Council Award

An Advocate for Equity

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Dr. Sharon Bal

Council Award Recipient: Dr. Sharon Bal

As a recent opinion piece in The Globe and Mail sagely pointed out, it is becoming more and more difficult to be recognized as a good physician without also being a good person. When it comes to practising medicine in the 21st century, clinical expertise is still vital — but not nearly enough. Attributes of character and integrity, interpersonal skills and compassion, and community-mindedness, collaboration and leadership, all lie at the heart of being a fantastic doctor.

Our latest CPSO Council Award recipient, Dr. Sharon Bal, certainly embodies these values. Looking at her long list of awards, accomplishments and activities within the profession — or even just talking to her for a few minutes — one gets the sense that Dr. Bal is both a highly skilled physician and a profoundly good person. Born in Toronto and raised in London, ON, she did her medical training at the University of Toronto and her family medicine residency at the University of Ottawa. Since 2006, she has been the lead physician at the Delta Coronation FHO in Cambridge, ON, with a special focus on women’s health, and she has active privileges at Cambridge Memorial Hospital. Beyond her clinical work, Dr. Bal is also a passionate educator and mentor of the next generation of doctors. She is an assistant clinical professor and the pre-clerkship coordinator at the Waterloo regional campus of McMaster University’s School of Medicine, where she develops and coordinates undergraduate pre-clerkship curriculum, all the while building strong and meaningful relationships with her students to help them reach their career goals.

Beyond this work, Dr. Bal is also a tireless advocate for equity in medicine, especially when it comes to patient access to treatment and care throughout Ontario’s health system. For Dr. Bal, collaboration, transparency and communication within that system are key to ensuring all Ontarians have equitable access to care. The importance of collaboration has come into stark focus during the COVID-19 pandemic, in which Dr. Bal has been a key player for her region. She is both the co-lead for the WW Pandemic Response Triad for Ontario Health West Region and co-chair of the COVID-19 Health Sector Control Group for Waterloo Region. The impact of the pandemic has been nothing short of devastating for patients, health-care workers and communities at large. Yet, being who she is, Dr. Bal can’t help but have a sense of hope and optimism when speaking about what health care might look like when we come out the other side of COVID-19. She has never seen such a level of collaboration and cooperation within the health system. It may never go back to the way it was before the pandemic — and that’s probably a good thing.

In honour of her well-deserved CPSO Council Award, we caught up with Dr. Bal to ask her some questions about her life and work. We also have a video of her remarks 🎥 when she accepted the award at the June meeting of Council at the end of the article.

How did you first become interested in a career in medicine?
It was a bit of a process for me, for sure. I had a reputation for wanting to help people early in my life, but medicine wasn’t really on my radar until late in high school. I was always a big reader, and loved English literature and storytelling, and I had a good deal of pressure from my high-school teachers to study literature at university. At first, I thought I’d major in English and minor in science, but I ended up reversing that. Once I focused on science, a path toward medicine was clear.

And how did you choose to specialize in family medicine?
I’ve always been interested in primary care. Radiology did hold some allure at one point — I think it spoke to my interest in storytelling because radiology is about looking at something and seeing the story that it tells. But the longitudinal nature of family medicine has really been the appeal for me. In 15 years, I’ve had patients who were kids when I first started seeing them who are now parents; I’ve had parents who are now showing me pictures of their grandkids. It’s so much about patients’ lives, their trajectories and the long-term relationships you build with them.

Your nominators mentioned your commitment to patient service. What is your philosophy when it comes to this?
I guess it comes from different experiences I’ve had in my own life. I’ll give you an example. My parents are from India and while they are fluent in English, they speak with an accent. So, growing up, I saw how they had experiences with the medical profession that weren’t as patient-focused as they could’ve been.

I recently witnessed a doctor ask my mother, “Do you speak English?” even though her name is Susan. I got really annoyed by that. I wanted to say, “My mother’s name is Susan. She has a PhD. Why wouldn’t you think she speaks English?” But then I started to reflect on what I would do differently in those situations and how I would treat patients. I think implicit biases are very real — we all have them and they can really impact patient care. So, I try hard to reflect on and be aware of my own biases when I’m with patients, and I think that helps a great deal in my service to them.

I also want to be aware of their level of health literacy — again, this comes back to my parents. My father has less education than my mother and, I would say, a lower level of health literacy. He sometimes needs to have medical information explained a few times and it’s a reminder to me that we, as physicians, need to show patience with our patients, especially if they don’t have a high level of health system knowledge. To me, patient-centred care is about asking open-ended questions, like “How can I help you?” and letting patients tell us their stories in their own words.

Of course, COVID-19 has added a whole other dimension to patient service. In the first wave, we didn’t have confidence in our knowledge. We were supposed to be the experts, but it was, after all, a novel coronavirus and we didn’t have all the answers. We didn’t always know how to triage; we didn’t know how much to go virtual. There were issues around our comfort level, thinking about our own families and their safety. We’ve seen things like cancer screening and other preventative medicine drop right off. So, it’s been a uniquely challenging time.

What have you learned about medicine and the health system from COVID-19 that you may be able to apply to your practice after all of this is over?
Putting on my system hat, we’ve never seen this level of collaboration before. As devastating as COVID-19 has been, it has created opportunities for system transformation. The connectedness between public health and the community sector has been extraordinary. The partnerships have grown; cracks in long-term care, in how we treat homelessness, have been magnified by COVID-19. I’ve just been humbled during this crisis, to see all the good work done by the agencies that help these vulnerable communities. Through the disaster of COVID-19, we’re really getting insight into what these groups and organizations are going through, and I know that bearing witness to all of this is going to make me a better physician.

And then there’s telemedicine. It’s funny: before COVID-19, our team set a goal aiming for 15 percent of patient encounters to be virtual — and we really thought that was too ambitious. And yet, it only took a pandemic to blow that figure out of the water. We now see the effectiveness of virtual care in those instances where it’s appropriate to use it.

What has the academic side to your career meant to you?
I absolutely love teaching. It’s one of the reasons why I’ve stayed in the Cambridge area. When I finished my residency at the University of Ottawa, I thought I might have to stay there if I wanted an academic career. But when the Waterloo regional campus of McMaster opened, that sealed the deal. I’ve had the privilege of working with our medical students. We talk a lot about choosing a specialty, about career trajectory, but also the importance of balance. I’ve had experiences, especially with female medical students, that have been gut wrenching: they often get interested in a specialty that has a long trajectory, and they really worry how that will impact family planning. I don’t have any easy answers for them, but, as a mother of two children, all I can say is: it can be done. When students see someone doing this job and enjoying this job, that can inspire them. I try to give them a true, authentic glimpse into the profession and it can really help with their choices.

Video from Council

Transcript

Dr. Sharon Bal, a family physician from Cambridge, Ontario, received the CPSO Council Award on Thursday, June 17, 2021. Here are her remarks from her acceptance speech at the virtual presentation.

Thank you so much for that – in particular, that very generous introduction, Joan. It’s truly humbling. I would like to begin by expressing my gratitude to the CPSO, to the Award Selection Committee, and to the Council today for this recognition. This award recognizes the concurrent hats doctors wear as clinicians, but also as leaders, academics and advocates, for our patients and our communities, and it celebrates this. It is critical to all of us, especially in this time of unprecedented challenge during the pandemic, to know the support of the CPSO, with respect to the many roles physicians assume in our society.

I would like to express my gratitude to my nominators for this award, of course, and for all the work that goes into these kinds of nominations, and to the primary care of community that I’m so privileged to be a part of, and with whom I share this honour. Like many others, I have been fortunate to have had phenomenal mentors in medicine, from Dr. Charles Czarnowski in residency at the University of Ottawa, to Dr. Cathy Morris as our first Dean at the Waterloo Regional Campus.

I am especially mindful of the sacrifices of my staff and colleagues at the practice, who support me in balancing myriad responsibilities. I believe that health equity and access to primary care is vital to the well-being of our communities. Understanding barriers to care – why certain populations are disproportionately affected, highlighted as an example as our black and non-white, racialized communities during this pandemic is key. When thinking about how to redesign systems, we need to ask ourselves two questions. First, who is the system NOT working for? And second, who is not at this table that should be? And Question 1 is always the answer to Question 2. It requires bravery to lean back and create space for those who are not traditional power brokers in the system. This reaching in and meeting people where they are is central to family medicine.

Another mentor, Dr. Judy Belle Brown, the Program Director of the Graduate Studies Program and Family Medicine at Western University, speaks often about the patient-centred clinical method. And just as we ask, one-to-one, our patients about their family backgrounds or influences and contacts, we need to think about these factors when planning population health also. All Ontarians should have access to team-based primary care, to a well-integrated system, and to culturally appropriate care. And in my work as part of the Ontario Health Team in my community, I see opportunity to truly transform our system.

Another wonderful colleague of mine, Dr. Clover Hemans, with whom I share the privilege of co-chairing OMA Women, is fond of saying the following phrase – “You cannot be what you do not see”. And this sums up why we need to lean into intentional representation of patients, caregivers, and their families of diverse populations, and of course, women physicians. Healthcare leadership needs to look like the communities we serve.

And I cannot conclude without turning to my incredible patients. Serving you, my patients, is the honour of a lifetime. And finally, thanks to my children – my support system. While my parents and husband are delighted to hear of every new role I take on, they’re the cheerleaders. There’s my brother, Paul, who is my life coach, who challenges me to protect my free time and have some fun. We all need a person like this in our lives, who takes care of us as we take care of others.

And on that note, once again, I thank you, Joan, and the CPSO Council, for this award that I share with my primary care colleagues. I am humbled and truly grateful for all the College does for us. Thank you.