It was sunny when I landed in Toronto, Tuesday evening last week so I felt a bit lifted as I sat down into one of the most pleasant cab rides I can remember. The driver was 69 he said, and his claim to good health was avoiding alcohol, shunning cigarettes, and waking up each and every morning to exercise. "Just 30 minutes a day," he said, "changed everything in my life." I held my tongue as he kept talking. The coincidence with the first meeting I'd have while in Toronto was startling. As Dr. Mike Evans and I talked over coffee the following morning, the serendipity of the unified voice in Canada was an unexpected delight. A patient and doctor sharing the same similar thought -- one from experience, one from expertise: 30 minutes a day could change your life. If you haven't seen the video, please watch 23 ½ hours now.
The cab driver was one of 10 children to his mother and father born in the Philippines (five boys, five girls -- how's that for biology playing out?) who has lived in Canada for 11 years. All of his siblings were living now in Canada or the U.S. and he'd asked why I'd arrived in Toronto. I'd arrived to, "Share some ideas on using social tools to transform health care," I said. Maybe it was our deeply political and nearly anthropologic conversation that charmed me. Maybe it was the story I re-read just prior to taking off in Seattle detailing the generous cab drive a man offered a dying woman. Yet Tuesday night in the cab I realized instantly, like I usually do, that although I was there to share my thoughts with a number of people, I would learn potentially much more from Canadians than I would impart. It really is so good to get out of Dodge and see how other people do things.
Maybe my near immediate bond with the driver was the reality that one of the first things he asked was the single question, "It happens every month or so now, yes?" and then waited to say, "mass shootings." I unfortunately had to nod and agree even if the math was inflated. He was talking about loss of innocent lives secondary to the mass shooting in DC this week. I added that all of us were still catching our breath.
It was the beginning of my attempt, in two days of Canadian travel, to function as both a patriot and loyal American, but also an embarrassed foreign traveller. I had to launch into my regret, my dissolution, my ache for the losses this past year from gun violence. I described my embarrassment for not feeling able to do more. I shared the disbelief that as a mother and wife, daughter and sister, paediatrician and citizen -- that we can't get adequate background checks and screenings for gun purchases and we can't seem to get a handle on controlling access to lethal weapons like we should. Gun access is not all of the problem, of course, but a big part. This is a lasting problem. For example Vanity Fair contributor David Eggers claimed this of the 1990s:
For every year of the 1990s, we averaged 31,000 deaths from handguns and semi-automatic weapons. The murder of 12 high-school students in Columbine, Colorado, briefly brought our attention to the madness of our gun culture, but very little was done -- Congress cowering as always under the shadow of the N.R.A. -- and the blood continued to flow. By the end of the decade, more Americans had died from guns than had been killed during the Yugoslav civil war, the Persian Gulf War, and the Somali civil war combined. We continued to think this was normal, where by most definitions that kind of body count -- over 300,000 children, women, and men in 10 years -- would signal that a nation was at war, or had lost its mind.
The cab driver talked to me about the challenge of getting a gun in Canada and his own right to health care when in need. Those two comments set the stage for a long Wednesday in both Toronto and Ottawa dreaming about health care innovation, access for all, and exceptional, personalized health care where physicians curate health information and patients share what they know. I met with hospital CEOs implementing electronic health records, physician government critics, consultants, and innovators working to reform a bottlenecked health system. I talked about this blog and the online environment ripe for learning about health (care). At dinner a number of attendees told me they had a very hard time "getting a family doctor," in Canada. So, of course, the Canadian public system isn't perfect when projected against our own. We each have our own struggles.
I never meant to work to change policies and the way we reimburse health care in North America. But with children dying in our schools from gunshot wounds, measles creeping back into our neighbourhoods, overuse of antibiotics persisting, ongoing mommy wars dividing us amidst a barrage of parenting content, an inability to access our health records uniformly across our nation, a lack of access to information and care, and an inability to practice as I'd like (in-office visits coupled with video chats and broadcasted messages to patients), it increasing seems I've got no choice.
At some point we'll have to rise up and demand that with the democratization of media -- where anyone and everyone (doctors included) can speak out online or on Twitter -- we need access to tools that connect us to our own doctors' and nurses' insight. As doctors we'll have to ask for the freedom and time to proliferate what we learn and know when distant from our patients. We have to teach medical students an residents strategies for managing the new role of physicians in the public.
I really loved Canada and the big blue skies they shared with me, their staunch ethic duty to serve all people in their nation when ill and in need, and their readiness to acknowledge health care's need to catch up and join patients where they live online.
It was the cab driver I think, not the hospital CEO, who said, "Oh yes, it sure would be nice if I could reach my doctor online."