Conversations In Complexity

In this podcast, Ross Upshur interviews Gail Elliot about dementia care and the state of dementia care and how it can measure up to expectations that will provide the kind of care which takes into account the individual’s entirety as a human, focusing on personal narrative, brain, environment, needs, abilities and disease. In this podcast, Ross Upshur interviews Gail Elliot about dementia care and how it needs to measure up to societal expectations, providing the kind of care that takes into account the individual’s entirety as a human, focusing on personal narrative, brain, environment, needs, abilities, interests and disease. Most importantly they will discuss the importance of helping each person to live with meaning, purpose, joy, higher self-esteem (by enabling abilities), choice and dignity. In the interview, Gail believes we have enough science, and the ability, to deliver good (non-pharmacological) dementia care.  Using research from diverse disciplines, she talks about how the science/the research

The academic research environment is changing and researchers report struggling to adapt in order to be successful. Funding shortfalls are perennial, but what systemic shifts should occur to enable researchers at all career stages to be productive and successful? A short overview: The academic research environment is changing and researchers report struggling to adapt in order to be successful. Funding shortfalls are perennial, but what systemic shifts should occur to enable researchers at all career stages to be productive and successful? Upon publishing “Healthy research ecosystem – healthy researchers? The researcher as an organism of focus within a ‘research ecosystem’” in Academic Matters in Fall 2019 issue, Ross Upshur and Michelle Nelson, convened to discuss themes from their paper as well as a number of other academic matters that have been issues of concern for academics far and wide for a long time. In the first part of the podcast, Ross and Michelle discussed some of the themes from the paper

Upon publishing “Healthy research ecosystem – healthy researchers? The researcher as an organism of focus within a ‘research ecosystem’ in Academic Matters in mid-March 2019, Ross Upshur and Michelle Nelson, convened to critique themes from their paper and discuss a number of other academic matters not originally mentioned in the paper but have boggled the minds of many academics far and wide for a long time. In mid-March 2019, Ross Upshur and Michelle Nelson published “Healthy research ecosystem – healthy researchers? The researcher as an organism of focus within a ‘research ecosystem’” in Academic Matters. The paper, as themselves put it “explores issues of relevance to higher education and is a forum for thoughtful and thought-provoking” discussions and consideration of academia’s future direction. The paper is a response to the ever-changing research environment that researchers find rather difficult to adapt in order to thrive and maintain a solid research. In the podcast, the duo try to discuss some of

In this podcast, Ross Upshur, interviews Marco Inzitari, discussing the mechanisms and nuts and bolts of integrated care provided to the elderly population in Barcelona, Catalonia, Spain. Dr. Inzitari is the current President of the Catalan Society of Geriatrics and Gerontology and the Director of Intermediate Care, Research and Teaching of Parc Sanitari Pere Virgili in Barcelona. In this podcast, Dr. Marco Inzitari gives his first-hand account of the health and social care services provided to the elderly population in Barcelona and Catalonia, and elaborates how these services address the issues of frailty, chronic diseases, loneliness, etc. In doing so, Dr. Inzitari sets an example of a healthcare system that has traversed academic, public and private sectors and even has integrated a coherent and uniform internet-based repository of medical records into the healthcare system to provide a seamless health and social care to its elderly population. Work and Education Marco Inzitari, MD, PhD, a specialist i

Gordon McGregor, a member of the Alternate Level of Care Patient and Caregiver Council, in an interview with Ross Upshur reflects upon his personal experience taking care of his wife in a span of nearly 30 years. His experience with the health system is what thousands of patients and family caregivers undergo on daily basis. The interview highlights both positive and not so positive aspects of care and the need to take care of the instances that patients might find rather inconvenient or challenging to overcome.  Mr. Gordon McGregor has personal experience with ALC as a bereaved caregiver. His devotion to a life taking care of his wife struggling with a severe type of mental disorder throughout the years, as well as his experiences as an advisor for different hospital councils, makes his experience indispensable in helping us understand the caregiver experience. In his ‘‘Books and Men’’1, Sir William Osler (1849–1919) wrote that “ To study the phenomenon of disease without books is to sail an uncharted sea,

Jane Barratt in an interview with Ross Upshur reflects on different aspects of elderly care and explains how it could be improved in Canada. In the interview, she gives an example of other countries and how they have been successful in laying the foundation for a more robust elderly care. In this interview, Jane Barratt, the Secretary General of the International Federation (IFA) on Ageing, describes how her interest in roams of care and allocation of services engaged her in the area of ageing and caregiving. She later highlights the sources of the problems that impact decision-making around the allocation of services and says they arise from different understanding and outlooks in the conversations among different health sectors although they all seem to be talking about the same topic. On equitable allocation of services, she exemplifies Australia’s age-care system and compares it to that of Canada and how they are different in this respect. Jane Barratt is one of the IFA’s 15 international directors. Cur

ST: A Palliative Approach to Decision Aids to Help Improve Patients’ Medical Choices Pete Wegier in this interview with Ross Upshur discusses complexities of the end of life care and how coordination in this care setting could be optimized by the use of new communication technologies. Interestingly, his journey from computer science to cognitive psychology, to medical decision making and later to the space of palliative care has equipped Pete with tools that could help untangle some of the problems in this most complex area in health care.   In the podcast, Pete also discusses how his research interests concern medical decision making, focusing on the effective communication of information to both patients and physicians to improve understanding in medical choices. Specifically, he focuses on the use of simulated experience as a decision aid for medical decision making; the effective communication of quantitative information in healthcare, specifically through data visualization; and how healthcare teams col

Michelle Nelson in an interview with Ross Upshur discusses the importance of intra- and inter-sectoral collaboration in healthcare and explains how the voluntary sector could be engaged to support improved patient and family experiences and the outcomes. In a recent interview with Ross Upshur, Michelle Nelson, a Research Scientist at Research Collaboratory, Lunenfeld-Tanenbaum Research Institute, explained about her research, the importance of intra- and inter-sectoral collaboration in health care, engagement of the voluntary sector to support improved patient and family experience and the patient outcomes. Michelle has been actively pursuing development of a complexity and stroke rehabilitation research network. Her tireless efforts recently led to holding a meeting attended by 43 researchers, policy-makers and clinicians. The meeting initially generated 120 potential research questions, from which 16 high-priority questions were identified focusing on complexity characteristics including multimorbidity, s

Jeff Myers, in this interview with Ross Upshur, discusses the evolution of palliative care and the evidence that has accumulated outlining its impact on outcomes for patients, families, and systems. With early efficacy studies having focused on end-of-life experiences for patients with cancer, strong evidence now clearly delineates a role for palliative care from the time of diagnosis for any person with serious illness and their family. Serious illnesses are those that are incurable and progressive and include but not limited to heart failure, COPD, chronic kidney disease, neurodegenerative diseases, dementia, frailty as well as metastatic cancer. No longer should palliative care be thought of as the alternative to disease-focused care, it is as an added layer of support that must be provided alongside disease-focused care. This expansion of relevance raises several questions and creates both opportunities and challenges for the growing discipline. What is it about the palliative care approach that makes su

Abhimanyu Sud, in an interview with Ross Upshur, talks about the current opioid crisis, the challenges and the opportunities to respond to the crisis at different levels including improved prescriber education and use of evidence-based non-opioid alternatives for chronic pain. Abhimanyu Sud is the Academic Director of Safer Opioid Prescribing at Continuing Professional Development at the University of Toronto. A graduate of Yale University and the University of Toronto, he is a community-based family doctor who also has a focused practice in comprehensive chronic pain medicine. He has played an active role in advocating for comprehensive and effective solutions for Canada’s opioid crisis and in particular for the role of evidence-informed education in chronic pain and opioid prescribing at all levels of medical training. He is a Lecturer at the Department of Family and Community Medicine at the University of Toronto’s Faculty of Medicine. Sud’s current work is focused on educational and research interventio

Maya Goldenberg, in an interview with Ross Upshur, talks about her academic journey from a close look at evidence-based medicine and its philosophical issues to a feminist approach to the philosophy of science. Later on, Maya will discuss her research interest in fundamental issues related to public health policy such as vaccine hesitancy. The interview culminates to a very fascinating view on the state of science in the current political world. Maya Goldenberg is an Associate Professor of Philosophy at the University of Guelph. Her research in philosophy of medicine and philosophy of science examines the intersection between science and values, and puts the fundamental epistemic question “How do we know what to believe?” in social and political context. She is currently writing a book on vaccine hesitancy and public understanding of science. Dr. Goldenberg is also a Graduate Faculty Member at the Institute for the History and Philosophy of Science and Technology at the University of Toronto. Here are some

Sarina Isenberg, interviewed by Ross Upshur, discusses palliative care from the lens of a scientist and health researcher committed to making a difference for those who receive such care in the course of their disease. Sarina’s first experience with palliative care was at a relatively young age when two loved ones were in palliative care in the course of their terminal illnesses. Later, her studies in health-related subjects landed Sarina in palliative care study and research, which is a subject area with great challenges in any health system in the world in terms of complexity, cost and degree of needed care. As mentioned in the podcast, palliative care is no longer limited to end-of-life care. The shifting face of palliative care, in light of the aging population in Canada, is a great opportunity for Sarina and others to research palliative care with the intent of improving access to, and the quality of palliative care. Sarina Isenberg is a Scientist at the Temmy Latner Centre for Palliative Care and th

Gary Newton, in an interview with Ross Upshur, discusses his agenda as the Chief Executive Officer of the Toronto Sinai Health System while explaining his views on complex care and how he is trying to bring about change in Sinai Health System in Toronto. In this fascinating and  candid interview, Dr. Gary Newton talks about his views towards complexity, his aha moments, his involvement in health administration, his experience of running a hospital based Division of Cardiology,  the Department of Medicine and ultimately to his role as the CEO of Sinai Health System after the merger of Bridgepoint Active Healthcare and Mount Sinai Hospital in 2015. Dr. Newton discusses the challenges of managing the process delivering care to individual patients to managing populations of patients with complexity, while helping complex health systems evolve. He further explains the shortcomings with the current “non-system system”. Gary Newton assumed the role of President and CEO of Sinai Health System in October 20161. H

Carolyn Steele Gray, in interview with Ross Upshur, discusses how her academic journey shaped her perspectives in understanding patient needs, health policy, organization and provider level issues and how to use that understanding to deliver a better care. The latter, she adds, necessitates a realistic approach of how to harness e-health technologies to deliver care, especially to patients with complex care needs. Carolyn discusses how technology in health is not the silver bullet to healthcare questions and its implementation is embedded within complex social layers, affected by people’s feelings about it; policy issues surrounding it; and how organizations treat it. Carolyn describes the value of adopting a user-centred design evaluation approach used to develop the ePRO tool; describing how it evolved from a tool intended to collect patient-reported outcome measures to one that enables patient-centred goal-oriented care within primary care settings. The talk addresses some of the current challenges in t

Kerry Kuluski, in interview with Ross Upshur, discusses her undertakings in her journey from being a social worker to a scientist. Her goal is to improve health system performance for people with multimorbidity and their caregivers. This is a fascinating talk as it explains how looking at data sets and trying to analyze them is not the only way to meet the needs of people, especially the ones who are “stuck in transition”.  She also draws interesting parallels between marathon training and grant writing! Kerry’s research focuses on quality and health system performance through the eyes of people with multimorbidity and their caregivers in the contexts of community based primary health care, homecare, hospital care, delayed discharge and transitions between care settings. She draws on both quantitative and qualitative methods to uncover population level trends in care utilization as well as patient and caregiver experiences in the health care system. Her ultimate research goal is to use patient and caregiver

Jon Glasby in interview with Ross Upshur, discusses his research focused on understanding and responding to “inappropriate” emergency hospital admissions of older people. In the interview, he discusses how his research took up the challenge of hospital admissions of frail older people with multiple chronic conditions and how many of the admissions could be prevented. His work expands the debate from merely one of how to allocate scarce resources in hospital settings to one of organizing better, not “appropriate” care for older patients in alternative settings closer to their homes. This fascinating discussion covers topics such as delayed hospital discharge, the notion of the “deep hospital” and “preventable moments”. Using different sources of evidence from his work with patients and front-life staff, from admission data to real patient narratives, he makes a powerful case of the need for culture change in the health and social system, attitudes to care for the elderly, and how we can learn from patients

Julia Ho in interview with Ross Upshur talks about her recent article “It’s a fight to get anything you need”—accessing care in the community from the perspectives of people with multimorbidity, published in the Open Access journal of Health Expectations.

Ross Upshur further examines evidence from a scientific, philosophical and ethical viewpoint in the second part of the podcast “Concept of Evidence in Healthcare”. Throughout the discussion, he presents practical examples of how the provisional nature of evidence has played a role in justifying the practice of medicine as it has evolved over time. The talk is intriguing as is the subject itself. Some of the articles mentioned in the podcast: We need both evidence and values to navigate uncertainty. Upshur RE. Hastings Cent Rep. 2014 Sep;44(5):4. doi: 10.1002/hast.347. Grey zones of clinical practice: some limits to evidence-based medicine. C.D. Naylor The Lancet, Volume 345, Issue 8953, 1 April 1995, Pages 840-842 Tolerating Uncertainty — The Next Medical Revolution? Arabella L. Simpkin and Richard M. Schwartzstein N Engl J Med 2016; 375:1713-1715 November 3, 2016 DOI: 10.1056/NEJMp1606402   More related articles on evidence: Renaissance or reformation for evidence based medicine? Fuller J, Flores LJ, Upsh

Ross Upshur explores a very important concept in modern healthcare: "The Concept of Evidence" in this and the next podcast. He talks about evidence and what it means to base decision on evidence. He would also dig into its evolution; attempts made to orient clinical decision making to the literature; its new dimensions and hierarchy of evidence; “what it is and what it isn’t”; and how it relates to patients values and expectations; and more. Links to some of the articles mentioned in the first podcast: Evidence-based medicine: A New Approach to Teaching the Practice of Medicine JAMA. 1992;268(17):2420-2425. Evidence –based Medicine; what it is and what it isn’t BMJ 1996;312:71

Ross Upshur discusses the problems with polypharmacy and looks at some proposed solutions to the problem in the second part of the two podcasts on the subject.