Advocacy in Orthopedics: Adding

your VoiceAnne Niec, MD, FRCPC

Professor, PediatricsFaculty Lead, Professionalism

2012

Medical Expert The health of my patient will be my first consideration;

Communicator I will give to my teachers the respect and gratitude that is their due;

Collaborator My colleagues will be my sisters and brothers;

Scholar I will not use  my medical knowledge to violate human rights and civil liberties,

even under threat; Professional

I will respect the secrets that are confided in me, even after the patient has died; I will practise  my profession with conscience and dignity;

Health Advocate I will not permit considerations of age, disease or disability, creed, ethnic origin,

gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;

I will maintain the utmost respect for human life; Manager

I will maintain by all the means in my power, the honour and the noble traditions of the medical profession;

Objectives:

What is Advocacy

Why do it

How do you do it in Orthopaedics

More Practically.....

Think of the last time you were on call. The day is often busy, chaotic and hectic

During those 24 hours (or more) of working in the hospital, which of the followingCanMeds Roles did you fulfill?

Take some time and consider all of the various aspects of your work as aresident:  How many patients did you see? How many procedures did you do? How many families did you meet with?  How many other health professionals and care providers did you interact with? How many pages? How many phone calls? How many decisions did you make? How much time did you have for yourself?   

CanMEDS modules: Postgraduate Medical Education at Queen's University

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What is Advocacy?

Defined by the Dictionary..... Speaking out Expressing one’s opinion on a matter of

importance The act of supporting a cause or proposal Storytelling leadership

What is Advocacy?

In Canada, advocacy is an important part of ourdemocratic government process. It means voters“speak up” and make their request for changeknown to their elected representatives. .. to carry outthe requested action or initiate the requestedchange.....For charitable organizations, advocacy isspeaking out on behalf of the people they serve, andencouraging those same people to help make the voicelouder..for the people the COF serves, it means tellingyour story and helping your elected representative toreflect the needs of his or her constituents inlegislature....Canadian orthopaedic patients can effectpositive change...

According to the Canadian Orthopaedic Foundation (COF)…..

Definition:

Orthopedic Surgeons responsibly use theirexpertise and influence to advance the healthand well being of individual patient,communities, and populations.

RCPSC: Health Advocate

Competencies: Orthopedic Surgeons are able to….

1. Respond to individual patient health needs and issues as part of patient care

2. Respond to the health needs of the communities that they serve

3. Identify the determinants of health for the populations that they serve

4. Promote the health of individual patients, communities, and populations

RCPSC: Health Advocate

1. Respond to individual patient health needs and issues as part of patient care

1.1. Identify the health needs of an individual patients

1.1.3.

Identify determinants of health particular to an individual patient

Adapt patient assessment and management according to particular determinants of health

Determine a patient's ability to access various services in the health and social systems

1.2. Identify opportunities for advocacy, health promotion and disease prevention with

individuals to whom they provide care

1.2.3.

Promote injury prevention with respect to recreational activities

Identify risk factors that can lead to nonunion, ulceration, amputation, Charcot joints, and

malignancy, and advise patients on lifestyle modifications to improve outcomes

Advise athletes on the risks and side effects of performance enhancing drugs and

substance abuse

RCPSC: Health Advocate

2. Respond to the health needs of the communities that they serve

2.1. Describe the practice communities that they serve2.2. Identify opportunities for advocacy, health promotionand disease prevention in the communities that theyserve, and respond appropriately2.2.1. Identify workplace and farming factors that lead toan increased risk of trauma2.2.2. Identify sport/recreational factors that lead to anincreased risk of trauma2.3. Appreciate the possibility of competing interestsbetween the communities served and other populations

RCPSC: Health Advocate

3. Identify the determinants of health for thepopulations that they serve

3.1. Identify the psychological, social and physical determinants of health of the

populations that they serve, including barriers to access to care and resources

3.1.1. Identify "at risk" populations within a given orthopedic practice inconjunction with Orthopedic Surgery specialty societies and other

associations3.2. Identify vulnerable or marginalized groups within the population servedand respond appropriately3.2.1. Apply available knowledge regarding prevention to "at risk" groups3.2.2. Contribute to the generation of population-based data for improvedunderstanding of orthopedic problems within “at risk” populations

RCPSC: Health Advocate

4. Promote the health of individual patients, communities, and populations

4.1. Describe an approach to implementing a change in a determinant ofhealth of the populations they serve4.1.1.Explain the need to advocate to decrease the burden of illness (at acommunity or societal level) of a condition or problem relevant to orthopedicsthrough a relevant orthopedic society, community-based advocacy group,

otherpublic education bodies, or private organizations4.2. Describe how public policy impacts on the health of the populations served 4.3. Identify points of influence in the healthcare system and its structure4.3.1.Discuss key issues regarding the Canadian health care system, indicatinghow these changes might affect societal health outcomes4.4. Describe the ethical and professional issues inherent in health advocacy,including altruism, social justice, autonomy, integrity and Idealism4.5. Appreciate the possibility of conflict inherent in their role as a healthadvocate for a patient or community with that of manager or gatekeeper

RCPSC: Health Advocate

“almost every household in America is affected in some way by disease of bones, joints, muscles, and skin….as orthopaedic surgeons, we have the unique opportunity to improve our patients’ lives….it is worth pointing out to our lawmakers how cost-effective MSK care can be….it keeps younger people working and enables many seniors to live independently” Dr. Katz, AAOS

Advocacy Issues in Orthopedics

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How do you practice advocacy?

Timely access to care

Recognition of IPV and offering assistance to its victims (IPV Working Group, Mohit Bhandari – Chair)

Models of care for foot and ankle surgery

Hip Hip Hooray – credibility with the public and a unified front between surgeons and the patient community as a campaign with MOH

Pediatric Orthopedics issues such as device development and approval, general pediatric-specific health care issues (obesity, wellness, disease and injury prevention, school screening for scoliosis)

Advocacy Issues in Orthopedics

“not just about getting patients their MRI or hip replacement faster…needed at a higher level in support of public policies that aim to reduce poverty and social exclusion and to promote the rights of all Canadians…Adoption of a population health approach is important that addresses the social causes of poor health – integral to practicing good medicine”.

Addressing the Social Causes of Poor Health CMAJ Dec 13, 2011 183(18) Andermann A.

Focus on the social contract between medicine and society: “priority health concerns of the community, region, and or nation they have a mandate to serve”

“Medical education and practice needs to be sensitive to the SDH and health care needs of people who are vulnerable and marginalized”

Professionalism and health advocacy seen to align closely with social responsibility

“Expect physicians to address health needs of communities served, identify the determinants of health of the population, promote health at individual community and populations levels.”

Physician as Health Advocate: Translating the Quest for Social Responsibility into the Medical Education and Practice Dharamsi et al Academic Med 2011

AMA: declaration of professional responsibility – calls on all physicians to advocate for social, economic, educational, and political changes that ameliorate suffering and contribute to human well-being

“Social responsibility is about ensuring, protecting and contributing to the collective welfare of society. A commitment to social responsibility is part and parcel of physicians concerns and the core values of doctoring.”

Physician as Health Advocate: Translating the Quest for Social Responsibility into the Medical Education and Practice Dharamsi et al Academic Med 2011

Residents need opportunities to practice advocacy; preceptors must model the behaviors they wish to see in future physicians

Its about identifying and involving yourself in advocacy activities related to your discipline, applying evidence regarding prevention and health promotion initiatives at the patient, community and population levels

Doctor–Patient Relationship: consideration where in society the patient lives

Need to identify and respond to factors outside the clinical scenario that influence health;

examine and respond to factors that led to barriers in care;

take a scholarly approach to advocacy by encouraging and /or participating in research that contributes to a better understanding of the issues at stake

Doctor-Patient Relationship and Society

Working to address the root causes of the problems patients face…..

It is a translational activity…..

It is a core element of professionalism…..

Earnest et al, Acad Med Jan 2010

Advocacy requires…

Health care influences whether people get well when sick

Determinants of health influence why some people are healthy and others are not

Consistent correlation between life expectancy/health status and various measures of social status

In order to improve health, need to think and act: upstream about determinants outside of health care

SDH Evans et al 1994

1. Income and Social Status2. Social Support Networks3. Education and Literacy4. Employment/Working conditions5. Social Environments6. Physical Environments7. Personal Health Practices and Coping Skills8. Healthy Child Development9. Biology and Genetic Endowment10. Health Services11. Gender 12. Culture

SDH Public Health Agency of Canada

Recognize that you make a difference You have the power to make change in the community Be well prepared as an advocate – map out your key messages Be patient and persistent – change does not happen overnight Create and cultivate relationships with opinion leaders and decision

makers Work with others – including people from other sectors Put a human face to your issue by telling your patients stories Be positive Always be sure of your facts Stick to issues that correspond to your experience and expertise Present yourself as constructive, well prepared, reasonable, well

informed and solutions oriented Take the time to thank those who have listened to you or helped you

advance your issue If not successful first time round, you may be building the foundation for

positive change in the future Be realistic – remember change is about compromise

Do’s of Advocacy www.docsfortots.org

Invest a lot of time and energy in something that you don’t have strong feelings about

Bite off more than you can chew (if you only have time for a phone call then that’s what you do)

Assume that your audience knows the issue as well as you do

Use jargon, technical terms or acronyms Criticize and complain – negativity will turn off the

people who have power to make change Underestimate public officials Leave an influential person’s office without leaving

behind your business card

Don’t of Advocacy www.docsfortots.org

1. Choose an issue

2. Get the data

3. Frame your message

4. Choose your methods of communication

How to Advocate Docs For Tots

www.docsfortots.org

About universities (consider medicine)…. “we tell stories: old stories about evolution….and we make up new stories…we call the old ones teaching, and the new ones research (quotes Prof. Edward Chamberlin). This description is based on humanity and its emphasis on narrative. It’s about people – about those of us on faculty here, telling old stories and with the help of our students and staff, writing new ones. And about our students,…preparing to write their stories in a world full of challenges that our generation has left them.”

David NaylorUof T Winter 2012 Magazine

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And the last word….