated into our system.
And I do have a lot of faith that as long as people continue to care,
we'll figure this out.
(29:56):
What I heard you say was medicine at its core is human and technology,
which is what my life is focused on right now has to be rooted in that humanity as well.
And I wonder in your unique circumstance of being an indigenous man but also a medical leader.
(30:18):
How is your heritage,
your cultural experience,
informed patient care.
What would you say to someone like me to understand your unique experience and how I can have a greater awareness of it?
Yeah,
I,
I,
I think there's,
there's probably two parts of the way that,
that I've been taught that I,
(30:39):
I'd probably focus on,
although there's a lot of indigenous philosophy that I,
I think is fantastic and very relevant to the challenges that we have nowadays.
The first one is,
is just the understanding that life happens in cycles.
You know,
I think sometimes we get so wrapped up that if we don't solve a problem in that very moment,
it will never get solved or that there'll never be an opportunity again.
(31:02):
And there,
there are situations specifically,
you know,
if,
if someone is,
is in an acute medical crisis,
then yeah,
absolutely.
You,
you have to get things done otherwise um they'll,
they'll pass and kind of move on to a different kind of type of existence.
But when,
when it comes to system problems in particular you know,
these cycles are happening over and over again and even though we may solve them,
(31:25):
and I really hope that,
that we'll move quickly soon to start to make the changes that people are waiting for,
the opportunities to have impact will come again and again.
You know,
and so the,
the real challenge I think to an individual is how do you prepare yourself for the next part of the cycle?
How do you feel the ebb and flow of what's going on?
(31:48):
You know,
and,
and I think that the second part of indigenous philosophy that I think is,
has been really helpful to me,
particularly in leadership is what I learned from my grandfather.
Like people are,
are essentially good.
You know,
people are expressions of their experiences and their contexts and your challenge in connecting with someone is seeing them as they really are.
(32:12):
And I,
I honestly don't think that that anyone is inherently bad within the system.
I,
I've never met a provider,
even those who create racialized situations who,
you know,
wakes up in the morning and goes,
you know,
if I just harm a couple of people today,
let's just be the best day ever that that's never where people are coming from.
So if,
if you can realize that you're part of a,
(32:32):
a greater cycle and there'll be other opportunities to have impact,
it'll change the way that you look at approaching situations,
you know,
you'll,
you'll be more reflective,
at least for myself,
I found it's,
it's brought a lot of reflectiveness to the situations I've been in.
It's less important for me to get people to hear what I have to say because there'll be another opportunity at some later time.
(32:55):
You know,
it,
it's less important for me to have people commit in that moment.
You know,
as long as it's not accused um to move forward and kind of give people space to,
to kind of learn and grow.
And then,
you know,
the other part that it's really affected as far as my leadership is,
you know,
helping people feel seen when we worked in.
And we had this big uh transformation project that,
(33:16):
that we worked on with the,
the federal government called the Indigenous Health Alliance.
It,
it involved uh 30% of indigenous communities in,
in three different provinces.
You know,
I still remember the moment where I really felt like the bureaucracy actually felt seen by us,
you know,
up until that moment,
it felt like we were on two different sides and that we were constantly in friction and a,
(33:41):
a push back and forth between each other.
And then there was a moment where,
where I think we finally saw each other and,
and suddenly that changed the entire environment like the mood and the energy around what we were doing.
And it really led to,
I think some really,
really great ideas,
you know,
and it's we're unleashing the ability for people to follow their own knowledge of what needs to change and helping them see beyond what they see right in front of them.
(34:08):
And,
you know,
that that's probably the most uh satisfying part of leadership for me.
And,
you know,
one of the reasons I,
I stay in leadership is I,
I feel renewed.
You know,
if I,
if I get down about,
you know,
a clinical experience or,
or feeling like change won't occur,
I,
I do a few more keynote talks.
I chat with people who,
you know,
are,
(34:28):
are in the audience and I,
I speak with people like yourself and I,
I walk away and I,
I feel hopeful again.
Well,
I am really happy that this conversation has helped even in a teeny way to renew your hope that change will come.
I know it has certainly helped me.
So you mentioned leadership and I know this is a tough question,
(34:48):
what's the most important role of a leader?
Because there's many I know,
but if you had a young person asking you,
you know,
what's the essence of a leader,
the most important thing that they can do?
Well,
what would you say?
So I think it depends on whether or not you're in a crisis or whether you're trying to create positive change in the absence of a crisis.
So the most important leadership characteristic right now in the midst of what's happening in the health care system with,
(35:15):
with collapse and deterioration is managing conflict.
So understanding,
you know,
what gets yourself into a position where you feel confrontational,
but then also helping people work through their own feelings of confrontation.
You know,
I,
I found the,
the conversation around,
uh you know,
quick wins is,
(35:36):
is often uh another way of saying,
well,
how can we do something that's maybe not impactful,
but no one will get upset about when in reality,
we have to push into the really tough conversations and,
and to be able to,
to get through those conversations,
you have to be able to manage conflict.
And so I,
I'd say really focus on that if,
if you want to become a leader in,
(35:57):
in,
in this area of what's going on in the health care system.
Now,
once we're out of crisis,
once we've stabilized it,
I think the most important role and skill of a leader is to be able to synthesize multiple different streams of data and remain very open to change your opinion.
You know,
I had that explained by my grandfather on my mom's side,
(36:19):
my,
my mom's originally from the island of Tonga.
She's a immigrant to the US and then came up to Canada after.
And,
you know,
he,
he used to say that,
you know,
ideas should be like holding sand,
you know,
the,
the tighter you hold on to them,
the faster they should slip through your fingers.
And,
you know,
I always remember that when I go into meetings just,
(36:39):
just be very,
very open to seeing things in a different way.
And I was coming back,
you know,
at the end of the day,
is it actually changing things?
You know,
that that's the best way to evaluate whether or not something is working.
Did it actually work?
I know it's very early in January,
but this is the best conversation I've had this year.
I love that.
I love what you just said.
You have done so much for your communities.
(37:04):
What are you most proud of?
You know,
I,
I would say this year was probably one of the first years that I started receiving a lot of emails from folks that I've worked with and I've worked in the area of indigenous health for,
you know,
20 years in medical leadership,
probably for 10 or 15 where,
where I get emails from folks that I met and they share with me,
you know,
(37:24):
a story about,
you know,
how we interacted or,
or a way that I've positively impacted,
you know,
their life.
And,
you know,
you don't often realize,
I think in leadership the way that you affect the people around you.
And my assumption has always been,
I'll try and do what good I can.
But at the end of the day,
it's really,
it's really everyone together that's,
(37:44):
that's making a big difference.
And I,
I'd say that what's been really meaningful is is recognizing,
you know,
the positive influence I've had over the past little,
you know,
I,
I'm really hoping this year we can bring some of these big changes home.
I think there's a lot of fear that,
you know,
things won't work and,
and as a result,
we,
we won't be able to have the impact that we want.
(38:06):
But we,
we got to be able to wade through that fear,
you know,
get to that other side where we can be open to,
to try something different that that's never been done before.
And I,
I do think we're,
we're really close,
closer than I've ever felt in,
you know,
the last 11 years of practice and tack on to that,
you know,
eight years of training than,
than we've ever been.
(38:26):
We need brave politicians.
Someone's got to grasp the nettle.
It's scary,
but this ain't going to change unless people really are bought into the,
the reality.
You've got to take some risks here.
So I,
I really agree with you and I cannot thank you enough for spending this time with me.
(38:46):
I just feel heard by you.
You really spoke to me personally and I feel very,
very grateful for you taking this time and sharing your thoughts.
Yeah.
Thanks for having me and thanks for the work that you do.
Thank you.
Ali is one of those people who encourages me to think in new ways.
(39:09):
His years of work on indigenous health strategy and his cultural heritage and beliefs have given him a kind of calm courage that I haven't seen in our health care leadership.
His deep confidence that change happens in time.
His patience and waiting for the opportunity to come around and his deep belief in the goodness of people are the gifts we need right now.
(39:32):
We're so fortunate to have Dr Lafontaine at the helm of the CMA at this really challenging time.
I feel hopeful that with his guidance and leadership,
we're finally going to see meaningful and sustainable change until next time.
Thank you for listening.
The Wicked Mind podcast is a series of unique conversations with individuals that share experiences and perspectives on mental health care together.
(39:59):
We will uncover ideas that inspire action.
Please make sure you subscribe,
share and comment and if you have a topic or guest suggestion,
please reach out to me at DrDianeMcIntosh.com.
You know,
just reminding political leaders those in government,
if we don't see something soon,
people will transition from simply being hopeless to being indifferent.
Today.
I'm speaking with Dr Alika Lafontaine.
He's the president of the Canadian Medical Association,
the largest advocacy group for medical doctors in Canada.
(00:24):
It's hard to imagine anyone doesn't know who Alika is because it seems he's being interviewed weekly on the subject of health care transformation.
Despite his incredibly busy schedule,
Dr Lafontaine continues to work as an anesthetist in Grand Prairie Alberta and he's also a busy parent and an active community member.
(00:46):
I first met Alika at a health conference in Montreal in 2022.
And I was struck by his wisdom and courage and also his fresh way of thinking about problems,
particularly in our health care system.
He's all about solutions but not just actions.
He's also deeply interested in people,
how they think how they feel and also how we all need to think differently if we want different outcomes.
(01:13):
As an anesthetist,
waking people up is just as important as putting them to sleep.
And Alika's message should be a wake-up call to every Canadian crisis is an opportunity to create change.
If we act,
I was inspired by Doctor Alika Lafontaine and I hope you are too.
(01:34):
It's so great to speak to you today,
Alika.
So if you're ok,
I'm just gonna jump right in here.
You're the head of the Canadian Medical Association.
And that means you're leading Canada's largest physician advocacy group,
many Canadians.
And I will say myself included,
believe that our healthcare system is broken,
perhaps irreparably broken.
(01:55):
And maybe that's me saying,
you know,
it has to change because the status quo ain't working anymore.
But as a medical leader in your position,
what do you think?
So it is correct to say that the system is broken.
It's correct to say that the system is collapsing at a different rate depending on where you're at.
You know,
it's not collapsing everywhere,
(02:16):
but it's definitely collapsing in different places.
And it,
it's really illustrating,
I think in,
in its collapse,
the connectedness of all our different parts of the system,
you know,
primary care began to collapse in the midst of the last couple of years,
particularly with,
you know,
the pressures of the pandemic and the continual decrease in resourcing when it came to being a family physician in the community.
(02:41):
And,
and as a result that demand was still there,
it just shifted to a different part of the system.
You know,
we tried to absorb it with walking clinics,
we tried to absorb it with virtual care.
It's now being attempted to be absorbed within emergency rooms.
But that collapse of the system slowly works it way through.
We noticed in,
in different ways,
waves of the pandemic that when we had acute spikes in demand,
(03:02):
we actually shut down different services in order to reallocate those resources to provide care for people that we decided were more acute and more urgently in need of that care.
You know,
my OR s were shut down at a point in time in the pandemic.
And all those personnel went to ICU.
You know,
I went to help with,
you know,
uh rapid response airway teams.
(03:22):
And as a result,
patients didn't get the care that they needed.
And so someone inside the system,
no matter where you're working,
you're starting to see now the interrelatedness of all these different problems,
how the pressure is moving from one place to another and,
and we're buckling under it,
you know,
and I think that's where the breaking is happening.
(03:42):
Now,
I think saying that we're having deteriorating systems that are collapsing and breaking is a lot different than saying that they can't be fixed.
And I,
I think that that's really where the hopeful part of it is for me,
you know,
we,
we are finally recognizing for the first time in a very long time that we can't depend on frontline workers to shoulder the burden of change.
(04:05):
How many times has a patient come in and had a near miss.
And the only reason why they didn't end up having temporary or permanent harm is because someone within the health care team said,
well,
I'm gonna go above and beyond what I'm supposed to do and I'm just gonna do this instead,
we've reached our limit within health care to do that.
(04:27):
We,
we don't have it in us anymore.
Whether that's because of energy or whether that's time or whether that's capacity,
you know,
there,
there's lots of different reasons behind this.
But we,
we can't depend more on the goodwill of providers to provide that workaround through sacrificing themselves,
you know,
their own relationships,
their own time and their own health,
(04:48):
etc.
We,
we now have to look to the system and the system now has a very clear choice.
You know,
we choose to change what we do or we continue to deteriorate moving forward.
I'm really glad you brought up family doctors and the crisis in primary care because as a psychiatrist,
I believe that Canada is facing a massive mental health care crisis and this has been coming for a really long time.
(05:14):
But my focus personally,
from a professional perspective is on the clinicians that bear the greatest weight within mental health care delivery in this country.
And that's family doctors and increasingly nurse practitioners.
What are your thoughts about mental health care delivery or the mental health care system versus health care?
(05:34):
In general,
I think one of the challenges that mental health has always had is that it was pushed out of view of folks.
We,
we always knew that there was a crisis in mental health.
We always knew that there was insufficient access and resources to people who could provide the care that patients for.
But we pushed it out of view.
It was replaced by things like surgical wait lists.
(05:55):
It was replaced by things like emergency wait times whether or not someone had a family doc,
et cetera.
And it's now coming back in full view.
So i it's not a crisis,
that's new.
It's just a crisis that was out of view that we're finally seeing again.
I believe you're right with the inter relatedness between what's going on with primary care and obviously the special of psychiatry and you know,
(06:19):
the,
the support that we have from allied providers,
nurses,
counselors otherwise and the area of mental health and the strain of the pandemic and the weakening of that social fabric that used to provide that mental health support,
I think are,
are,
are two big parts of why we're in this crisis.
You know,
the the need for these things has never disappeared.
(06:40):
It's just they were met in different ways and with the pandemic and with things that we were required to do with social distancing,
especially in the era where we had no idea how this pathogen spread,
we were forced into a situation where we did have to push each other away while we figured things out,
you know,
that that's obviously evolved to a different place than we are right now.
(07:01):
But the inevitable fraying of the social fabric,
you know,
the fact that we don't trust each other anymore because of what's gone on in the past few years.
The fact that we don't have capacity within the health care system's great workarounds.
People in the community don't have capacity to,
you know,
carry each other's stress anymore in the same way that they did before,
you know,
we do have to refocus and rebuild that capacity.
(07:24):
And I,
I think with with capacity building,
you have to split into two parts,
there's the stabilizing of systems and then there's the growth and scale of systems and with where mental health is at specifically,
and the health care system is generally,
we're not in a scale and grow area.
We,
we have to stabilize and that's a very different approach to how you support people.
(07:51):
Then I think what we're doing right now.
Well,
I couldn't agree more that what we really need to think carefully about is what capacity building actually means.
I'm especially concerned about how we build capacity in mental health care.
So I have a sense that you're a solution oriented person,
much like myself.
So if we could just take a few moments to solve this problem,
(08:13):
I would be grateful.
I I wonder when you,
when you're thinking about and of course,
I'm coming from a mental health perspective and you've got a more broad perspective and a more broad advocacy.
But are there some key areas where you believe that the focus would be most impactful if we in,
in addressing this mental health crisis?
(08:35):
This is where the money is.
And,
and I will say I,
we can't spend our way out of this.
There are bigger,
more systemic issues that we have to tackle.
Where do you think we got to focus first?
What are the top choices here?
Unsurprisingly,
a a lot of this answer will probably come down to what the CMA is focused on right now,
which I think probably speaks to the way that we went about finding our priorities over the past few years.
(09:01):
You know,
when,
when you don't have capacity within the system,
you keep the people that you have,
you bring other people in from outside and then you change the way that you work together.
You know,
we,
we actually went through these shortages and a crisis similar to this.
I,
I think it was less intense than what we're going through today.
Um But,
you know,
mid nineties to mid two thousands,
(09:22):
we,
we had a health care worker shortage,
you know,
and how do we respond to patient care during that time?
Well,
we blurred the lines between what people did and we all started to get focused on what needed to get done.
And so when,
when we talk about team based care,
which is one of the priorities of the CMA I think that we,
we often conflate that with,
(09:44):
with cost savings.
So a lot of the focus on team based care right now is how can you switch out the person who costs the most with someone who costs less?
So a lot of times it's switching out the psychiatrist with,
you know,
someone who's a non physician or the family physician with someone who's a non physician.
I don't think the issue is necessarily,
you know,
the,
the letters behind your name,
but it's the question of what tasks need to be done and who's in the right position to have those tasks done in a way that they actually get solved the first time around.
(10:13):
You know,
there,
there's an enormous amount of redundancy when it comes to seeing patients,
particularly those with mental health.
You know,
you,
you come into a family office,
for example,
and they don't practice,
you know,
mental health interventions.
And so you get referred somewhere else,
right?
Or you go to,
you know,
a specialty provider who doesn't necessarily work within your area.
(10:36):
So that,
that's a big problem with understanding your health workforce and being able to match skills to needs.
Right?
Other times you go to the emergency room with your mental health issues,
but you don't have any idea that the psychiatrist is not on because there's only temporary coverage or you know,
folks within the emergency room don't feel comfortable providing,
(10:56):
you know,
mental health support.
And and as a result,
patients continue to go through this holding pattern of,
of going to different places for care,
never receiving it.
And then folks who can provide the care not being given the opportunity to actually connect with those patients.
You know,
so we we make it very,
very difficult for patients to navigate the system.
But we make it equally difficult for providers who can service these needs to navigate their way through the system.
(11:22):
And so being able to create environments where people can freely move through systems and go to places where their needs uh or where their,
their talents can meet needs.
You know,
that that's an extremely important part of what we're doing.
I think the third part is,
is really taking the non clinical elements that have piled up for people who are providing the clinical care and simplifying that,
(11:48):
you know,
in Alberta,
we adopted,
you know,
a pan provincial electronic medical record system not too long ago.
And to some degree,
it's,
it's been really great,
you know,
you have one place that you can get information,
etc.
But what it's also done is that in saving costs for debt input.
So example is we used to have these huge teams that would transcribe dictations,
(12:10):
right?
So you'd you'd speak into a phone,
someone else would write it up,
they check your grammar,
they send it off to the people that you need to send off to.
Now,
all that is done by the person who's at the bedside.
So you fired these transcription teams,
saved your money on that team.
But now all the work has now shifted to the person who's at the bedside.
And so I it's not been uncommon for me to have to go search through lists of contacts within the system to find a family.
(12:34):
Do I've never seen before,
you know,
or connect with a colleague in a department that I I don't regularly connect with.
And that takes,
you know,
56 minutes when I'm going through that,
you scale that across,
you know,
15 2025 patients in a day,
that's an enormous amount of time.
And so opening up that time,
I think could have an enormous impact.
And then pan national data sharing would be another place that we can unlock a lot of time,
(12:58):
how many,
how many patients are seen by one person and then seen again for the exact same problem because you can't get access to the blood work or you can't get access to imaging or a patient history,
etc.
There's a lab down in the US called IAN.
It's run by a doctor named Toan.
He's written a bunch of books on,
on quality improvement.
(13:19):
Uh One of the ones that's really relevant to the OR is the surgical checklist.
One,
but they estimate that within health care there's probably at least 30% of redundant care that occurs.
So imagine every three in 10 patients are seeing someone again for the same problem.
You know,
that's an enormous amount of capacity that we could open up.
I want to pick up on that idea that so much more is being asked of the person at the bedside.
(13:46):
I want to bring up the CMA surveys regarding physician burnout and which are just jarring.
So in 2017,
I think about 30% of physicians said they were highly burnt out or at a high level of burnout in November 2021,
it's up to 53% as a physician who has personally experienced burnout,
(14:09):
I wasn't surprised,
but I was actually quite frightened looking at that number and what the implications were for that number.
And you touched on that a little bit earlier because I've never fully recovered from my burnout.
And so I also know that too often burnout is blamed on the individual on the clinician rather than on the system that they're working in.
(14:32):
And it,
it's not that there's no responsibility for the clinician,
but that it tends to be all on the clinician and not on the system.
So as I've said,
my focus has been on family doctors and helping them to have the tools they need to support patients who have a mental illness.
What can Canadian health care system do better to support clinicians,
(14:55):
especially in this post pandemic period.
I am glad that we're,
we're talking about burnout the way that we are now.
He used to be in the realm of wellness or resiliency.
This idea that we were all rubber bands and all we had to do was regain our elasticity before going into,
you know,
the difficult situations were often found in at work when I talk about burnout,
(15:16):
I,
I think I'm a lot more blunt now,
burnout happens because you have a toxic working environment.
You can have high stress in an environment and not have it be toxic and still feel renewed.
At the end of the day,
what wears again away at clinicians that leads to burnout.
It's frustration,
helping patients navigate systems.
It's trying to fix problems that,
(15:37):
you know,
our problems,
people around you agree your problems no matter what you do,
no one wants to change.
It's having dangerous situations.
And I,
I think particularly in today's environment,
this is very true,
unsafe situations that we know violate standards of practice.
We know are things that objectively people would say you should not do things this way and being told.
(16:01):
Well,
don't make noise about it.
We,
there's nothing we can do.
This is just the reality of what we're doing.
Now.
I,
I think these are the things that,
that wear away at us and when we see patients now suffer when we see calls buckle under the weight of what it's like to carry these experiences with you.
(16:21):
I mean that that kills souls.
You walk away and you feel empty inside after.
And so what,
what do you do to solve?
Burnout?
You fix toxic working environments.
You know that that is the simple solution.
And I think that leads you to questions that we don't confront directly in a lot of the places in Canada.
You know,
we,
we need to ask like,
what is making working environments toxic?
(16:45):
Sometimes it's the volume of work.
Sometimes it's the way that we treat each other.
Sometimes it's the way that we're treated by administration or the system,
you know,
the,
the system seems very well designed to consume us.
You know,
we,
we walk into environment and it takes away every part of us.
(17:07):
You know,
I,
I,
I have colleagues who,
you know,
have requested time off for really important family events and,
and whether it's an objectively important family event,
it's relevant,
it's important to them.
You know,
they,
they feel like they need to show up and be there for,
you know,
people that,
that they love and care about and,
you know,
they're,
they're told,
well,
you can do it but you have to be back like within some ridiculous timeline,
(17:30):
you know.
Um Well,
we'll do it but only this once,
you know,
why are we making people feel bad for being human.
You know,
why are we making people feel bad for going through emotional experiences that you'd expect anyone to go through,
you know,
even things like,
you know,
depressive episodes,
etc.
You know,
the triggers of those things are often very human experiences.
(17:51):
You know,
and we have become very cold to each other in how we treat and allocate each other's time.
And if we fix toxic working environments and there's a lot of different ways we can go about doing that.
You know,
it,
it depends on the place that you work.
Um As far as the,
the solutions,
(18:11):
uh I think we'd have a much better outcome when,
when asking people about burnout and,
and seeing the effects of burnout,
you know,
when,
when people walk away from something that they've spent often more than a decade pursuing training for,
there's a really,
really deep reason for it.
You know,
people do not walk away from a career in medicine when they've spent this much time training and sacrificing all this time and effort unless they found that they just can't tolerate things anymore.
(18:42):
And,
and that's the situation I think we're at in,
in many places in Canada right now.
So you just made me feel very emotional in your response.
And I'm just so grateful to feel heard by you,
the way that you spoke just really again,
made me feel like you understood my experience.
So I'm so grateful for that.
(19:04):
And I certainly understand why you're the president of the CMA.
And I'm very happy.
I'm just wondering if you ever thought about psychiatry because I,
I gotta tell you,
I,
I feel very emotional because you just get me and what I went through and it,
that's very meaningful.
So,
and I know part of your job is supposed to get up every morning and think,
how do I advocate for Diane and all of our other colleagues?
(19:27):
That's,
that's your role.
And I,
I guess it moves into my next question around.
How do we help to engage our colleagues to accept,
to embrace,
to participate in this desperately needed change because they're exhausted because they feel overwhelmed with new technology and they feel like the systems that were,
there were put in place that are we supposed to support them and make their life easier?
(19:51):
Actually,
that hasn't been the case.
So we need change,
but it ain't gonna happen if we don't get doctors on board thoughts on how we do that.
You know,
the,
the very simple direct answer to that is,
is people have to see things happening to have hope that things will change.
So,
a big push that,
that I've been making with the CMA and it's building on work that has been done in previous years.
(20:14):
You know,
Katherine Smart did a ton of advocacy is her role as president and,
and previous presidents have,
have done the same,
you know,
just reminding political leaders those in government,
if we don't see something soon,
people will transition from simply being hopeless to being indifferent.
You know,
there,
there's this uh emotional continuum,
(20:35):
I think when it comes to change where,
you know,
things are going well,
you're kind of happy and then things start to kind of slide down.
You get the early stages of burnout,
you're now in it for a while,
you get late stages,
then you start to get hopeless that things can change,
but you're still showing up doing work trying hard and then you,
you kind of fall off this cliff where you just stop caring.
(20:57):
You know,
you say,
you know,
if administration doesn't care if colleagues don't care if government doesn't care,
why do I care?
And it's a protective mechanism,
right?
It's,
it's a way that we deal with what we're witnessing and what we're feeling in everything that's,
that's going on around us.
And so depending on where someone's at,
they,
they need to see something different.
But I,
I do think in general what we need now is to stop people from falling off that cliff of indifference.
(21:25):
We need to do something soon.
Uh Yesterday would have been the best time to do it.
But there,
there has to be a very,
very clear signal that things are changing.
We're gonna make a fundamental difference in,
you know,
the,
the way that we collect and,
and collaborate and share data or,
you know,
health,
human resources or to provide freedom for people to move from place to place without having to go through lots of red tape.
(21:50):
You know,
a signal that we're gonna move towards team based care.
We need to hire more people.
You know,
we need more people within the system to carry the burden that's in there right now.
You know,
we,
we can start with any one of these things,
but we have to do at least one right now.
And that's the urgency that's building,
I think.
And,
and if we don't do anything,
I,
I do imagine it won't be much longer before more and more of people in the system just kind of shrug their shoulders and say,
(22:16):
you know,
nothing's going to change.
And,
and I just stopped caring.
And again,
for me personally,
I was shocked that I was starting to lose my sense of compassion.
And it was the thing I loved most was seeing patients.
So I know my other colleagues are probably,
you know,
I spent 14 years in university getting to the end of my specialty.
(22:38):
And I'm imagining that my colleagues are,
well,
I have many in my practice actually who have experienced the same thing that this shock,
how could I,
how could I be here?
How did,
how did I get here?
And I think we don't,
we've lost compassion within the health care system,
but something you talk about that.
I want to ask you a little more about is this ability to listen,
(23:01):
which I think we've lost collectively our ability to pay attention,
whether it's the internet or access to 24/7 entertainment.
But you talk about the importance of listening,
especially to patients and families.
And I couldn't agree.
More paternalism and medicine has always been an issue.
And I think even more in psychiatry,
(23:24):
this issue of a lack of objective measurement so that it allows subjectivity and personal biases to at times profoundly impact patient care,
profoundly impact a patient's experience.
So do you think clinicians are getting any better on this front?
And what about for members of more vulnerable communities,
(23:45):
this loss of compassion or,
or inability to listen,
you know,
why,
why do we interrupt patients on average within the first minute of them explaining their situation when,
when we see them in,
you know,
clinical consultation,
right?
It's something that,
that I have to push back on myself on,
you know,
it's something I know we all struggle with.
(24:05):
It's because we were taught that we know the answers.
You know,
we've read through the chart,
we've seen the medications they're on,
we have collateral information.
Sometimes from other folks that have done investigations,
we've looked at vitals,
we've looked at imaging and other investigations and we haven't had a working diagnosis already.
So let's just get on with it.
You know,
because I have other people who need to see me as well.
(24:27):
And if I spend too much time with you on something that's not gonna change the outcome of what we're gonna do,
then why,
why am I spending that time?
I,
I can be much more efficient and,
you know,
spread myself around to more patients and let's have more impact,
et cetera.
So that's the thought process of,
I think uh a lot of folks who are challenged by listening to patients,
(24:48):
you know,
and I,
I'll just say again,
we've been trained to believe that when you become a diagnostician,
you know,
we,
we are trained to recognize patterns,
you know,
we're trained to look at certain things a different way.
This is why a psychiatrist who looks at one patient looks at it different than an anesthesiologist is,
you know,
we see different patterns evolving from the same clinical constellation.
(25:08):
And what I think we've realized in more recent years is sometimes solving the problem in our way isn't actually what the patient is asking for.
And in letting go of what we think our role is,
we,
we start to discover what it actually is and we actually get what we want out of the clinical encounter.
(25:35):
And I,
I am very hopeful that we're starting to see a cultural change towards this because people are realizing that what they're getting right now in medicine isn't what they want,
you know.
And if,
if we can have more conversations that help us to unpack what we're actually trying to get out of the clinical encounter,
you know,
and recognize again that it's like a,
(25:57):
it's a two way value exchange between both sides.
You know,
we,
we often talk about patient centered care.
I I think something intrinsic in patient centered care is that it's not only about what the patient is asking for you to do,
it's also what you're getting from the patient as well.
You know,
I've never sat down and talked with a group of patients about patient centered care without them expressing,
(26:20):
you know,
appreciation for,
you know,
what,
what their provider has done and how they've expressed that in different ways.
I think having those conversations helps to lead us towards,
you know,
what we really need,
which is these moments where we can sit back and reflect,
you know,
maybe what I'm doing isn't really getting me what I want and how,
how can I do things differently?
(26:41):
Aleka.
I was really fortunate to hear you speak at a health conference in Montreal and there you talked about the health care system specifically about how we need to change the way we think to adjust our mental models,
you said during your talk and I write everything down.
I was writing furiously every word that you said,
(27:02):
but I may misquote you here so you can correct me.
But what I wrote down was systems are just people.
I have a great deal of faith in people,
but I don't have a great deal of faith in systems.
What does that mean to you when,
when you think about the mental health care system and really what I'm getting at is,
do you have hope?
(27:23):
What can people do?
What can the average person do to create the change that we need?
So,
I,
I think that's a pretty accurate quote.
Yeah.
And,
and,
and specific to,
to mental health,
you know,
we we've tried to fix the human problems in our systems.
(27:43):
You know,
people not being able to see things because of bias,
people mistreating or maltreating each other for a variety of different issues through applying algorithms and you know,
standards of care and you know,
introducing technologies,
etc.
But the safety net in,
in all of that has always been the person across from who needs the help when you're struggling as a patient,
(28:04):
your safety net is the provider sitting across from you.
No matter if that's the,
you know,
specialist physician or family doc who's doing an emerge shift or,
you know,
the the nurse who sees you during triage,
you know,
that that's your safety net to make you,
you don't fall through the cracks when you have a policy in place in a hospital that you know,
(28:26):
it is causing harm for yourself as a provider or for patients that you see your safety net is the administrator,
you know that you,
you sit across to and,
and talk to.
And so systems are,
are only as good as the ability that,
that their structures have to confront the challenges that are happening right now.
And,
and you know,
whether or not they can confront the challenges based on how much,
(28:48):
how frequent and how intense crises occur.
That's the best test of a system.
You know,
our,
our health care systems were able to get through multiple waves of COVID and survive.
So that that was a good test for the system as far as,
you know,
being confronted with acute care.
But in this time of weathering,
you know,
people getting to the point of,
(29:10):
of extreme burnout,
our systems are not well designed to provide that sort of care.
And the,
the only hope that you have in the midst of a crisis is,
is for someone to sit back and say to themselves.
Well,
I see you as,
as you,
you see me as me,
you know,
we're both people,
let's figure this out together.
I,
I do have a lot of hope.
I,
I do think that at the core of people who work in health care and people who work in government,
(29:35):
you know,
but I,
I also believe that the ways that we've been unpacking these issues are outdated,
you know,
they,
they don't apply the newer um more impactful ways of looking at things that have yet to be integrated into our system.
And I do have a lot of faith that as long as people continue to care,
we'll figure this out.
(29:56):
What I heard you say was medicine at its core is human and technology,
which is what my life is focused on right now has to be rooted in that humanity as well.
And I wonder in your unique circumstance of being an indigenous man but also a medical leader.
(30:18):
How is your heritage,
your cultural experience,
informed patient care.
What would you say to someone like me to understand your unique experience and how I can have a greater awareness of it?
Yeah,
I,
I,
I think there's,
there's probably two parts of the way that,
that I've been taught that I,
(30:39):
I'd probably focus on,
although there's a lot of indigenous philosophy that I,
I think is fantastic and very relevant to the challenges that we have nowadays.
The first one is,
is just the understanding that life happens in cycles.
You know,
I think sometimes we get so wrapped up that if we don't solve a problem in that very moment,
it will never get solved or that there'll never be an opportunity again.
(31:02):
And there,
there are situations specifically,
you know,
if,
if someone is,
is in an acute medical crisis,
then yeah,
absolutely.
You,
you have to get things done otherwise um they'll,
they'll pass and kind of move on to a different kind of type of existence.
But when,
when it comes to system problems in particular you know,
these cycles are happening over and over again and even though we may solve them,
(31:25):
and I really hope that,
that we'll move quickly soon to start to make the changes that people are waiting for,
the opportunities to have impact will come again and again.
You know,
and so the,
the real challenge I think to an individual is how do you prepare yourself for the next part of the cycle?
How do you feel the ebb and flow of what's going on?
(31:48):
You know,
and,
and I think that the second part of indigenous philosophy that I think is,
has been really helpful to me,
particularly in leadership is what I learned from my grandfather.
Like people are,
are essentially good.
You know,
people are expressions of their experiences and their contexts and your challenge in connecting with someone is seeing them as they really are.
(32:12):
And I,
I honestly don't think that that anyone is inherently bad within the system.
I,
I've never met a provider,
even those who create racialized situations who,
you know,
wakes up in the morning and goes,
you know,
if I just harm a couple of people today,
let's just be the best day ever that that's never where people are coming from.
So if,
if you can realize that you're part of a,
(32:32):
a greater cycle and there'll be other opportunities to have impact,
it'll change the way that you look at approaching situations,
you know,
you'll,
you'll be more reflective,
at least for myself,
I found it's,
it's brought a lot of reflectiveness to the situations I've been in.
It's less important for me to get people to hear what I have to say because there'll be another opportunity at some later time.
(32:55):
You know,
it,
it's less important for me to have people commit in that moment.
You know,
as long as it's not accused um to move forward and kind of give people space to,
to kind of learn and grow.
And then,
you know,
the other part that it's really affected as far as my leadership is,
you know,
helping people feel seen when we worked in.
And we had this big uh transformation project that,
(33:16):
that we worked on with the,
the federal government called the Indigenous Health Alliance.
It,
it involved uh 30% of indigenous communities in,
in three different provinces.
You know,
I still remember the moment where I really felt like the bureaucracy actually felt seen by us,
you know,
up until that moment,
it felt like we were on two different sides and that we were constantly in friction and a,
(33:41):
a push back and forth between each other.
And then there was a moment where,
where I think we finally saw each other and,
and suddenly that changed the entire environment like the mood and the energy around what we were doing.
And it really led to,
I think some really,
really great ideas,
you know,
and it's we're unleashing the ability for people to follow their own knowledge of what needs to change and helping them see beyond what they see right in front of them.
(34:08):
And,
you know,
that that's probably the most uh satisfying part of leadership for me.
And,
you know,
one of the reasons I,
I stay in leadership is I,
I feel renewed.
You know,
if I,
if I get down about,
you know,
a clinical experience or,
or feeling like change won't occur,
I,
I do a few more keynote talks.
I chat with people who,
you know,
are,
(34:28):
are in the audience and I,
I speak with people like yourself and I,
I walk away and I,
I feel hopeful again.
Well,
I am really happy that this conversation has helped even in a teeny way to renew your hope that change will come.
I know it has certainly helped me.
So you mentioned leadership and I know this is a tough question,
(34:48):
what's the most important role of a leader?
Because there's many I know,
but if you had a young person asking you,
you know,
what's the essence of a leader,
the most important thing that they can do?
Well,
what would you say?
So I think it depends on whether or not you're in a crisis or whether you're trying to create positive change in the absence of a crisis.
So the most important leadership characteristic right now in the midst of what's happening in the health care system with,
(35:15):
with collapse and deterioration is managing conflict.
So understanding,
you know,
what gets yourself into a position where you feel confrontational,
but then also helping people work through their own feelings of confrontation.
You know,
I,
I found the,
the conversation around,
uh you know,
quick wins is,
(35:36):
is often uh another way of saying,
well,
how can we do something that's maybe not impactful,
but no one will get upset about when in reality,
we have to push into the really tough conversations and,
and to be able to,
to get through those conversations,
you have to be able to manage conflict.
And so I,
I'd say really focus on that if,
if you want to become a leader in,
(35:57):
in,
in this area of what's going on in the health care system.
Now,
once we're out of crisis,
once we've stabilized it,
I think the most important role and skill of a leader is to be able to synthesize multiple different streams of data and remain very open to change your opinion.
You know,
I had that explained by my grandfather on my mom's side,
(36:19):
my,
my mom's originally from the island of Tonga.
She's a immigrant to the US and then came up to Canada after.
And,
you know,
he,
he used to say that,
you know,
ideas should be like holding sand,
you know,
the,
the tighter you hold on to them,
the faster they should slip through your fingers.
And,
you know,
I always remember that when I go into meetings just,
(36:39):
just be very,
very open to seeing things in a different way.
And I was coming back,
you know,
at the end of the day,
is it actually changing things?
You know,
that that's the best way to evaluate whether or not something is working.
Did it actually work?
I know it's very early in January,
but this is the best conversation I've had this year.
I love that.
I love what you just said.
You have done so much for your communities.
(37:04):
What are you most proud of?
You know,
I,
I would say this year was probably one of the first years that I started receiving a lot of emails from folks that I've worked with and I've worked in the area of indigenous health for,
you know,
20 years in medical leadership,
probably for 10 or 15 where,
where I get emails from folks that I met and they share with me,
you know,
(37:24):
a story about,
you know,
how we interacted or,
or a way that I've positively impacted,
you know,
their life.
And,
you know,
you don't often realize,
I think in leadership the way that you affect the people around you.
And my assumption has always been,
I'll try and do what good I can.
But at the end of the day,
it's really,
it's really everyone together that's,
(37:44):
that's making a big difference.
And I,
I'd say that what's been really meaningful is is recognizing,
you know,
the positive influence I've had over the past little,
you know,
I,
I'm really hoping this year we can bring some of these big changes home.
I think there's a lot of fear that,
you know,
things won't work and,
and as a result,
we,
we won't be able to have the impact that we want.
(38:06):
But we,
we got to be able to wade through that fear,
you know,
get to that other side where we can be open to,
to try something different that that's never been done before.
And I,
I do think we're,
we're really close,
closer than I've ever felt in,
you know,
the last 11 years of practice and tack on to that,
you know,
eight years of training than,
than we've ever been.
(38:26):
We need brave politicians.
Someone's got to grasp the nettle.
It's scary,
but this ain't going to change unless people really are bought into the,
the reality.
You've got to take some risks here.
So I,
I really agree with you and I cannot thank you enough for spending this time with me.
(38:46):
I just feel heard by you.
You really spoke to me personally and I feel very,
very grateful for you taking this time and sharing your thoughts.
Yeah.
Thanks for having me and thanks for the work that you do.
Thank you.
Ali is one of those people who encourages me to think in new ways.
(39:09):
His years of work on indigenous health strategy and his cultural heritage and beliefs have given him a kind of calm courage that I haven't seen in our health care leadership.
His deep confidence that change happens in time.
His patience and waiting for the opportunity to come around and his deep belief in the goodness of people are the gifts we need right now.
(39:32):
We're so fortunate to have Dr Lafontaine at the helm of the CMA at this really challenging time.
I feel hopeful that with his guidance and leadership,
we're finally going to see meaningful and sustainable change until next time.
Thank you for listening.
The Wicked Mind podcast is a series of unique conversations with individuals that share experiences and perspectives on mental health care together.
(39:59):
We will uncover ideas that inspire action.
Please make sure you subscribe,
share and comment and if you have a topic or guest suggestion,
please reach out to me at DrDianeMcIntosh.com.
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