Reflecting the College’s EDI Work in Policy
I remember the first time I heard the word unlearning. It was in connection with the popular Choosing Wisely Canada initiative, which questioned some of the reflexive ways we have been practising medicine for years. When an estimated 30 percent of tests, treatments and procedures in Canada are unnecessary, offer no clinical value, or can, in fact, cause harm to patients, we need to start questioning some of our more ingrained clinical practices.
Over the last few years, we, at CPSO, are applying the term unlearning to a number of other aspects to how physicians practise medicine. Specifically, we are examining how our organization can better fulfill our mandate by bringing an equity lens, one grounded in anti-oppression, to our processes and policies, and to address all forms of discrimination impacting the health care space. As an organization, we are in the long, sometimes difficult, process of unlearning.
In medicine, physicians often feel that we are inherently neutral, objective and without bias. But before we are doctors, we are humans, and often bias works outside our awareness, without our knowledge and despite our best intentions. Physicians are committed to treating all patients equally, yet everyone makes unconscious judgments that can affect how we respond to patients during a medical interaction.
Recently, Dr. Saroo Sharda, the College’s Equity, Diversity and Inclusion Lead, talked in these pages about the process of unlearning. It happens, she said, “as we become aware that we all carry inherent degrees of bias in how we take care of patients, how we listen, how we develop systems, policies, processes. For many who are part of dominant groups, the privilege we have is often invisible to us. Acknowledging that privilege and unlearning the idea that health care systems are inherently fair and neutral, can take time and be deeply uncomfortable. However, those who have been most marginalized in our health care systems have had to endure actual harm, which really pales in insignificance against our own discomfort.”
At our last Council meeting, we approved a policy for consultation that goes to the heart of what Dr. Sharda is describing. The Human Rights in the Provision of Health Services draft policy, which is built around the framework of human rights and accessibility legislation, has new obligations for physicians to take reasonable steps to create and foster a safe, inclusive and accessible environment for patients. These obligations incorporate such concepts as cultural humility, cultural safety, anti-racism and anti-oppression.
Such terms might seem new, but in providing patient-centred care, physicians are already incorporating these concepts into their practice. We recognize how the quality of a patient’s health can be determined by factors including race, ethnicity, sexual orientation, gender identity, socio-economic status and postal code. Those who are from racialized or marginalized groups are more likely to have difficulties accessing care and experience poorer health outcomes.
Recognizing the existence of inequities is just the first step. Effectively addressing health care disparities requires concerted, systemic and, indeed, multi-sector efforts. The College, through different initiatives — and policies such as this one — is committing itself to being part of that push for change.
This is an important policy and I hope you will participate in our consultation to help ensure that we have considered all the critical issues. Are our expectations realistic? Are they practical? Do they help us better fulfil our public interest mandate? Please participate and let us know.