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Postcards from the North: the winds of change are coming


In healthcare dramatic change is also afoot. For the first time in a generation, the barriers between primary healthcare and tertiary care are being eroded.

Denise Campbell-Scherer


The wind is blowing in Alberta; the blue sky is painted with brilliant colours as the leaves turn dozens of shades of yellow, orange and red. The bite in the air is taunting us with the knowledge that the weather will turn in a moment, and winter will be upon us.

Winds are blowing of another sort – small gusts of promise indicating that a different change is in the air, which I believe are gathering to so profoundly transform the landscape that the mind will struggle to recall the previous season. Living in the North, as Sid Marty says “under the spell of the great Chinook”, we are accustomed sudden, rapid change.

We are, in a sense, culturally more aware of the need this brings to rely on neighbours and community, which translates into a distinct culture of consensus building and relationships. Maddening in some senses, when one wants to “get something done”, but incredibly powerful in building communities of understanding.

In healthcare dramatic change is also afoot. For the first time in a generation, the barriers between primary healthcare and tertiary care are being eroded. The first steps are tentative, with sincere efforts to forge trust and understanding. Though the clinical cultures are very different,  the intense siloed structures have not been working to the benefit of those we serve, patients. While more resources have been poured into healthcare, we are left struggling with problems of access in a “universal system”. As a consequence, practitioners are experiencing profound burnout, as they endeavour to patch the system through individual efforts to build bridges and connections.

Wise Canadian sage, André Picard, in his book Matters of Life and Death, compiles decades of challenges in health care. Outlining the need to stop over investigating and over treating, to focus on people – especially those marginalized – to reframe health care around people, and to tackle the determinants of health head-on.

How do we focus care on people then? This is far more an adaptive challenge than a technical one. It involves changing the culture, evolving systems, shifting expectations, learning new skills, and finding new ways to understand. How do we help healthcare practitioners not only stay abreast of new information but also develop the skills and resources to effectively engage in collaborative deliberation with their patients?  How do we help healthcare teams co-create new ways of working together? How do we help health policy makers craft the narratives to help shift the system organization to do this work?

Like any good journey, I’m not sure where this one will lead. I have more question right now than answers. There will be many interesting challenges and characters to meet along the way to sit and chat with for a while, new experiences to reflect on, and unique places to visit. I’ll be sure to send along a postcard from time to time.

Till then, goodnight.


Denise Campbell-Scherer, Associate Editor BMJ EBM

Associate Professor in the Department of Family Medicine, University of Alberta,

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