Latest / Podcasts By Donna Jodhan / Remarkable World Commentary Episode #97: Interview with Dr. Danielle Manis, Chief, Department of Family and Community Medicine, North York General Hospital

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Remarkable World Commentary Episode #97: Interview with Dr. Danielle Manis, Chief, Department of Family and Community Medicine, North York General Hospital · Podcasts By Donna Jodhan

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Podcast Commentator: Greetings, Donna J. Jodhan, LLB, ACSP, and MBA invites you to listen to
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her bi-weekly podcast, Remarkable World Commentary.
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Here, Donna shares some of her innermost thoughts,
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insights, perspectives, and more with her listeners.
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Donna focuses on topics that directly affect the future of kids,
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especially kids with disabilities.
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Donna is a blind advocate, author, sight loss coach,
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dinner mystery producer, writer, entrepreneur,
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law graduate, and podcast commentator.
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She has decades of lived experiences, knowledge,
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skills, and expertise in access, technology and information.
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As someone who has been internationally recognized for her work and roles,
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she just wants to make things better than possible.
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Donna J. Jodhan, LLB, ACSP, MBA: Hello everybody, and welcome to another episode of Remarkable World Commentary.
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I'm Donna J. Jordan, a lifelong disability advocate and one who sees the world mainly
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through sound, touch and stubborn optimism.
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I'm a law graduate, an accessibility consultant and author,
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lifelong barrier buster who also happens to be blind.
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You may know me from a few headline moments, as in November 2010,
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I won the landmark charter case that forced the Canadian government to make its websites
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accessible to every Canadian, not just to sighted ones.
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And in July of 2019, I co-led the Accessible Canada Act with more than two dozen
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disability groups to turn equal access into federal law,
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and most recently, on June the 3rd, 2022, I was greatly humbled.
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Humbled by Her Late Majesty's Platinum Jubilee Award for tireless commitment to
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removing barriers. When I'm not in a courtroom or in a committee room or in a
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pottery studio, you will find me coaching kids with vision loss,
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producing audio mysteries, or helping tech companies to make their
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gadgets talk back in plain language.
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Everything I do circles one goal to turn accessibility from an afterthought into
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everyday practice. I invite you to think of this show as our shared workbench,
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where a policy meets lived experience and lived experience sparks fresh ideas.
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Now, before we jump into today's conversation,
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let me shine a quick spotlight on today's guest,
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a change maker whose work is as every bit as remarkable as the world that we are trying to
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build. I am absolutely pleased and honored to have my family physician,
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Doctor Danielle Maness, as our guest today.
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Welcome, Doctor Danny.
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Dr. Danielle Manis: Thank you so much, Donna.
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What a wonderful introduction that was.
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Donna J. Jodhan, LLB, ACSP, MBA: Well, let's get going.
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So, doctor Danny welcome to the remarkable world commentary.
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And I'd like to begin at the beginning.
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I want to begin at the beginning.
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So tell us, what first drew you to medicine and how did you find your way to family
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medicine in particular?
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Dr. Danielle Manis: You know, this is such a great question and I'm so I've come so far from ever thinking
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about this. So thank you for making me think about it again.
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It's been so many years since I chose this path.
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I would say part of it was as a child, I loved learning and I'm very curious and I
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love problem solving. So I was very much drawn to sciences and the intellectual
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challenges of solving problems, you know, making a diagnosis or whatever it
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may be. But I also really like people.
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I always default to sort of a positive feeling when I meet new people.
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And I'm very interested in other people's lives and experiences and playing a
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meaningful role. So that was kind of where I,
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how medicine was a draw for me.
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And when I was lucky enough to get into medical school,
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which was a little bit easier in those days than it is now.
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And I made my way through all of the courses and all of the different experiences and
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rotations. I was interested in everything.
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The common thread. I found everything interesting, but if it was too specialized,
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I found myself getting bored very.
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So, you know, three weeks in cardiac surgery,
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literally holding on to someone's heart while it's being operated on sounds really,
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really cool. But after the second day I thought,
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okay, this is the same thing over and over again. I like variety,
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I like not knowing what I'm going to deal with.
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And then I was really lucky to have some inspirational mentors along the way and
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excellent role models. And I can remember some of them, I can even call some of them
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out by name of doing electives and rotations.
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I already kind of thought I wanted to be a family doctor because of the meaningful and
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long term sort of relationships that family doctors have with their patients.
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But then I did an elective with Doctor Val Ratcliffe,
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who was a leader in our department and a former chief of this department and a big
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leader in health care in Canada.
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And I watched his interactions with his patients,
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and that was it. I said, yes, this is what I want to be.
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I want to be that trusted advisor, that expert clinician who really cares about
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their patients. You know, and that was it.
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That was it for me.
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Donna J. Jodhan, LLB, ACSP, MBA: I can tell you that you are a fine example of one of the best doctors that I have ever
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interacted with. And I'm not telling you this to give you a big head,
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I mean it.
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Dr. Danielle Manis: Oh, that's so kind of you, Donna.
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Donna J. Jodhan, LLB, ACSP, MBA: I really mean it. For some reason, I thought you are from Montreal.
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No.
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Dr. Danielle Manis: No no, no, from Montreal.
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I'm actually quite local.
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I was I grew up in North York, so I really haven't strayed too far.
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And I did, I did some undergrad training in London,
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Ontario, but I did most of my training in Toronto.
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Donna J. Jodhan, LLB, ACSP, MBA: Okay. So you've built your whole career right on training your,
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your practice and your teaching, And now your leadership within the North York
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General and University of Toronto community.
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What has it meant to you to put down roots and grown in one community for more than 20
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years?
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Dr. Danielle Manis: You know, this is hard to even put into words,
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but I'm going to try because we are because we are a podcast.
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There's something really special about the community that I work in.
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It is, it is, I can't really explain the warmth and the collaboration and the open
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mindedness and the acceptance.
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And it, it just sort of creates this culture of wanting to give back and wanting to stay.
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So as a student, you know, I was a medical student at North York
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General. I was a medical resident at North York General. I joined a practice in North
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York, and I've never left.
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And when I look around, so many of my colleagues are the same,
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some of them quite a bit senior to me.
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So if I've been here for 25 plus years.
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Some of them have been here for 40 plus years.
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What I see with our our young graduates from our residency program is they want to stick
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around and they want to stay here and give back because they've had such a wonderful
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experience in their training that they want to turn around and work with the same group
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of people and train the next group of people that is coming up and what it really means,
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especially in a community based model that we have,
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it would be very easy to get very isolated and siloed in your office,
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right? If you're a doctor in an office and you work with 3 or 4 people,
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and you never once met any of the specialists at the hospital or know anybody who picks up
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the phone at any of these other clinics.
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It's really easy to be isolated when you're really embedded,
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especially in education, or you get involved with Ontario health teams
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or any kind of volunteer opportunities.
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It just enriches your practice so much.
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You don't feel so alone.
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You feel part of a medical community, and it's just a really,
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really wonderful one. So I feel like I've gotten to know the community for years and
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years through all of our trainees, through all of our services, through all of
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our committee work and my involvement.
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And I just would not want to be anywhere else.
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Donna J. Jodhan, LLB, ACSP, MBA: You know that that's so refreshing to hear.
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Like some people would say I can't wait to get out of this,
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this, this environment and move somewhere else.
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But giving back and is very important to me.
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And I really appreciate you saying this as well,
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you know.
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Dr. Danielle Manis: Well, and I feel like it's our job, like, especially as a leader in this
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department to retention, retaining our wonderful health care workers
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is a huge part of our strategy.
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You know, we have to perpetuate this welcoming community.
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You know, practicing medicine and working in health care is very hard. It's very
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challenging these days. So it's not that we don't have those challenges,
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it's that we have a very supportive, positive environment in which to do that kind
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of work. And it's part of the mandate because we need those people to stick around.
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I need someone to take care of me one day, too.
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Donna J. Jodhan, LLB, ACSP, MBA: And your office certainly exudes warmth and welcoming vibes whenever we walk in there,
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you know?
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Dr. Danielle Manis: Nice to hear. I always feel like it's a very happy family in my office as well.
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And we've been working together now for about 25 years.
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Donna J. Jodhan, LLB, ACSP, MBA: Wow. So you're what's known as a comprehensive family
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physician. Some people call it cradle to cradle care.
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For listeners who may not know the term, what does full scope family medicine look
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like day to day? And why have you stayed so committed to practicing that way?
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Dr. Danielle Manis: So, you know, I guess I will say I'm what's known as an office based,
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comprehensive family physician.
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The real comprehensive family physicians are the ones who not only run their clinic in
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their office, but they also come into the hospital and deliver babies,
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and they might also be working in the operating room as an assistant.
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And some of them work in the emergency department.
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And there's a whole bunch of other settings which in which family doctors can work.
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Especially if you get into the more rural and smaller communities,
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that is the model that most of those family doctors do. And it is remarkable.
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In the city environment, it's, you know, definitely a lot of my
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colleagues are doing all kinds of interesting work outside of their office. I am office
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based. So what does it mean to me?
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I mean, certainly it's, you know, I'd like to put the family and
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family medicine as much as possible.
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We like to have whole families in our practice.
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We like multiple generations.
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We like to have all the siblings, all the kids and the grandmas and grandpas
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because it's, it's a it's convenient for patients.
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It's much, much easier.
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You know, when you have a couple in their 80s and they are both coming to see the same
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physician or the parents are bringing their newborn in,
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but they're also the patients and they don't have to go to different places to get their
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care.
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Donna J. Jodhan, LLB, ACSP, MBA: Right, Right.
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Dr. Danielle Manis: As a physician, you really I really strongly believe we do better medicine when we
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understand the patient and their context.
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So knowing who else is in their family, who they live with,
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you know what? You know, they're dealing with their husband at home
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with dementia and their caregiver stress or whatever context we know about.
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The patient allows us to understand their symptoms and their presentation and how we
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can best help them. So that's really what it means.
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It's a long the full life span from birth to death.
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And there really is no problem that can ever get presented to us where we can say,
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well, that's not my department. We will always do our best to address it and figure
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it out and deal with it and access the services that people might need.
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We're just kind of there for the long haul.
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Donna J. Jodhan, LLB, ACSP, MBA: I was certainly so relieved when he took such good care of my mom when she needed your help
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a few years ago. Yeah.
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Dr. Danielle Manis: To know her?
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Donna J. Jodhan, LLB, ACSP, MBA: Yeah. She's always asking about you.
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Man is still there. So you've cared for many of the same patients and
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families since 2003. What do those long relationships teach you that a single
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visit never could? And how does that continuity shape the care you give?
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Dr. Danielle Manis: It's it's really about knowing the patients, you know?
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Like it's I feel so spoiled because in some ways,
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my practice has gotten a bit more challenging over time.
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Just because we're a lot myself in here, we are all getting older.
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So therefore we have more health problems and a little bit more complexity and more things
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to deal with. So I'm getting a lot busier with the same number of patients that I
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always had. But on the flip side, it's also easier because I know my patients.
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So if somebody who rarely ever comes in for any reason,
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you know, just kind of really high functioning and stoic comes in with terrible
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abdominal pain. You know, I approach that a little differently than
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someone else who I see once a month with abdominal pain that has had 100
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investigations. You just kind of have a sense of,
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okay, this, this, this might be appendicitis because I've never seen this person. So it's
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that kind of context. It's the understanding again,
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what's going on at home, what's going on at work, what is causing them
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stress, what excites them?
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What are their, what is their health literacy?
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What is their understanding of their symptoms? Do they prefer to go on medications
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or prefer to avoid medications?
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Like I know this about my patients. So it just really,
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you know, you're kind of starting ahead as opposed to having to catch up from the very
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beginning. And I know because you might know that I have had,
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yes, of course, you know that I've had a locum physician filling in for me a little
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bit in the last year or so while I've been really busy and he's wonderful,
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but there's a lot of catch up that you have to do when you don't know people.
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And I just sort of already, I don't have to go back and,
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you know, spend 20 minutes reading the chart before I go in the room. I already know what
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I'm walking into. To.
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Donna J. Jodhan, LLB, ACSP, MBA: And, you know, I often hear your voice saying to me,
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have you booked your mammogram, Donna?
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Yes, I have. Good. Thank you.
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October the 13th is the big day, so I thought I'd share that with you.
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Dr. Danielle Manis: Oh my gosh, that's a big win.
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That's the thing is sometimes we have to have conversations with people many times to try
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to get buy in to make change.
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You know, things like quitting smoking or eating a bit better or going for that test,
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don't want to do you know, their values and their reasons.
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You're not going to meet a stranger and they're going to tell you once and then
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you're just going to do it. Sometimes you have to build that trust over time,
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and we have to be patient.
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And sometimes people book their mammograms.
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That's great.
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Donna J. Jodhan, LLB, ACSP, MBA: I guess it took you a very long time to convince me to go and get it.
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And I will tell you, I was afraid to go because like,
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those things are painful.
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Dr. Danielle Manis: Yeah, they are, they are.
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And I will say like, you know, I know you have your questions,
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but I was very honored you asked me for this podcast.
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I don't feel qualified because I think I've really it's been very eye opening to learn
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about your advocacy work and to really stop and think about how much better we should be
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and should be doing in my office and in healthcare for people with blindness.
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And I think, oh my gosh, Donna's going to ask, I'm like ashamed to,
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to have learned that our secure messaging portal is not accessible to you and that
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there are so many things we could be doing better. So for me,
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this is a like I'm going to eat some humble pie and say,
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I want to learn how we can do better to make it accessible.
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And maybe going for a mammogram is not just about the pain.
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Maybe you're way into the hospital or wherever you're going for it is very
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challenging. And I think we have to be very sensitive to that too.
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Donna J. Jodhan, LLB, ACSP, MBA: And I will definitely let you know when I go how it turns out to be.
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You know, I would I would say that your office,
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they're very, very aware of accessibility issues and they're very attentive to my needs
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and requirements when I get in there, you know, like they don't hesitate,
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you know, let me help you to take your weight.
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Let me help you with the blood pressure machine and all that.
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So it, you know, I think you're doing your office and yourself,
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you're doing a marvelous, marvelous job.
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And, you know, it's one step at a time.
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Dr. Danielle Manis: Yeah.
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Donna J. Jodhan, LLB, ACSP, MBA: Right. And, and we, we, we would, you know, work by example and keep
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going.
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Dr. Danielle Manis: Yeah. Well, we're very lucky because we've managed to retain our some of our
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administrative staff for a very long time.
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And so they know our patients really, really well also.
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Ramona just celebrated 20 years with us, if you can believe.
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Oh yeah. So it's, it's so it's, you know, their,
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their medical office admins are very much part of the healthcare team.
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And, and that interaction with patients is so important.
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And they need to know patients as well.
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Donna J. Jodhan, LLB, ACSP, MBA: Yeah. Now you started out as a brand new family doctor and you have since been
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named chief and program medical director of family and community medicine at North York
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General. Looking back, what were the moments or experiences
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experiences that carried you from the front line to leading an entire department?
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Dr. Danielle Manis: I'm actually not even sure how this happened to me.
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I still don't really know.
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It was definitely not It was not an ambition of mine to say,
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oh, I'm going to be a leader and rise, you know,
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rise through the ranks.
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It's, it's a lot of mentorship, a lot of other people seeing leadership
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potential in me and then voicing that and giving me the confidence to try to put myself
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forward for this role.
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Because it was definitely not something that I ever thought I could do or even that I
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wanted to do because it seemed like quite a lot.
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And it's one of the things that now that I'm in this role,
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is my mandate and my job to mentor that in others and to raise other people up into
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leadership positions. And, and I will say like as a whole,
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family doctors are quite humble.
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They're very heroic. Their job is really difficult,
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but they, they just kind of get, you know, their nose to the grindstone and
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take care of their patients and do what needs to be done. And most of them don't see
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themselves as leaders or think they necessarily have the skills to do certain
19:03
leadership roles. And so it does take a lot of,
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we call shoulder tapping to say, hey, are you thinking about doing this?
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So I had a few very memorable people in my department who I consider to be mentors reach
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out to me and say, you know, this, this role is coming up and I think
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you're the one who should be doing it. And I had to hear it a number of times before I
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started to think it might actually be true.
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And then once I got here, it required and still requires a lot of
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coaching and mentorship from the chief who came before me,
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Doctor David Eisen, who was a huge mentor of mine and one of the people who had to,
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who had to twist my arm until I finally accepted that maybe I could do this.
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And, you know, the open door policy around being able to ask questions of anyone.
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You know, it's really that that's how you get here.
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That's how leadership happens through support. And I guess it goes back to speaking
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to how wonderful the culture of our department really is.
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Donna J. Jodhan, LLB, ACSP, MBA: And such was your humbleness, is that I did not learn this from you
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personally. It was Ramona who let the cat out of the bag.
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Months later she said, did you know she's now the big cheese?
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I said, big cheese of what?
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And then told me I. I'm so pleased.
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I think no one else deserves it better than you.
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Dr. Danielle Manis: But you know what? It's so nice that you say that, Donna, because I.
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I sent out an email blast to my my patients and I.
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Now, I know you were unable to read it, which is upsetting to me, but I only sent it
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out because I had decided to hire a locum physician one day a week because I just
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needed more time away from the office to do this other role,
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and I and I had to explain to my practice why I was doing that.
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And I anticipated a lot of pushback because people get very attached and territorial with
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their family. They often don't want anyone else they don't know,
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or they don't want the after hours doctor.
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They just want the person who knows them. And the reality in this world is most family
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doctors, we can't be there all the time for everyone.
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And many of us do have other roles and responsibilities.
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So I was really expecting that from my patients.
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And I got the opposite.
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I got a lot of, wow, I'm so proud of you.
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I got emails, I got cards sent to me.
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Congratulations on your role.
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We're so proud of you. And I thought, wow, that's really telling about that
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relationship and how valuable that is.
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Value their family doctor. And I guess it goes, it goes both ways. I'm really grateful
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for that.
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Donna J. Jodhan, LLB, ACSP, MBA: Now your locum is Doctor Kim.
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Dr. Danielle Manis: No, my locum is Doctor Taglione.
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Donna J. Jodhan, LLB, ACSP, MBA: Oh.
21:25
Dr. Danielle Manis: Doctor. So Doctor Kim is actually my resident.
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So he's my. He's my. They're both like young men,
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so I can see why you might confuse them, but yeah. Doctor Kim is my resident doctor.
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Taglione is my locum.
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Donna J. Jodhan, LLB, ACSP, MBA: Okay. I met both of them.
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Dr. Danielle Manis: Yes. Wonderful.
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Donna J. Jodhan, LLB, ACSP, MBA: And it was Doctor Taglioni who said you have to go and get your mammogram.
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Dr. Danielle Manis: Yeah. So maybe he gets the credit.
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That's fair.
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Donna J. Jodhan, LLB, ACSP, MBA: No, he doesn't get the credit.
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Because afterwards I kept hearing your voice saying, Donna, have you booked your
21:49
mammogram? Oh, gosh. So what I find remarkable is that you didn't step away from
21:59
seeing patients when you took on leadership.
22:03
You still practice. Why was it so important to you to keep one foot firmly in the clinic,
22:12
even as chief?
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Dr. Danielle Manis: It will always be important to me.
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I mean, this from a professional standpoint.
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Being a family physician is my is my number one role and my number one priority.
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And there's a very strong sense of responsibility to our patients because we
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know them and we're, you know, that's a core value of being a family
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physician. The role I have is called a clinical chief,
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and that's for a reason.
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All of the department chiefs at our hospital are clinical, meaning they're still doing
22:41
their patient facing work in addition to being leaders of their departments.
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And I think it really is necessary to inform the leadership role to be in that.
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I say this in the trenches day to day, doing health care in our system to really
22:56
understand what our department members are dealing with every day,
22:59
what our patients are dealing with every day, and then using that to inform,
23:02
you know, leadership and system change.
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But really on a personal level, like I'm a family doctor first before I'm a
23:09
leader and I've had other, I guess we'll call them side gigs,
23:12
professional jobs along the way in education and leadership.
23:16
But always that was a compliment to being a family physician.
23:19
And it will always be that way.
23:22
That's just the way it is.
23:24
Donna J. Jodhan, LLB, ACSP, MBA: May you stick around until I pass on.
23:28
Dr. Danielle Manis: Oh, I don't know. I don't know about that.
23:31
We'll see.
23:33
Donna J. Jodhan, LLB, ACSP, MBA: So you're defining work is something called health system integration.
23:41
In plain language, what does that mean and why should it matter to an ordinary patient
23:49
sitting in the waiting room?
23:52
Dr. Danielle Manis: So health system integration, I mean, it is a you know,
23:55
I was going to say it's kind of like the Holy Grail. Like when our system is perfectly
23:59
integrated, then we can all die happy.
24:01
But it's actually a work in progress.
24:03
And so I think it has to be looked at as a process,
24:06
but it is absolutely the goal to making a system that works better for everybody,
24:11
the both the patients and those who provide care.
24:14
And I would think anybody who's had pretty much any interaction with the health care
24:17
system could probably attest to the fact that there are bumps along the way.
24:22
There are communication gaps, there are unnecessary delays and extra,
24:28
you know, duplication of efforts that just make health care a little bit less accessible
24:34
and less seamless than it should be, and probably more expensive and less
24:38
efficient. And, you know, overall, just not helping the health of our
24:42
population. So this is like absolutely everything I'm working on is to try to
24:47
improve that. And I don't mean me, this is there's tons of leaders and people
24:52
across the province who are working on integrating our health system. And there's a
24:55
million different ways that that looks from allowing electronic systems to speak to one
25:00
another so that information can be found wherever you're seeking care.
25:05
Or maybe one day, like our provincial government has announced,
25:08
working towards a single electronic record for the whole province.
25:10
Wouldn't that be something or processes that mean referrals happen more seamlessly.
25:17
So if I need to send someone to see whoever a dermatologist that I don't spend time going
25:23
on a map and looking for dermatologists and sending them a letter to find out that they
25:27
won't take my patient and then do that all over again.
25:30
You know that there should be seamless portals that just.
25:33
I can pop this information into a portal and the system will find my patient,
25:36
a dermatologist, in their area that's available.
25:39
Poof! It's done. It's faster.
25:41
It's less work for me.
25:42
It's less waiting for the patient. It's less on the receiving end of the referral.
25:45
So these are all the kinds of things that are being worked on.
25:49
They require a huge amount of time and money.
25:52
Digital tools, as you can imagine, is a big part of it.
25:56
Privacy legislation is a big part of it.
25:58
So there's a lot of this is going to take a lot of effort,
26:00
but we're already making good strides.
26:02
And there's a lot of neat programs in place that make care much better already.
26:06
And there's still a long way to go.
26:10
Donna J. Jodhan, LLB, ACSP, MBA: You helped lead one of Ontario's first Ontario health team,
26:16
and for anyone hearing that phrase for the first time,
26:21
like myself, what exactly is an Ontario health team and what does it change about the
26:30
way care is delivered?
26:33
Dr. Danielle Manis: You're really hearing that term for the first time. And that says to me,
26:37
they know better. They need to do better PR because they need to get the word out there.
26:41
So what is an Ontario health team? So an Ontario health team.
26:44
The model was devised about 7 or 8 years ago.
26:48
Essentially the whole province is divided up into health regions.
26:51
Each one has a health team.
26:53
And each team is basically a collaborative body that incorporates all the health care
27:00
providers, patient representatives within that region.
27:05
And ours is called the North York Toronto Health Partners.
27:08
It is one of the you know, they were they were all developed at the same
27:12
time, but it was definitely one that developed quickly and matured very quickly
27:16
under fantastic leadership.
27:19
And it incorporates not only a primary care network,
27:22
but also our hospital and our, our not for profit partners in the community
27:28
and our home care agencies and a patient care advisory council.
27:33
So the idea is it's working towards that seamlessness,
27:36
right? It's the idea of stitching together silos that are providing care in the same
27:41
geographic area, having them work together like collaborators to provide services and
27:47
pool their resources.
27:50
Donna J. Jodhan, LLB, ACSP, MBA: That's a big job, isn't it?
27:51
Dr. Danielle Manis: It's it's a huge undertaking.
27:53
It's been, I think, hugely successful.
27:55
Obviously the primary care side is what I'm most involved in.
27:59
And the Ot's have really been delivering on the mandate of creating primary care
28:06
attachment. So making sure that pretty much everyone in our,
28:09
in our neighborhood has access to a family doctor or family health team.
28:13
The Oaks have been a big vehicle for making that work come to fruition among many,
28:18
many other amazing initiatives.
28:20
And, and we're great partners with North York General.
28:22
They really support this work, as do, you know,
28:25
all kinds of, you know, Baycrest and all kinds of other.
28:28
I don't want to start naming them because I will miss some because I think we have over
28:31
20 partners. But it's a very tight knit, collaborative group of health care providers
28:37
and agencies that have a shared goal, which is equity deserving care in our
28:42
communities. Seamlessness of care in our communities and just basically making our
28:47
community healthier and our system function better.
28:53
Donna J. Jodhan, LLB, ACSP, MBA: A phrase that comes up often in your world is patient attachment.
29:02
Along with the challenge of so-called unattached patients.
29:09
Can you explain what that means and what you and your partners are doing to help people
29:16
find a family doctor?
29:19
Dr. Danielle Manis: So unattached essentially refers to somebody who doesn't have a family doctor or access to
29:24
primary care. And it was identified.
29:27
I mean, this is no secret. This has been all over the media the last several years that
29:30
that more and more and more Canadians did not have that reasons are very complex.
29:36
A lot of it has to do with burnout and remuneration in family medicine,
29:41
and people quitting and not choosing to do family medicine or not choosing to do it in a
29:45
comprehensive way. And, you know, narrowing their practice down.
29:48
And lo and behold, we had lots of people without family doctors.
29:51
So there have been a lot of great policy shifts across the country to try to address
29:57
that. And one of them has been in Ontario, this,
30:01
this task force led by Doctor Jane Philpott, to basically attach all Ontarians to primary
30:07
care. I think the year was 2029.
30:09
I might be wrong about when that is.
30:11
So what's been happening in our Ontario health team is money flows.
30:16
If you create a proposal that is robust and meets the needs of the of the mandate of that
30:22
committee. And so we've been successful with getting some of that funding and creating
30:27
some that we actually there's actually a new family health team in North York,
30:31
which is a huge win because there are never new family health teams don't come along that
30:35
frequently. It's called the Get well family health team and that's run by Doctor Kevin
30:40
Lai. So that's, that's a big deal that a new family health team was formed and some of our
30:44
existing family medicine groups and family health teams were able to expand and accept
30:49
more patients because they got more funding for things like nurses and dietitians and
30:54
administrators, and basically having more people on the team that can help pick up some
30:59
of that workload, that can therefore allow everybody to take care of more patients.
31:03
So so far we've been doing quite well.
31:05
And one of the big wins, I think also because again,
31:08
the system can be a bit confusing was the fairly recent creation of a central intake
31:15
pathway. So anybody in North York who needs a family doctor can simply go to a website,
31:19
call a phone number explain who they are.
31:22
And there's an intake person who can help match them to a family doctor in North York.
31:27
So all of this takes a lot of work, and we've been quite successful in attaching
31:33
many of our unattached patients. I don't have the numbers right in front of me.
31:38
Donna J. Jodhan, LLB, ACSP, MBA: Is that website accessible, doctor?
31:40
Dr. Danielle Manis: Well, you know, I'm it's funny if you hear clicking clicking on it right now,
31:44
I have to find out if it's accessible.
31:46
How can I tell if it's, if it's accessible.
31:50
Donna J. Jodhan, LLB, ACSP, MBA: I guess I would have to go in and have a look.
31:52
Dr. Danielle Manis: Okay. Well, I can tell you what the website is and then you can go in and have a look.
31:56
Donna J. Jodhan, LLB, ACSP, MBA: Sure.
31:58
Dr. Danielle Manis: So it's the North York Toronto Health Partners website.
32:01
So it's that whole North York, Toronto Health partners.ca.
32:06
And if you can navigate through it, there's a button right at the top that says,
32:09
do you need a family doctor?
32:11
Click here, a red bar at the top.
32:13
And that actually takes you directly to our central navigation portal.
32:17
You can fill out an online form or call them if you like.
32:21
Donna J. Jodhan, LLB, ACSP, MBA: I would be interested to see how accessible the form is.
32:25
Dr. Danielle Manis: Yeah, it's in multiple languages that I can tell you for sure.
32:27
I don't know about the accessibility for people who are visually impaired.
32:31
Donna J. Jodhan, LLB, ACSP, MBA: Okay.
32:32
Dr. Danielle Manis: But we can have a look together and then you can let me know.
32:34
And then I can then I know who to who to contact if it's not okay.
32:40
Donna J. Jodhan, LLB, ACSP, MBA: So the clock is starting to wind down.
32:42
But I have this for you.
32:43
Dr. Danielle Manis: Sure.
32:44
Donna J. Jodhan, LLB, ACSP, MBA: You are a real champion of team based primary care nurses,
32:51
social workers, pharmacists, dieticians, and more.
32:57
All working side by side.
33:00
What does a true care team make possible?
33:05
That one physician alone simply can't?
33:09
And what do you mean when you talk about everyone practicing at scope?
33:17
Dr. Danielle Manis: So I'm old enough to remember being not being in a team.
33:22
So when I first started practice with my colleagues, it was just we were four
33:26
physicians and one and a half administrators,
33:29
and that was it. No. No nurses.
33:30
We had no access to mental health supports for our patients.
33:33
We had nothing, no dieticians which really just meant we did everything ourselves,
33:37
which is okay. You know, everybody's happy to roll their sleeves up
33:40
and get to work. But then what happens is if you're,
33:42
if you're trained to do a certain set of skills,
33:46
but someone else can also do some of those skills. So you can do some of the higher
33:49
level skills and you're not busy, I don't know,
33:51
like giving vaccines to babies.
33:53
That's fine. I don't mind doing that.
33:55
But now that I'm in a team based model I've got a nurse who can do that and I've got
34:01
actually, to be honest, a nurse who can do a lot of things better
34:04
than I can do them because that's their expertise.
34:06
So, so they can spend some time you know, counseling the patient on all their screening
34:11
prevention maneuvers or diet or exercise or how to take their medications properly and
34:17
doing their height and weight and giving them vaccines and all of that stuff that I can
34:21
also do. But the idea of everybody working at the top of their scope of practice,
34:25
doing the job that they're trained to do, just means that you build capacity in the
34:30
system. It means that therefore it's more efficient and you can actually take care of
34:34
more people and do more things.
34:37
And so that's really where team based care excels.
34:40
Again, it also goes back to that one person cannot be everything to everyone.
34:44
So if you can't be in the office seven days a week,
34:46
but you have somebody who can answer messages,
34:48
answer the phone you know that you create more access for people to their health care
34:54
team, but also we have to rethink, like, again,
34:57
we've talked a lot about how valuable that one on one relationship is with the family
35:01
doctor. We do need people to start opening their minds to this team based model and
35:05
understand that, yes, their family doctor might be kind of the
35:08
anchor of the team, but that's their team too.
35:11
And that getting care from the nurse or the dietitian or the social worker or the
35:15
administrator who answers the phone is care.
35:17
And so that that counts as access and that those people are really there to help take
35:21
care of them. Because I think it also contributes a lot to burnout when people feel
35:26
they have to do everything themselves. And this is where we saw people leaving family
35:30
medicine. So when teams work well together, everybody is happier.
35:34
You know, the people who are providing the care,
35:37
the patients get a little bit more access.
35:39
They get more expertise from people who know how to do different things.
35:43
You know, and ultimately things just run better.
35:45
So it really is the, the ideal model.
35:49
Donna J. Jodhan, LLB, ACSP, MBA: I think like for me, I've had to get used to the team based approach.
35:53
And, and I remember at first nurse Emily, I didn't want to see Nurse Emily.
35:58
No way would I want to see poor old Nurse Emily.
36:01
But I've gotten used to her.
36:03
I understand her function and, you know, like she's there to help.
36:07
Dr. Danielle Manis: Yeah. And she really does have expertise.
36:09
She's a certified diabetes educator.
36:11
She's got expertise that I don't have.
36:13
You know, that's the other thing, like, I really felt the absence of it in my
36:16
early practice years around the mental health support.
36:19
And it's shocking, really, how much of our days we are spent dealing
36:24
with mental health problems.
36:25
It's like, I think it's the bulk of what family doctors are doing these days.
36:28
At least that's me. And I'm no psychologist or social worker.
36:31
And if you have no access to that support for the patients and they can't pay for it.
36:36
And, you know, it's it's a huge burden and we're not really equipped for it.
36:40
Now, I have social workers I work with.
36:42
I can refer my patient to someone who has that skill set or a dietician who can help
36:46
them work through how to manage their IBS and their high cholesterol.
36:49
I don't have that skill set.
36:51
And it's not just that I don't have the time. I don't actually know how to do it. Well, I'm
36:54
not trained for it. So really, it does elevate the level of care across the
36:59
board to have all of these other experts in their areas working together.
37:04
Donna J. Jodhan, LLB, ACSP, MBA: And I will share with my listeners, a few years ago,
37:06
when my mom fell and I, I don't know, I just thought,
37:09
oh gosh, am I going to lose my, my girl here?
37:12
What's going to happen?
37:13
You sent me to a social worker on your team who really,
37:18
really, really helped me out and, you know, like worked out for that team based
37:23
approach, like, where would I be?
37:25
Dr. Danielle Manis: Yeah. You know, and I don't have the skills that she had.
37:28
Right. And so I'm really grateful for that because I think you needed that and I needed
37:33
you to have that. And we're really, really lucky to work with wonderful
37:37
professionals.
37:39
Donna J. Jodhan, LLB, ACSP, MBA: So Doctor Danny, we're almost at the end of our podcast and I have this personal question
37:44
for you. Sure. Would you like to see any of your kids in family medicine?
37:52
Dr. Danielle Manis: You know, I would, but the ship has sailed because my kids have chosen their paths and
37:57
and medicine is not happening for them.
38:00
But would I recommend it for them?
38:02
100%. I think it is such a rewarding career.
38:06
And yes, there are challenges.
38:07
And yes, it is difficult and it is a hard work.
38:10
And you know, the the inbox management is a bit of a plague upon all of us.
38:16
That being said, I'm so hopeful for the future.
38:18
I've already seen, I think, transformational change just in the past 4 or
38:22
5 years in terms of care models and oat work and changes in remuneration.
38:27
And I see our young trainees coming through, our medical students and our medical
38:31
residents. And I've been teaching trainees for many,
38:34
many years. And I there's a feeling of optimism in.
38:39
It's palpable in the last couple of years of our trainees.
38:42
I just think that they're coming in at such a great time.
38:45
And primary care is primary.
38:47
You know, like it's, it's, it was there was a lot of years where the
38:50
focus is always on acute care and hospital care and surgery and in medical education.
38:55
And there's what they call this hidden curriculum where there's a quiet messaging
38:59
that like, you know, if you're just going to be a family doctor or if you're,
39:03
you're, if you're too smart to be a family doctor,
39:05
why aren't you being a surgeon or something like that?
39:08
And I think that we've really done a great job of reversing that messaging and
39:12
understanding that family medicine physicians are specialists,
39:16
and that generalism is a specialty, and it does take a very challenging skill
39:21
set. It is intellectually rewarding and difficult.
39:24
It is emotionally rewarding and difficult.
39:27
You know, sometimes I liken it to parenting a little bit where,
39:30
you know, parenting is all encompassing and, you know,
39:33
you're exhausted at times and it's exasperating at times because you care so
39:36
much. But at the same time, it's incredibly rewarding.
39:39
And I feel the same about family medicine.
39:41
It's hard, but it matters.
39:43
And the rewards are so great.
39:45
And, and I just feel really optimistic about it.
39:47
I feel there's no other career I would have wanted for myself.
39:50
I would definitely have encouraged my kids to go down that road if they had any inkling of
39:54
an interest. And I'm delighted to mentor any of our medical students,
39:58
aspiring residents into family medicine because I think it's fantastic.
40:03
Donna J. Jodhan, LLB, ACSP, MBA: I'm kind of sorry that none of them decided to follow in your footsteps.
40:07
Oh, dear.
40:08
Dr. Danielle Manis: Oh, there they are. Their own people, and that's great.
40:11
And I'm here to support them. That's perfect.
40:14
Donna J. Jodhan, LLB, ACSP, MBA: There is one particular resident that I met and I told you this.
40:18
I thought she was one of the best residents.
40:20
I don't remember her name.
40:22
Nice young lady.
40:24
Dr. Danielle Manis: How many years ago?
40:25
Donna J. Jodhan, LLB, ACSP, MBA: Roughly about 2 or 3 years ago.
40:27
Dr. Danielle Manis: That was probably Zahra.
40:29
Donna J. Jodhan, LLB, ACSP, MBA: Could be.
40:30
Dr. Danielle Manis: Zahra Bahira. Did she have an accent?
40:32
She's from Iran.
40:33
Donna J. Jodhan, LLB, ACSP, MBA: A little bit of an accent, but she was.
40:36
Oh my God, my. I said, this is our future.
40:39
Dr. Danielle Manis: Oh well, then I'm going to have to send this to her. If it was her, it could have been
40:42
someone else. I've had a few female residents.
40:45
I've had mixes of different residents over the past years,
40:48
but had some wonderful.
40:50
I had Nicole Schooley.
40:51
She was a resident about during Covid, so probably six,
40:55
seven, five, six years ago.
40:58
Donna J. Jodhan, LLB, ACSP, MBA: No. Not her. No.
40:58
Dr. Danielle Manis: Not her. So maybe it was Zahra.
41:00
Yeah. We've had some wonderful, wonderful trainees. I can't say a bad word
41:03
about any any one of them.
41:04
I would be delighted for them to take care of me in my old age.
41:09
Donna J. Jodhan, LLB, ACSP, MBA: You have a long way to go.
41:10
Dr. Danielle Manis: Don't worry.
41:12
Donna J. Jodhan, LLB, ACSP, MBA: It has been a pleasure having you, and if you ever wanted to come back and talk
41:17
about, you know, what's going on in your neck of the woods,
41:20
please reach out to me and let me know, because I'd be delighted to have you again.
41:25
Dr. Danielle Manis: Thank you John. I'm honored to know you. And it's funny, as much as I say I love knowing
41:28
my patients. The first I ever heard of you in a pottery studio was during your
41:32
introduction. So clearly some things to learn about you still.
41:37
Donna J. Jodhan, LLB, ACSP, MBA: Well, there you go. So thank you very, very much.
41:41
I wish you a great summer.
41:42
And I think I'm supposed to see you at the end of September.
41:45
Dr. Danielle Manis: Perfect. Have a wonderful summer. Thank you so much for having me.
41:48
Donna J. Jodhan, LLB, ACSP, MBA: Thank you. Doctor. Danny. Take care now.
41:51
Dr. Danielle Manis: Bye bye.
41:51
Donna J. Jodhan, LLB, ACSP, MBA: Bye bye.
41:55
Podcast Commentator: Donna wants to hear from you and invites you to write to her at donna@gmail.com.
42:01
Until next time.