reflections

Doctor as advocate for “w”holistic health

Richard Denton, MD, CCFP, FCFP

Never doubt that a small group of thoughtful, committed citizens can change the world; indeed, it’s the only thing that ever does.

—Margaret Mead

Now, more than ever, Canadian doctors need to be leaders in protecting our environment, which is a social determinant of health. As doctors, we look after the health of our patients; as politicians and advocates, we can look after the health of our communities. Oandasan and Barker1 have suggested that we can be educated for advocacy. I would like to share my experiences with you.

Dr John Howard and Dr David Rapport have defined “ecosystem health” as it relates to the doctor-patient relationship and a new role for physicians (personal communication from John Howard, 2003). Ecosystem health challenges physicians to look at the causes of disease and what we can do as advocates to prevent other patients from developing disease. Dr Rapport and colleagues2 have described 7 principles:

• healthy ecosystems are characterized by organization (species composition and interactions), resilience (the capacity to bounce back), and vigour or productivity;

• ecosystem health is transdisciplinary;

• man-made stress is the major determinant of ecosystem health;

• highly degraded ecosystems do not necessarily bounce back;

• ecosystem distress syndrome (EDS) is a real syndrome;

• ecosystem health is a major determinant of human health, economic well-being, cultural survival, and community integration; and

• barriers to ecosystem health are less a matter of science than politics.

This last point is why physicians need to become political leaders. We need to practise “w”holistic health—to look at health as a whole. We need to examine the health of the ecosystem that determines the health of our patients.

Wanting to make a difference, to ensure the health of the larger ecosystem, and to help my community, I went into politics. I had good role models along the way who encouraged me to become involved. I followed a colleague who ran for mayor. While he was unsuccessful, he paved the way for me to become a councilor and then mayor of Kirkland Lake, Ont. With a great deal of help I went on to prevent Toronto’s garbage from being dumped in Adams Mine and to prevent a polychlorinated biphenyl (PCB) incinerator from being built next to school and day-care facilities. I would like to share with you what I have learned from this experience.

Leadership

Our communities see medical doctors as leaders. We are highly educated, we are well regarded, and we are big fish in small ponds. As a politician, I was at the bottom of the public opinion poll. My colleague, Dr Pete Sarsfield, Medical Officer of Health, quotes from the CBC’s radio program Ideas, “If you are going to change things overnight, be prepared to leave in the morning.” I learned more about my community as a politician than by any other means. As mayor, I was at the cutting edge of what happened in my town. Entrepreneurs came to me for advice. I cut the ribbons of new businesses and events. I attended weddings and anniversaries of my constituents and spoke at a variety of events. I headed up various committees. I was head of the police committee and then was involved in civil disobedience. Rather than hearing the rumours, I was at the centre of the rumours.

I also learned about politics.

• Never attribute to malice what can be explained by stupidity.

• It helps to have informers giving you information in brown envelopes.

• Always book a room too small for your anticipated crowd; have standing room only.

• The media shape public opinion.

• Perception is everything.

• You will change if you are involved in politics for long enough. Power tends to corrupt and absolute power corrupts absolutely.

• We spend much of our time keeping the organization going, rather than doing what the organization was created for in the first place.

• There is no such thing as free will; there are many people behind the scenes calling the shots.

• Compromise is important if you want to be re-elected.

• As a leader, you follow the herd.

• There are two governments: the elected, which changes, and the bureaucratic, which does not.

• Most importantly, it all comes down to money.

Teamwork

Teamwork is interdisciplinary or, as John Howard would call it, transdisciplinary. The most important member of my team was my spouse. I needed her to be onside. When I was gagged by my council, my wife was the one who carried on the fight. She attended protests and spoke to the media. My wife was not disappointed, however, when I lost the mayorship the second time around. In fact, she threw a huge “unaugural” party.

I needed a team to get myself elected: a team of supporters and friends to see me through the difficult times. I stood on the shoulders of my predecessors. I worked with colleagues, constituents, patients, farmers, Natives,* school boards, other politicians, mayors, councilors, Members of Provincial Parliament, and Members of Parliament. I joined the Canadian Medical Association MD-MP project and wrote letters to, met with, and talked to my Member of Parliament. Likewise, I joined the provincial MD-MPP project. The Ontario Medical Association hosted leadership meetings, meetings with the press, and a day at Queen’s Park. I joined my local riding association, and became president for a couple of years. The Ontario College of Family Physicians’ Environmental Committee was very helpful to my cause. I joined such groups as the Canadian Association of Physicians for the Environment. I made new friends through all these groups. I also created a few enemies along the way. Patients who agreed with me told me so. Others said that they respected me for my integrity. Those who definitely disagreed with me said nothing while attending my practice.

Continuity of care

Change takes a long time. You should not expect that things will happen overnight. We have opposed the Adams Mine proposal for 13 years, and I am sure that it is not over yet. But I am encouraged by attitude changes about drinking and driving and about smoking in public places.

Comprehensive care

I have also been involved in issues surrounding low- and high-level nuclear wastes and PCB incineration. I got involved in my community, the local little theatre, service clubs, Cubs and Scouts, church, and other groups. I did these things for their own intrinsic value, but they also built a broad base of support before I went into politics. I spoke out on health issues, I wrote letters to the editor, I spoke in schools. I have tried not to be a single-issue person.

Education is lifelong

We talk about continuing medical education; learning about other things is no different. I have had to learn about garbage, PCBs, geology, hydrology, and incineration. I have learned about composting, production of methane gas, and electricity.

Personal growth

Because power tends to corrupt, I did not want to stay in politics for too long. Sir Charles Tupper, our own medical doctor Prime Minister lasted only 6 months. But I have grown as a person during my time in politics. I have begun composting; I recycle eggshells back to the chickens; I feed scraps to the horse, cat, dog, and chickens. I bike to work. I take more things in to be recycled. I have also become a better public speaker.

Costs

I have made some enemies, usually powerful people with money. The more they protest, the more I know that I am doing the right thing. My family has suffered because I spent less time with them owing to never-ending meetings. My wife and I spent our anniversary at a protest meeting, writing letters. There have been financial costs from time and money donated to initiatives.

Benefits

I have made a lot of new and good friends. I have grown. I believe that I have done things to help the environment, my family, and my patients. I believe that I am helping my community, although some might disagree.

As doctors, our patients and our community expect us to be leaders. We can work with such other groups, as the College of Family Physicians of Canada, the Canadian Association of Physicians for the Environment, and the Canadian Medical Association. We continue learning, working across disciplines, on the continuity and comprehensiveness of programs. While there are costs, there are also benefits. We can fulfill our leadership roles in a variety of endeavours, be they medical, social, or community. We can practise holistic medicine. We and our patients will be glad that we did.

Dr Denton practises family medicine in Kirkland Lake, Ont. He is past Chair of the Canadian Association of Physicians for the Environment and is on the Board of Directors for the Ontario College of Family Physicians.

References

1. Oandasan I, Barker K, Educating for advocacy: exploring the source and substance of community-responsive physicians. Acad Med 2003;78(10 Suppl):S16-9.

2. Rapport DJ, Howard J, Lannigan R, McCauley W. Linking health and ecology in the medical curriculum. Environ Int 2003;29:353-8.

*Native is used to refer to the indigenous and aboriginal inhabitants of Canada and their descendants.