Anne Niec, MD, FRCPC
Professor, Pediatrics
Faculty Lead, Professionalism
2012
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Medical Expert
 The health of my patient will be my first consideration;
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Communicator
 I will give to my teachers the respect and gratitude that is their due;
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Collaborator
 My colleagues will be my sisters and brothers;
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Scholar
 I will not use my medical knowledge to violate human rights and civil
liberties, even under threat;
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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;
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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;
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Manager
 I will maintain by all the means in my power, the honour and the noble
traditions of the medical profession;
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What is Advocacy
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Why do it
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How do you do it in Orthopaedics
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 following
CanMeds Roles did you fulfill?
Take some time and consider all of the various aspects of your work as a
resident:
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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?
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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
In Canada, advocacy is an important part of our
democratic government process. It means voters
“speak up” and make their request for change
known to their elected representatives. .. to carry out
the requested action or initiate the requested
change.....For charitable organizations, advocacy is
speaking out on behalf of the people they serve, and
encouraging those same people to help make the voice
louder..for the people the COF serves, it means telling
your story and helping your elected representative to
reflect the needs of his or her constituents in
legislature....Canadian orthopaedic patients can effect
positive change...
Definition:
Orthopedic Surgeons responsibly use their
expertise and influence to advance the health
and well being of individual patient,
communities, and populations.
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
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
2. Respond to the health needs of the
communities that they serve
2.1. Describe the practice communities that they serve
2.2. Identify opportunities for advocacy, health promotion
and disease prevention in the communities that they
serve, and respond appropriately
2.2.1. Identify workplace and farming factors that lead to
an increased risk of trauma
2.2.2. Identify sport/recreational factors that lead to an
increased risk of trauma
2.3. Appreciate the possibility of competing interests
between the communities served and other populations
3. Identify the determinants of health for the
populations 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 in
conjunction with Orthopedic Surgery specialty societies and other associations
3.2. Identify vulnerable or marginalized groups within the population served
and respond appropriately
3.2.1. Apply available knowledge regarding prevention to "at risk" groups
3.2.2. Contribute to the generation of population-based data for improved
understanding of orthopedic problems within “at risk” populations
4. Promote the health of individual patients, communities, and
populations
4.1. Describe an approach to implementing a change in a determinant of
health of the populations they serve
4.1.1.Explain the need to advocate to decrease the burden of illness (at a
community or societal level) of a condition or problem relevant to orthopedics
through a relevant orthopedic society, community-based advocacy group, other
public education bodies, or private organizations
4.2. Describe how public policy impacts on the health of the populations served
4.3. Identify points of influence in the healthcare system and its structure
4.3.1.Discuss key issues regarding the Canadian health care system, indicating
how these changes might affect societal health outcomes
4.4. Describe the ethical and professional issues inherent in health advocacy,
including altruism, social justice, autonomy, integrity and Idealism
4.5. Appreciate the possibility of conflict inherent in their role as a health
advocate for a patient or community with that of manager or gatekeeper
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“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 costeffective MSK care can be….it keeps younger
people working and enables many seniors to
live independently” Dr. Katz, AAOS
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Timely access to care
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Recognition of IPV and offering assistance to its victims
(IPV Working Group, Mohit Bhandari – Chair)
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Models of care for foot and ankle surgery
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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)
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“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”.
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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.”
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.”
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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
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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
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
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Health care influences whether people get well
when sick
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Determinants of health influence why some
people are healthy and others are not
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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
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Income and Social Status
Social Support Networks
Education and Literacy
Employment/Working conditions
Social Environments
Physical Environments
Personal Health Practices and Coping Skills
Healthy Child Development
Biology and Genetic Endowment
Health Services
Gender
Culture
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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
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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
1.
Choose an issue
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Get the data
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Frame your message
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Choose your methods
of communication
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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.”
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