Danielle Martin

A family doctor and the VP of medical affairs and health system solutions at Women’s College Hospital in Toronto, Danielle Martin is an evangelist for single-payer health care. (Nathan Cyprys)

Features | From Pivot Magazine

The good doctor

Danielle Martin is shaping the future of Canadian health care

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A family doctor and the VP of medical affairs and health system solutions at Women’s College Hospital in Toronto, Danielle Martin is an evangelist for single-payer health care. She writes books about it. She lectures the U.S. Senate about it. And she points out where it falls short. Her ultimate goal? To make our system faster, cheaper and more effective. 

A few years ago, you schooled the U.S. Senate on the benefits of single-payer health care, earning accolades from Bernie Sanders. So what’s Bernie like? Do you text? 
DM: Ha, no. We’re not BFFs, but I respect him. He and I agree that the core value—one that’s shared by all Canadians—is equity, the notion that access to health care should be based on a patient’s need and not their ability to pay. 

At Women’s College, you’re trying to reduce the number of health care services we use. For example, the hospital can perform same-day knee replacements, where the patient is home six hours after surgery. How does that work? 
DM: The procedure itself doesn’t change. What changes is pre-surgery education and home monitoring afterwards. It’s not super high-tech: we do virtual care using tablet apps, email, even the phone. During the operation, we use innovative anaesthesia techniques where people can be awake but experience no pain. That allows them to get up and start moving 

How do the patients feel about it?
DM: They love it. One patient who did his same-day knee here is coming back to have the other knee done. It’s not going to be for everyone—certainly not for someone who lives alone or in unsafe housing. But if just 20 per cent of joint-replacement patients were appropriate for this kind of intervention, the savings to the health care system would be huge. Our early analyses suggest these operations may cost half as much as those where the patient is admitted. Going forward, we’re hoping to do similar same-day procedures for hip replacements, hysterectomies and some cancer-related surgeries. 

Canada is now known as a hub for artificial intelligence research. How will that change the way we use health care?
DM: AI is already being applied in radiology—it can read MRIs and CT scans and differentiate normal from abnormal results. Some people believe AI will eliminate the need for radiologists entirely within five years, though I think that’s probably an extreme prediction. AI can’t provide the same comfort as real people. Although, at a nursing home in Tokyo, robots are trying to do that for senior residents, so who knows?

What other ultra-futuristic technologies are you excited about?
DM: I just visited a virtual hospital in St. Louis, where there are no beds or patients. It’s just doctors using screens to monitor ICU beds, rural hospital wards, patients who require mental health care. Some of it feels quite futuristic: people with complex chronic diseases like diabetes, heart failure and lung disease are sitting in their homes while their weight, blood pressure and other metrics are beamed back to their health care providers. Sometimes they need a special scale or piece of equipment, but most of this can be done using devices people already own—there are mobile apps that can measure biometrics just as well as hospital monitors. 

And I’m sure virtual care cuts down costs significantly. 
DM: It cuts hospital admissions, readmissions, visits to the ER. We need to help people manage their illnesses in their homes, communities and natural habitats, instead of dragging them to the hospital every time they need something. We don’t have enough beds for them, and they don’t want to be in a hospital. 

Does home-based care deliver the same health outcomes as in-hospital care? 
DM: If done properly, the outcomes are better. We just need to be as rigorous about evaluating these new methods as we are when we evaluate new drugs. 

We’re in the midst of a start-up boom, and many people are creating health-related apps and wearables that patients can use themselves. How do you feel about these private companies entering the health care sphere? 
DM: Some of them are addressing real gaps in the health care system—virtual mental health care services, for example. But as soon as you make these private, paid things, you introduce barriers for the people who would most benefit.

How do we solve that problem? 
DM: The public system can either treat them as competition and perform better in these areas, or purchase the technology and make it available to everybody. 

Universal pharmacare will be one of the biggest issues of next year’s federal election. I know you’re a proponent—you’ve authored studies on its viability and advocated for it at conferences. What’s your elevator pitch? 
DM: Canada is the only developed country in the world that has universal health care that doesn’t include prescription drugs. It’s absurd that a person can see a physician at no cost, but the minute we try to treat them, they’re on their own. One in five Canadian households includes a person who is not taking their medication because of cost. Huge numbers of people who come into the ER for preventable complications could have been treated if they had been able to afford their medicine. If we had a single buyer, we could regulate those costs, buy medications in bulk and bargain with the pharmaceutical industry. In the short term, it could save about $7.3 billion per year.

Now, I need to know: what’s your healthiest habit? 
DM: I drink at least three litres of water every day. 

And your biggest vice? 
DM: Dark chocolate in unlimited quantities.