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A challenge for new doctors: Focus on the patient, not just the symptoms

This is a version of a convocation speech I delivered on May 14, 2015, to the graduating class of medical doctors at the University of Manitoba.

Mr. Chancellor, Mr. President, distinguished guests, soon-to-be MDs and their deeply indebted family members. I’m touched and humbled to receive an honorary degree from the University of Manitoba. Thank you for letting me share this special moment with you.

Courtesy University of Manitoba Jun. 09 2015, 11:00 AM EDT
Video: André Picard’s advice to Canada’s future doctors from his 30 years of health reporting
I’m not a doctor. I never will be. I’m a lowly journalist. I tell stories.

For almost 30 years I’ve tried to help Canadians understand their health system and their medical care.

In that time, I’ve seen tremendous advances in medicine and I’ve met, quite literally, thousands of health professionals, from students to Nobel Prize-winners – and patients, from those with rare genetic mutations to those with everyday ailments, from those cured miraculously to those who died needlessly.

Today, I’d like to take a few minutes to share some of what I’ve learned from telling their stories.

One of the greatest privileges in our society is to have the letters MD after your name. Those two letters confer great power. And with that power comes great responsibility, to quote Voltaire – or Spider-Man, depending on your literary predilections.

Shortly, you will be taking the Hippocratic oath. You’ve probably all heard that it says: “First do no harm.” It doesn’t actually – that’s just bad media reporting.

But it does say a lot of important things. I think the line that matters most in the oath is this: “Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.”

Sadly, too many physicians fail to honour that part of the pledge.

We have built a sickness care system rather than a health system. We have designed that system for the convenience of practitioners, not patients.

Modern medicine has become so specialized that many physicians treat specific syndromes and body parts, and the patient herself gets lost in the process. We have filled our temples of medicine with such bedazzling high-tech tools that we’ve forgotten that we should treat people where they live.

In our desire to cure, we over-treat.

We fail too often to say the three most important words in medicine: I don’t know. We see death as a failure, instead of aspiring to make patients comfortable and at peace at end of life.

In our unrelenting quest for efficiency and measurement, we too often lose sight of what really matters. The patient.

What does your patient want? What are his or her goals? Those are the questions that must guide your practice.

For some of your patients, the goal is to repair their acute woes, to help them live long. But most of your patients will be older, and have a number of chronic conditions and be nearing the end of life. Their goals are different.

They’re not going to be cured. You have to focus on their quality of life.

They want to be at home. They don’t want to fall. They don’t want to be in pain. They don’t want to be a burden. They don’t want to be alone. They don’t expect miracles – but they would like respect.

They don’t fear dying. They fear losing their autonomy and their dignity. They don’t care about your metrics, or your age-adjusted mortality rates, or your fancy new genomic test. They want to be listened to, and heard.

We hear a lot these days about personalized medicine, about drugs and treatments that can be tailored to specific genomic and epigenetic markers. But you know what people really long for: personal medicine, not personalized medicine.

They crave a human connection. Not just care, but caring.

The very best medicine you can offer your patients is a listening ear. The very best treatment you can offer them is a compassionate heart.

Now you may be sitting there thinking, this is all feel-good nonsense. It’s not. The more sophisticated and complex medicine becomes, the more the basics matter.

What did you learn in medical school? Anatomy, biochemistry, genomics, countless mnemonics to help you remember bits of knowledge; you know how to deliver babies and treat cancer and diabetes and depression and asthma, take out people’s appendix and do MRIs and PCIs and countless other things.

What you’re going to learn now, in the real world, is that physical woes are the least of patients’ worries. Their health problems aren’t strictly caused by mutating cells, opportunistic pathogens and poor genes, but by poverty, lack of education, poor housing, stress and social isolation.

You’re going to, sooner or later, learn humility. And the earlier you do, the better the doctor you’re going to be.

In this, the Internet age, we are drowning in information, but starving for wisdom. I urge you, as you forge long, successful and prosperous careers, to not just be smart, but be wise.

In every interaction you have, embrace the ancient wisdom of Hippocrates: “Whatsoever house I may enter, my visit shall be for the convenience and advantage of the patient.”

André Picard is a health reporter and columnist at The Globe and Mail, where he has been a staff writer since 1987. He is also the author of three bestselling books

The Path to Health Care Reform: Policy and Politics (The 2012 CIBC Scholar-in-Residence Lecture)

The Conference Board of Canada, 250 pages, October 2013

After examining health care systems in Canada and abroad, the author outlines ways to reform our system by balancing competing demands, building on successes, ensuring sustainable funding, and addressing the highest priorities.

Document Highlights

In this Scholar-in-Residence Program monograph, Globe and Mailcolumnist André Picard aims to answer one question: “How do we reform our health care system?” He says we must continue to focus on the principles of medicare: universality, accessibility, comprehensiveness, portability, and public administration. He argues that two opposing extreme views—that medicare is an unsustainable failure or an unalterable sacred cow—have made it impossible to have a constructive debate, and that the way to reform lies somewhere between them. After examining the history of health care systems in Canada and other developed countries, Picard argues that Canada’s system needs to be modernized by conciliatory, cooperative, pragmatic leaders. We need to set clear limits on what the system covers, build on successes, find the most effective funding mechanism, and address five key gaps: pharmacare, primary care, community care, social determinants of health, and health care quality.

Three distinguished health care experts offered their insights into health care reform at the 2012 CIBC Scholar-in-Residence Lecture.

Table of Contents


Introduction—Principles and Goals: What Are We Trying to Achieve?

Section I—The Path to the Present: How Did We Get Here?

  • Chapter 1—An Unhealthy Past: Life Before Medicare
  • Chapter 2—Health Care for the Masses: Medicare Is Born
  • Chapter 3—The Canada Health Act: Icon or Paper Tiger?
  • Chapter 4—Back to Earth: The Era of Cutbacks
  • Chapter 5—Is More Study Needed?
  • Chapter 6—The Fix for a Generation?

Section II—Frozen in Time: The Canadian Health Care System Today

  • Chapter 7—How We Compare: What Have Others Done Better?
  • Chapter 8—What Are the Barriers to Reform?
  • Chapter 9—National Issue, Provincial Authority
  • Chapter 10—The Third Rail: What Is the Role of the Private Sector?
  • Chapter 11—Paying the Piper: Is Medicare Sustainable?
  • Chapter 12—The Economic Footprint

Section III—Health Care Reform: What Needs to Change?

  • Chapter 13—The Path Forward: Structural Reform
  • Chapter 14—The Path Forward: Affordable Care

Conclusion—A Call to Action


Transcript of the Lecture

Bending the Cost Curve in Health Care: Can it be Done?

November 18, 2013

Listen to the PODcast:

For at least the past two decades, governments across Canada have grappled with the issue of ever-rising health care costs.  On November 18, the Institute for Research on Public Policy held a luncheon panel discussion on what – if anything – can be done to bend the cost curve in health care. IRPP author Terrence Sullivan, President, Terrence Sullivan & Associates, presented the findings of his recent IRPP paper (coauthored by Steven Lewis). André Picard, public health reporter for the Globe and Mail, and Maureen O’Neil O.C., President, Canadian Foundation for Healthcare Improvement, commented on the paper and presented their own insights on this seemingly intractable problem.

The IRPP Insight How to Bend the Cost Curve in Health Care, by Steven Lewis and Terrence Sullivan, is available online.

Health-care focus should switch to prevention: André Picard

The Senior Times

André Picard photo by Peter Ford / Pinpoint National

André Picard photo by Peter Ford / Pinpoint National

André Picard’s romance with journalism began as an extracurricular affair.

While studying administration in the mid-1980s at the University of Ottawa, he developed a passion for writing as a music reviewer for the student newspaper, The Fulcrum.

Instead of becoming an accountant or business executive, Picard earned a second degree in journalism. As a top graduating student at Carleton University, he was snapped up by The Globe and Mail, where he has worked for more than a quarter-century.

Posted to the Montreal bureau, he shifted from political to health reporting with a national focus and in the process acquired an international reputation for excellence.

Picard is not satisfied with merely factual and in-depth reporting and analysis.

Those who worked alongside him got to know a colleague/competitor who would not make do with “he-said-she-said” journalism, a slice of colour and some background.

His work as one of North America’s top health journalists reflects his personality: Behind the placid exterior lies an inquisitive, perceptive and industrious scribe for whom the work only begins with the official story.

Philippe Couillard, the health policy adviser-turned-Quebec Liberal Party leader, said of Picard at a symposium last year: “André, in my view, is the most thoughtful and certainly often courageous public writer we have on the health care sector in our country.”

Passion and commitment are what drove Picard to write the first of several books, such as The Gift of Death: Confronting Canada’s Tainted Blood Tragedy (Harper & Collins, 1995), where he pieced together the story behind the 1980s scandal. More than 1,200 people had contracted AIDS from tainted blood in what is said to have been the worst health-care disaster in Canadian history, much of it centred in Montreal.

“That was a sprawling story. I wrote about it for many years, so I thought it needed to be brought together in one coherent story,” Picard said in an interview.

Juggling his day job, a busy public speaking schedule, and family life—he is married to Gazette reporter Michelle Lalonde and they have two teenage daughters—Picard followed up with a 118-page study of The New Face of Charity in Canada for the Atkinson Foundation and Critical Care: Canadian Nurses Speak for Change (HarperCollins, 2000).

Picard’s latest is a comprehensive review of the history, strength and weaknesses of health care in Canada, written for the Conference Board of Canada.

Picard’s guiding thread is “to embrace social justice without abandoning fiscal prudence.”

“I tend to be a pragmatist. Social justice has to be important, but we can’t be spendthrift. We have to think about the money part. Maybe that’s the accountant in me.”

Picard writes that Canadians are getting “more care, faster and better” and that the $200 billion Canadians spend annually on health care ($140 billion is from the public treasury) is “good medicine for the country’s economy, especially when the economy is ailing. … It’s a redistributive social program as well as a health-insurance plan.”

On the weakness side, he asserts that the focus on acute medical care rather than enhancing social welfare programs and preventing health problems has been “politically expedient, but a costly mistake and missed opportunity.”

We can be “a little smarter and get more bang for the buck” by spending more on prevention, he observes.

Improvements in education, child care and housing have a major impact on human health and he agrees Quebec has been “a little smarter” with such programs as pharma-care, free dental care for children up to age 10, and $7-a-day child care.

“Quebec is really good on the social, but spends a little less on health care, and has a very bureaucratic medical system.”

With the increasing cost of publicly funded health care and a steadily aging society, Picard expects private and insurance-funded care will have a greater role.

“The objections we have toward private care are way too dogmatic. Every country that has universal health care has a mixture of private and public care.

“The discussion we should have is what’s the right mix, where is it most appropriate?

About 23.2 million Canadians have private health insurance, covering drugs, various diagnostic services, and supplementary health care such as private rooms.

Picard’s leitmotif for private care: “We should turn to the private sector if the services provided are of equal quality (private and public institutions need the same rules and regulations), if they are the same price or cheaper, if they are faster, and if the public option has been exhausted.

“We need to avoid so-called cream-skimming, where all the profitable procedures are left to the private sector and all the complex, expensive care is left to the public system.”

Public awareness and pressure can be effective, as it was in 2004 when Ottawa pumped in an additional $5.5 billion to reduce wait times for cancer and heart surgeries, hip and knee replacement, and cataract operations.

“Our system was created when our population was young. Now we have this older population that needs chronic care. We have to rejig the system with a different philosophy.”

Picard says that on any given day, 7,500 patients are in Canadian hospitals, at a total cost in one year of $4 billion. Half of them could be at home if proper home care were available, at one-third the cost.

“Imagine $4 billion being put into home care instead of having people live somewhere they don’t want to live. We could get a lot of home care out of that money.”

Picard is critical of the Harper government for “withdrawing completely from the health-care leadership game, concentrating instead on writing cheques.”

“I don’t think their interpretation of the constitution—responsibility for health care is shared with the provinces—is correct. It’s convenient for their beliefs, but I think Canadians expect more than that.

“The federal government’s role is not to take over the provinces, but it is to level the playing field.”

The Path to Health Care Reform: Policy and Politics may be downloaded from, or ordered by mail for $20 from the Conference Board, 255 Smyth Rd., Ottawa, Ont., K1H 8M7. 1-866-711-2262.

Photo: Peter Ford / Pinpoint National

Ontario University Institute of Technology is proud to present Mr Andre Picard with the honorary degree of Doctor of Laws

Mr. Andre Picard

We are proud to confer upon Mr. André Picard the honorary degree of Doctor of Laws, honoris causa for his advocacy and tireless efforts to improve the Canadian health-care system.

Mr. Picard is an award-winning health journalist, best-selling author, renowned speaker and an advocate for improving the health of Canadians. Widely considered the top health journalist in the country, his approach of researching, documenting and sharing health issues through the eyes of patients, health-care workers, caregivers, and other often-forgotten individuals provides compelling insight into everyday challenges.

His broad scope of research areas, including HIV/AIDS, mental illness, health-care reform, food safety, child obesity and the nursing shortage informs the public on relevant, timely and real-world issues. The light he shines on complex issues through his writing makes a positive difference on how the public, government, and policy makers work toward the better health of Canadians. He is currently the Scholar-in-Residence at the Conference Board of Canada where he has just completed a book on health-care reform.

Mr. Picard has received numerous awards, including the Centennial Prize of the Pan American Health Organization as the top public health reporter in the Americas, the Michener Prize for Meritorious Public Service Journalism from the Governor-General and the Hyman Solomon Award from the Public Policy Forum.

The Globe and Mail’s André Picard named recipient of Queen Elizabeth II Diamond Medal

The Globe and Mail

Globe and Mail public health reporter André Picard, who has already won numerous awards and accolades throughout his illustrious career as a journalist, can now add one more honour to his name: recipient of the Queen Elizabeth II Diamond Medal.

Picard learned he was a recipient of the medal after coming back from a conference and discovering it on his desk. It was “a complete surprise. And a pleasant one,” he said by e-mail.

“It’s very flattering to get this kind of recognition, especially for doing something I love – writing about health.”

Picard, who has been a journalist with the Globe since 1987, is one of the top health writers in Canada and has carved a reputation as a noted public policy expert. Throughout his career, he has written on everything from the sustainability of the health-care system to the need for a national mental health strategy to developments in medical science.

In 2011, Picard won the Hyman Solomon Award for Excellence in Public Policy Journalism and in 2010, a National Newspaper Award as Canada’s top columnist. In 1993, he received the Michener Award for outstanding public service in journalism for his coverage of the tainted blood crisis. He has received many other accolades from other groups and organizations.

The Queen’s Diamond Jubilee Medal is awarded to Canadians who have made significant contributions and achievements, and to recognize service to the community and country. It was created in commemoration of the Queen’s ascension to the throne on Feb. 6, 1952. A total of 60,000 medals have been given to deserving Canadians over the past year.