Shaping the future of medicine: How TMU is redefining patient care

What if the next time you see a doctor, you are treated as a person, not just a patient, and your culture and background are embraced, not overlooked? That’s the vision Toronto Metropolitan University’s School of Medicine is bringing to life. Through its bold new approach to medical education, TMU is transforming health care in Ontario to provide a person-centred experience that is as unique as you are.

Transcript

Amanda Cupido: This is The Forefront, a Toronto Metropolitan University podcast that explores ideas for cities. I'm Amanda Cupido.

So here's the problem: while our population continues to grow, it's becoming harder for Canadians to access the health care they need. According to Statistics Canada, 2023 was the country's fastest growing year since the 1950s.

Plus, according to OurCare research, approximately one in five Canadians don't have a family physician. Wait times for specialists have skyrocketed too. Last year, a report from the Fraser Institute found that the median wait time for you to get a referral from a general practitioner to the time you actually receive the treatment is over six months. It's the longest wait time in the report's history. 

With our health-care system so overwhelmed, Canadians often have little to no say in who ends up giving them care. And with immigration making up 97.6% of our new population growth, many of us may find ourselves in a situation where our provider knows little to nothing about our culture, background, or the type of care we need. 

Angela Carter: I went through some mental issues, you know, had some family issues that really affected me. You know, it was a tough time, and I did seek help of a psychiatrist, who was not from our cultural background, and the way he spoke to me was so standoffish. 

Amanda Cupido: That's Angela Carter. She came to Canada in 1989 from Barbados. She knows firsthand how important it can be for a provider to understand their patient's culture.

Angela Carter: I went to him twice and I left. He wasn't sympathetic. He didn't understand what I was saying. He didn't understand our family dynamics and stuff like that. He couldn't connect. He had no idea about our culture, background or why we do certain things, right? So it's like, I understand. People would just probably go further into their shell, go further into that state and probably become more depressed. 

Amanda Cupido: Luckily for Angela, this was a one off.

Angela Carter: I've been fortunate to have chosen doctors that understand me, are willing to work with me. Because if they're not, I'm going to leave them and go somewhere else. 

Amanda Cupido: She says she has confidence in herself to speak up in those moments, and credits her background in journalism. But she knows it's not easy, and is driven to help others. 

Angela Carter: For many years, I've been a community advocate, really, especially in the Black, African and Caribbean communities and marginalized groups. I'm always a champion of people who seem voiceless or who are afraid to speak out or don't have the time or the energy to do that work. 

Amanda Cupido: That's what motivates her every day as the Strategic Advisor for Roots Community Services, an organization that works to provide culturally sensitive and culturally enriching programs to the Black, African and Caribbean communities in the region of Peel. 

Angela Carter: When you go and you see someone that looks like you that's providing that service, it makes a difference. It provides a bit of a comfort level. And then when you're talking to them, and the way they talk and exchange information with you and allow you to have a voice as well. 

Amanda Cupido: Angela has spent 40 years doing this work. She says one of the things that makes them stand out is their streamlined intake. There's no huge stack of papers you need to fill out as soon as you walk in, it starts with a conversation. 

Angela Carter: You know, why did you come to see us? Because, what do you need? And we start to talk and build that relationship. Have them understand, we are there for you. Helping them to say, you know, within you, you probably have the answers, but we are here to help guide you to find those answers. 

Amanda Cupido: Their program is called Pathways to Wellness, and focuses on areas that tend to be overlooked. 

Angela Carter: So especially from a mental health perspective, this is a big taboo in many cultures, we know, but especially in the Black culture we have in the Caribbean, you know. And so by talking about mental health, people go straight to, "You're asking me if I'm mad?" And mad means, not getting mad, angry, but mad means that you're cuckoo. You've gone crazy, right? You belong to the, as we say, belong to "the mental" because when we talk of belonging to "the mental", that is a mental asylum. So when you talk about “mental” anywhere, people's heads are going to, "Okay, you're talking about going to an asylum." Understanding these things, right, and using certain terms, or avoiding certain terms when we're talking to people, really makes a difference. 

Amanda Cupido: Angela is not the only one who understands the importance of fighting for these kinds of tailored approaches.

Excerpt from School of Medicine promotional video - (different voices speaking): They would speak our language. They would understand our culture and our faith.

Amanda Cupido: That's a snippet from Toronto Metropolitan University's latest video about creating healthy change for communities across Canada. They're doing this by introducing a bold new medical school. The founding Dean, Dr. Teresa Chan says the change that's so desperately needed starts with education. 

Dr. Teresa Chan: What makes a physician awesome is that they integrate not just the medical knowledge. They also understand the person in front of them. They also understand the society that we live in, and they also understand how we're going to put that all together in a package that works for that particular person in their circumstance. And I think we're still far away from all of that. So, suffice it to say is that we're trying to train doctors who are savvy enough to be able to help tackle the big, wicked problems of the future. 

Amanda Cupido: Dr. Chan is also the Vice-President of Medical Affairs at TMU and an emergency physician. Her dad and her sister are also doctors, which she says has given her a strong sense of agency within our health-care system. 

Dr. Teresa Chan: I'd love for everyone to feel as empowered and as engaged in their health as a physician who's going through the system. I want to bring that kind of agency and that kind of disruption in a good way to health care and be able to help physicians close that gap, decrease the power dynamic, but activate the patient so that they can also meet us halfway, right? Thinking about it as power sharing, thinking about it as changing the system around, so that the patient actually becomes a better systems navigator over time, that they don't need us as much, but that we can then be doing something different for them and helping them in a different way. 

Amanda Cupido: In the summer of 2025 the Toronto Metropolitan University School of Medicine will open its doors. Dr. Chan says one of the elements she's particularly passionate about is keeping equity and inclusion front of mind through a student's entire schooling and career. 

Dr. Teresa Chan: It's great if we think about equity, and if we have equity in our hearts, but if we can't get that out into the world, then we're in trouble, right? And so I think that it is not just about living and thinking about equity, it's about actually being able to make it manifest in reality. Sitting at the really boring, boring meetings, writing the 70th iteration of a protocol, you know, like having yet another Zoom call where you're arguing about the semantics of the fifth word in a sentence, all of that is actually really important in order to change reality. And how can we give the gift of tools to a new generation of physicians so that they're really prepared to do all of that in a way that doesn't burden them. 

Amanda Cupido: She says since the COVID-19 pandemic and the advent of AI models like ChatGPT, it's more important than ever for educators to play a more active role in preparing future physicians for a rapidly changing world. 

Dr. Teresa Chan: Medical knowledge has been democratized in a way that is very, very different, and now we have to think about fighting misinformation. Think about how we can actually engage physicians to actually be out there in the world, being able to truly think through and guide patients as someone by their side through their health-care journey. To help them navigate, to be one part GPS, one part friend, one part confidant, one part coach and one part someone who truly just gets some of the science in a way that integrates it well.

Amanda Cupido: In Canada, we pride ourselves for our diversity. In our most recent census, more than 450 ethnic or cultural origins were reported, and Dr. Chan believes in a future where we can all get access to inclusive health care. 

Dr. Teresa Chan: First of all, technology is going to be huge in this. I've seen some universal translator technology that literally, it's going to be like Star Trek. I'm going to put an earbud in, I'm going to give someone else an earbud, and then they're just going to hear me speak in English and simultaneously translate. We're still going to need to overcome cultural differences and other kinds of mannerisms and all the soft skills, but the language part might actually be taken care of. 

Amanda Cupido: She says another way to help is by educating a more diverse student group and helping them break into the health-care profession. 

Dr. Teresa Chan: Cultural and background alignment can be very powerful. Someone that understands how hard the struggle is to put food on the table is going to think about the difference between an expensive inhaler and an inexpensive inhaler when they're writing a prescription. But also, I think that having more diverse doctors in the system can help change the education system, create that peership across the country, and help bring people along to understand all the different backgrounds, content, culture, language nuances. I think health-care equity is something that everyone cares about in medicine. And in a publicly funded system, we have to care about it a lot more. 

Amanda Cupido: Dr. Chan explains how breaking stereotypes can be really powerful and have ripple effects. 

Dr. Teresa Chan: It really changes the way that you see the world when you see diversity, and especially in places and spaces that are around health care. Because I think if you see a diverse group of physicians coming round at your bedside, you realize that they're there to take on the world, and that you can have different experiences with different people, and change the way that you think about what it is that you could offer the world too. It's all paying it forward. And I think that having diversity in all ways helps us all think about how we could diversify the way that we contribute to the city in return. 

Amanda Cupido: Looking ahead, Dr. Chan says she thinks the School of Medicine will definitely be able to make change. But there's one thing she knows the current system needs. 

Dr. Teresa Chan: The system itself needs to be more agile. And if we can bring people in, we can help the system slowly but surely change. We can make great headway in making the world a more equitable place. 

Amanda Cupido: When it comes to Angela's hopes for the health-care system, she wants to see three things: a preventative approach, more availability and a new definition for healthy living. 
Angela Carter: Don't say healthy living, "Oh, go and exercise," or "go and join a gym." It's more than that. It is more than, "Oh, go on a diet." It is, "Okay, how can I prepare the foods that I'm accustomed to in a healthier way? How can I do that?" Yes, you know, we all have our different tastes and likes for the foods that we grew up with. Don't tell me when I'm 60 or 50 or 60, that I can't eat cassava or breadfruit anymore. You know what I mean? So how can we prepare these from very young and help them to understand this? So instilling that in our culture, in our country from a very early age, and help people to live comfortably within their culture and embrace each other's culture. 

Amanda Cupido: Before we go, here's a final word from Dr. Chan about why TMU's approach to inclusivity is so special. 

Dr. Teresa Chan: Toronto Metropolitan University has developed this reputation of really being that changemaking organization that really understands, just like this podcast, what it means to be a true citizen. I think that health care needs more citizenship for doctors to see themselves, not just as ivory tower top notch people, but rather people who can actually be engaged in the world and live alongside patients and integrate into the community. So how might we be able to bring all these people together to rethink the future of what health care could be? That's been something that I've really enjoyed since coming here, is that the community really, really, really, really, really sees the potential in the medical school, and so we want to make sure we live up to that expectation, but also the generosity that people have displayed in being able to think through, how might we be able to work better together?

Amanda Cupido: This podcast was created for alumni and friends by University Advancement at Toronto Metropolitan University. Special thanks to our guests on today's episode, Angela Carter and Dr. Teresa Chan. This podcast was produced by me, Amanda Cupido and Jasmine Rach, who also edited the show. We are both proud grads of TMU. The team from the university includes Haweya Fadal, Meredith Jordan and Rivi Frankle. To help fuel the research and learning coming from the TMU School of Medicine, consider donating to Toronto Metropolitan University. Join us in shaping a brighter future together. Visit torontomu.ca/alumni/podcasts.