Close Up – Chief Medical Advisor

Dr. Sheila Laredo brings her experience as a health-care leader, advocate and teacher to her new role at the College

Late last year, Dr. Sheila Laredo, a health-care leader recognized for her evidence-based advocacy and teaching excellence, joined the College as its first Chief Medical Advisor.

The endocrinologist, who was chief of staff at Women’s College Hospital (WCH) for five years, has built a distinguished reputation for her expertise in health advocacy, social justice policy, and physician training initiatives. In fact, in her role at WCH, she was critical to the development of a domestic violence learning module for physicians and other health-care professionals.

At the College, Dr. Laredo will be leading the team of Medical Advisors (MAs), a group of doctors who have become more tightly integrated into the work of the College. Recently, we spoke to Dr. Laredo about her role at the College.

Q: How are you enjoying your new role here?
A:I like it. I am still very much in listening mode because there is such a steep learning curve here. But I am excited about using my experience in a way that is of service to medical regulation and the public interest. And my new colleagues are great. The people who work here are clearly dedicated to doing the right thing. They have also been very welcoming and invaluable in bringing me up to speed.

Q: How are we using the experience and knowledge of our Medical Advisors to best effect?
A: The role of the MA is evolving at the College. We are seeing more opportunities for the doctors on staff to contribute a real world context to the discussions of individual cases. With their experience, they recognize when the circumstances that have led to a bad outcome are within the control of the doctor as compared to those situations which appear to have come about as a result of a particular system constraint, for example.

Q: And how does that align with the right touch regulation framework that we have recently adopted?
A: It allows for a more proportionate regulatory response. The MAs can distinguish those situations that are truly concerning from those that pose low risk or perhaps no risk at all. They understand that most situations don’t call for a heavy hammer. And of course, with the ability to efficiently identify the level of response needed, we can devote more bandwidth to dealing with those cases that do demand a greater urgency in ensuring public safety.

Q: Do you think this more nuanced approach can strengthen our relationship with the profession?
A: I think a smarter use of resources means better regulation for both the public and doctors. Of course, our obligation to the public is of paramount importance, but if this new approach has the effect of improving relations with the profession, I would be thrilled. Frankly, it is pretty discouraging to hear a physician say that receiving an envelope from the College is so upsetting that it can ruin the rest of their day, even after it is revealed to simply contain a receipt for an invoice. A better relationship with the medical profession should be expected to lead to more constructive interaction with physicians, and that is good for health care in Ontario.

Q: Is it possible to carry out the duties of a regulator without being perceived as intimidating?
A: In many cases, I think so. We are partners in the same effort towards quality care and system improvement. The vast majority of physicians are in medicine for all the right reasons and are just trying to provide good care to their patients. The College is staffed by people who want to help them succeed and are, in fact, developing a variety of tools to help them succeed. To me, that is the stuff of collaboration, not division.

I do think ensuring a healthy system also means allowing doctors latitude to provide complex care for our patients with complex conditions. We need to be very careful that doctors are not choosing to do lower risk procedures for fear of retribution from the College. We need to convey that we understand that the very nature of complex care means that there will be a greater likelihood of adverse outcomes.

Q: Do you think physician burnout is becoming more pervasive?
A: Definitely. I think there are higher expectations for physicians. Providing medicine in a digital world presents huge opportunity but it also creates huge burden. One simple example of this is that you can face a public flogging on an anonymous rating site if a patient is unhappy with your care on a particular day.

Q: Is burnout a regulatory issue?
A: Fallout from burnout is definitely a regulatory issue. If a doctor feels disengaged from her/his practice or is not able to be in the moment with a patient because he is overwhelmed by the eight other things that he needs to be doing right then, that is a concern. And it’s a concern for a whole host of reasons, not least of which is that patient care will be adversely affected. We need to be cognizant about the prevalence of physician burnout and be a partner in ensuring that resources are available for help. A healthier physician workforce will provide better health care to their patients.

Q: Are you going to continue your clinical practice?
A: Yes. I appreciate now, having taken this role, that understanding the real day-to-day concerns of front-line clinicians will inform my work at the College in important ways. I think it is essential to stay grounded in the issues that affect physicians and their work.

Q: What led to the development of a learning module for physicians about domestic abuse?
A: In my role at WCH, I had a conversation with other medical leaders after the murder of Dr. Elana Fric. We realized that we needed to be more knowledgeable about recognizing when health-care providers are experiencing domestic violence, and how to safely provide them the support they need. In doing this, we realized that we had an opportunity to train other physicians and health professionals. The module will be utilized by several thousand physicians in Ontario, and we hope it will prevent future cases of domestic violence. One thing we didn’t really anticipate was that we would also be able to use what we had learned to help our patients. In the face of terrible tragedy, we hope to bring some meaning, and positive change to our health system.

Q: Are you comfortable in the role of advocate?
A: Yes. I think, for physicians, not only is it okay to be an advocate, but it is often imperative. The CanMEDS health advocate role anticipates that physicians will use their position of privilege to improve the health not only of their patients, but of their health system. To me, the keys in advocating for change are to take a principled approach, use the scientific evidence, and advocate for greater public benefit.