Transforming Care with Physician Leaders
Date
January 29, 2025
Runtime
43:58
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When it comes to health system transformation, the frontlines are at the forefront. Explore how clinical expertise and leadership drive innovation as two physician leaders share their journeys – and what past lessons we need to carry into our future health systems.
Themes
- Change management lessons learned from EMR adoption and COVID-19
- Supporting clinicians to implement new workflows
- No matter how shiny the technology – health care is about people
- The transformative power of strong mentors and effective teams
Learn more
Guests
- Dr. Chandi Chandrasena, Chief Medical Officer, OntarioMD
- Dr. Lisa Bryski, former emergency department physician
Speakers
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Dr. Chandi Chandrasena
Chief Medical Officer, OntarioMDDr. Chandrasena is OntarioMD’s Chief Medical Officer and an experienced peer mentor and educator. She is knowledgeable about digital health tools and technology and practical ways to incorporate them into practice.
Dr. Chandi Chandrasena has been a family doctor for over 20 years and practises in Ottawa, Ont. She is also OntarioMD’s Chief Medical Officer, providing the clinical perspective and advice to inform current and future digital health products and services for physicians to add increasing value to patient care.
Before joining OntarioMD, Dr. Chandrasena was an OntarioMD physician peer leader for six years mentoring physicians and practice staff to incorporate technology effectively into their workflows. She has been a regular speaker at many national and provincial conferences providing practical tips and best practices on certified electronic medical records systems and integrated digital health tools, as well as medical mobile apps that clinician practices have found valuable for patient care. Dr. Chandrasena also works closely with the Continuing Medical Education Department at the University of Ottawa.
Dr. Chandrasena has advised the Champlain Local Health Integration Network on local issues and providing clinician-facing solutions, and has had roles on several boards and executive committees and co-chaired committees on virtual care and digital technology. Dr. Chandrasena has held many leadership roles at the OMA, including the elected chair (2018-2020) for District 8.
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Dr. Lisa Bryski
Former emergency department physician
Transcript
Transforming Care with Physician Leaders
Dr. Chandi Chandrasena: You don’t want to make your burden less and technology better for you at the expense of someone else.
Katie Bryski: Hello and welcome to Digital Health in Canada, the Digital Health Canada podcast. My name is Katie Bryski and I am a podcaster turned digital health professional.
Shelagh Maloney: And I’m Shelagh Maloney, a digital health professional turned podcaster.
Katie Bryski: When it comes to health system transformation, the front lines are at the forefront.
In today’s conversation, we’ll explore how clinical expertise and leadership drive innovation and how we can support clinicians in implementing new technologies. And we are very excited to welcome two great clinician leaders to share their perspectives and their journeys. A very warm welcome to Dr. Chandi Chandrasena, Chief Medical Officer at Ontario M. D. and Dr. Lisa Bryski, a former emergency physician from Winnipeg. Welcome to you both and thank you for being on the podcast.
Dr. Chandi Chandrasena: Thank you.
Dr. Lisa Bryski: Thank you, Katie.
Katie Bryski: And in the interest of full transparency, I will say that Dr. Lisa Bryski Is a relation of mine.
She is my aunt and so it is extra special to have you here today Thank you so much for being part of the show
Dr. Lisa Bryski: Thank you Katie. You’re an awesome niece and not just for this opportunity.
Shelagh Maloney: One of the things that we often do in our podcast is just ask folks to tell us a little bit about their career journeys This is about digital health, and it’s also about leadership.
Chandi, why don’t we start with you? Tell us sort of what drew you to medicine, and how you got to where you are today.
Dr. Chandi Chandrasena: That’s a great question. You know, I think most people who go into medicine, it’s because they want to help people. You must hear that all the time. You know, I want to help people. So, I’m going to be the same and say I want to help people.
So, I got into medicine for just that. But it was a little bit more for me. So, I had some significant medical issues as a child. So, I spent a long time on the patient side of healthcare. And you know, my parents were new immigrants, we were navigating a totally unfamiliar system, not a lot of resources, not a lot of support.
So we ended up kind of muddling our way through the health care system and then eventually I became the family navigator pretty early on. And so, I think these experiences really shaped me because since I was very small, I was in the health care system all the time. And I kind of realized how challenging the health care system was and I really do want to make a difference but I think it was also how do I help those that have similar struggles because our health care system isn’t so easy to navigate.
And then along the way I had these incredible mentors. So I have to tell you, as much as I want to help people, I think if I hadn’t met these amazing doctors and I had met amazing other people I could have very easily gone another way because I think we underestimate the power of amazing people and mentors.
And I had great docs that looked after me and doctors in the hospital and they really pushed me into medicine also. And then I had these amazing family doc mentors when I was a medical student and I was like, “Oh, that’s so cool. I want to be just like them.” And then I became a family doctor and then, you know, I met all these amazing docs in digital health.
And then that’s how I ended up in digital health. So really, it’s about giving back and advocating for patients and the profession and the health system as a whole and just doing something that you really like, you know, and that’s exciting.
Dr. Lisa Bryski: Surprisingly, I have a bit of a similar experience. My interest began also in childhood when I had an orthopedic issue.
I’m originally from Montreal, so it was easy to go down to Boston at that time where arm lengthening, humerus lengthening, they were only doing legs mostly at the time when I was a young pup. And that continued on and in high school had a little bit of arts pop up with me and grade 12, that big decision of which way are you going to go?
Is it arts or sciences? And the drama program shut down that year. So that was like, well, the world is saying this is where I’m going. It felt like a natural fit too: the same thing of wanting to help people, feeling like there’s some power of giving that makes you fulfilled. And within med school and going into residency, I noticed that I gravitated mostly to the emergency department.
It’s very full teamwork, full on teamwork. You are part of a team, nursing staff, unit clerks, unit assistants, housekeeping. The thing that just made me just click into there is that I would always hear the stories and feel closest to what was going on there. And you never knew who in your team was going to find out what was actually going on with the patient’s health to help them through it.
It could be the health aide saying, “They mentioned this when they were walking to the bathroom and I was assisting them.” That part fascinated me. Going on in emergency medicine at that time was starting to be a residency program in both family medicine and FRCP. I came from the family medicine route and went through the emergency program and eventually ran it in Manitoba and had the grace of being able to be part of it.
Our national emergency program – made it up to the chair of the program for the family medicine and met such great people, and my homegrown people that I had in my department at the Health Sciences Centre, adult side, still, even though I’m retired, that’s my heartbeat.
Katie Bryski: I love with both of you, this sort of interplay between your personal experiences and what started you down the road and the importance of having that team around you, right?
Whether they’re mentors that are encouraging you or pushing you down a certain path, whether it’s colleagues that you’re inspired by, maybe after you no longer work together, even. I’d like to dive a little bit into the day to day. As you know, we are the Digital Health in Canada podcast. Digital Health Canada and our listeners have an interest and a familiarity with digital health technologies.
From your perspective, both as a family physician and an emergency medicine, what is the average experience with health care technologies right now for clinicians?
Dr. Chandi Chandrasena: So I have a bunch of lenses when I’m going to answer this question, right? So I’ve been a family doc for over 20 years. So I’ve got that community and I started on paper, like literally it was just me, a stethoscope, a pad, a paper and a telephone.
And that was my life. And now we’re all fully digital. But I’m also, as you had mentioned, I’m the chief medical officer for Ontario MD. So I’m also kind of that clinician facing kind of advice for digital health in the community for Ontario. So I kind of get a view of what’s happening through the province and other people.
And you know, it’s a tough question what you’re saying because we’re not a unified voice. I think everyone knows that. We like to say we are. We like to say we’re the voice of family medicine or the voice of tertiary care, but the truth is if you get five of us in a room, we’re not going to agree on anything.
So there’s a lot of strong opinions in this group, and so I think that comfort level, it depends, right, it depends on what area you’re looking at. But I can tell you that when the EMRs came out around 2008, when most of us were on paper, it was very low. And it took a lot of change management and adoption and education and learning and teaching to kind of get that comfort with technology.
And then by 2010, the majority were on EMRs, at least in Ontario. And that’s gotten, now it’s more other digital health technology. So I think clinicians are more comfortable with their EMRs. But they’re not using it to their full potential. And we’re not really early adopters as a group. We tend to kind of wait and see, and then kind of learn as we go along.
So I think there’s still a lot of room there and there’s a lot we can leverage. But I do think as a whole, we’re starting to become very tech savvy.
Katie Bryski: How about in acute medicine, Lisa?
Dr. Lisa Bryski: In Manitoba, we had a similar experience. I came out in ‘96 for my area. And again, yeah, it was all paper. You would flip through the charts to see, you’d actually look for a colleague that you trusted their opinion especially, and you’d look for their writing, and you knew they’d do a good summary that way.
And then, it’s almost like each level and step we had, you could almost see whoever was close to retirement and be like, “Okay, well, I’m out because this is the step that I don’t feel like I’m ready to learn from.” And with each step, like we started having, first of all, voice activated. One guy was trying it, our department head at that time in the emerg, and we’d be listening to how he was fumbling through it. And some of us be interested in trying it too. And then we would move towards having a pager system that was reachable anywhere, including the bathroom. So that was the only difficulty with that one.
And then we started having, yeah, the EMR and the, for us, the radiology went first and that was a revelation being able to have it on computer and being able to screen through and scroll through, I think, gave us in emerg a little bit of an excitement and we were lucky in my emerg, Dr. Bob Sweetland – Dr. Robert Sweetland – was our liaison between the digital systems and the group, and he brought in so much great teaching, both in teaching sessions, as well as hands on in the emerg during your shift, that it brought people on board pretty quickly in my group.
We were pretty lucky with Bob’s leadership and expertise in that. Some of the things I haven’t been there for at least two years, three, four years, actually. I went to vaccine clinics after we filled up, I sort of got to move through the emerg. I was retiring as the pandemic came in, came in to help until we got filled up again.
And from that, I think the main things I had when I was moving, and it may still be, is that the information glut, trying to pick through what is important, what’s not important. You used to be able to have a better sense of this person, okay, a flip through a chart. And now you have to tab it and look through and try to find a summary within there that will give you that sense. So, we’re still finding our way with how to make it succinct across the emergencies, but where I hope it goes also is that it becomes something Canadian wide, where we have the succinctness.
So if somebody is traveling to a different province, and if there’s something that goes on, say with a cardiac event, that there’s an access across the country with specific parts of their information, that is obviously. I think it’s really important that we get that information held safe, but also gets that information access so quickly across provinces, and that’s where I hope things will go more quickly, considering we have the steps in place already.
Katie Bryski: Yeah, it’s interesting. Speaking of steps and listening to you both. I mean, it sounds like in general, yes, having that change management support champion on the inside to help others and maybe set the example, but also the sort of stepwise approach layering on rather than doing one big change. And Chandi, I noticed you nodding all the way through Lisa talking about the information glut.
I’m curious. I take it that resonates.
Dr. Chandi Chandrasena: A hundred percent. And then what I was really also nodding at is that champion that you just highlighted, Katie, right? I think for any change management, you have to have a champion that you trust. And then when you have someone that you trust, who’s done it and kind of says, this is great, you should do it.
You’re probably way more likely to do it than someone who doesn’t write. And then I think it’s doing it in piecemeal, gradual. So you’re not overwhelmed and doing it slowly. And that’s really important that that trust, that relationship and process, that doesn’t always happen. So the reason I was nodding was like, “Oh, someone there knew what they were doing.”
And I was like, “They did it well.” But yeah, absolutely. But now we’re burdened with this glut of information because it’s so hard. It’s so easy to send something, like, on a computer or an EMR, whereas before you had to, like, print it off or mail it, and that limited you, right? Or you had to carry a chart that was, like, this thick.
And so, it limits you, but now it could be 50 pages and no one knows. You still have that cognitive load.
Katie Bryski: Almost that built in break, right? When it’s analog. Also what I’m hearing is, if all your friends were using AI Scribes, would you use one too?
Shelagh Maloney: Well, and I think if your friends are using it, and they like it and they say it’s the best things since sliced bread and here, I’ll show you how to do it. It gets back to that navigator point, right?
It’s like, if you see who’s doing it and succeeding and it’s improving their life, it’s like, “Hey, I want a piece of that top.” Come full circle and how you guys even started in your career, right? You talked about having great mentors and great role models and champions of people and, and helping you that way.
But you both also touched on data and alarm fatigue and all those kinds of things that technology enables. And so we’ve often heard this, and especially, you know, as EMRs were first introduced, is that a help or hindrance? I’d be curious to hear from your perspectives. What do you think? And what’s that balance?
What does it look like for you?
Dr. Chandi Chandrasena: You know what? I’m going to flip that around a bit and say that technology is an enabler. And our EMRs are just enablers. And they’re really just there so that we could look after our patients better. And really it’s just like our stethoscope or otoscope or like any other tool we have than EMRs.
They’re just another tool. But I think it’s because we don’t look at technology as enablers. We look at more as like, look at this really cool, shiny thing I developed to solve all your problems. And here it is fully baked. And now you just use it. And it’s kind of like, “Oh, hang on. That wasn’t the problem that I had.”
“And hang on, this doesn’t even fit my workflow or anything I want to do.” And now I have to change it. So now I have workarounds and I keep slapping things on, and we don’t set any guidelines or standards around what you can send through the EMR. And it just kind of morphs into something big. And I think that’s what happened with digital health.
I think EMRs are fabulous. Like, I think they’re amazing. If you look at their functionality and what they’re meant to do and the whole concept of it. Because I can tell you when I was paper, and I was carrying those charts home, I did get a workout, which was awesome, which I don’t get anymore, because I’m not carrying these charts home anymore.
But it was hard, like if you misfiled something, or if you missed something, or you didn’t color code it and remember that you had to do like a mammogram or something, you’re depending on your memory and that patient coming in and there’s a lot there. You couldn’t mine your data. You couldn’t understand what was happening with your patients.
Like, there’s so much you can’t do when it’s paper, right? But then when EMRs came, you could do all that. But we just didn’t. It probably needed a little bit more kind of user co-design to make it better. The workflows absolutely could have used more co design as to how we onboarded things. And then we absolutely should have set boundaries around, like, what can you send me?
Like, how often am I going to check my EMR? Like, the stuff that’s created all this burden now, then in retrospect, we’re like, we should have just done it differently, right? So I’m hoping going forward, that’s what’s going to happen. Because right now, I think a lot of docs would happily kick their EMR to the curb.
But I don’t know if it’s the EMR. I think it’s more just the way we’re using it.
Shelagh Maloney: I like that differentiation. And even setting expectations from the beginning, in that this is the next best thing since sliced bread and it’s going to solve all your issues and all your problems and just plug it in. It’s going to go.
And I think that was probably just a shock in and of itself. But Lisa, I’m sure you have opinions
Dr. Lisa Bryski: Yeah, it’s the bit of the glut and the other thing is I had to in the start to make sure I reminded myself that the computer is not the patient. And that went into my teaching: that no matter what you’re seeing on the screen, the more valuable information about the real time is directly talking with the patient to confirm stuff that you’re reading about, what other people have said, confirm, and give them a chance to voice because as you know, like, yeah.
Patients can think of how things are changing and affecting them, and staring at the computer gives you the information, spending time with the patient gives you the person that you’re going to use the information with to help them solve, improve, get rid of whatever health issue is happening. So, computer, I didn’t want to make them become the main part of the partnership.
And caring for somebody’s health. And that was one of the things I wanted to be really specific about when I was doing my teaching on shift. And that was a bit of a challenge because when you’re confused about something at first, and you’re trying to put a new tool in, you’re going to spend more time with it at first.
So I had to keep reminding myself where the time needs to be spent.
Katie Bryski: It makes a lot of sense. Like, I think you can’t have a relationship with the computer, right? And I’ve talked to docs who are saying, like, they had to train themselves to look even at the patient. Like, you don’t just look at the screen and type.
It’s little things like that. So it’s not just the tool, but how it’s used.
Dr. Chandi Chandrasena: But it’s also how you set it up, right? So if you think about it, we all had our own clinics, paper based clinics, and you just had a table, a small chair, maybe a place for, I don’t know, a glass of water. The rooms were not even set up for technology, so all of a sudden you’re putting an EMR, and now you have to sit in front of it to type, because not everyone is fortunate enough to have learned how to type during high school.
That’s probably the best skill that I ever learned, I have to say. I’m dating myself because I was forced to learn how to type.
Dr. Lisa Bryski: Thank you, grade 10 Mrs. Walsh.
Dr. Chandi Chandrasena: Same thing. And so if you don’t know how to type and now you’re put in front of a computer where you have to enter all this data and you’re in this tiny room and the bed is behind you, like you’re already setting yourself up for a failure when it comes to connecting and the reason you went into medicine, right?
Because you almost need to have this technology and then start looking at recreating what the space is going to look like. And all that should have been thought about. early 2000s, but now we’re 2024 and we’re still in these small rooms with two screens, a printer, a computer, and it’s just like, you know, you’re not connecting with patients anymore.
Katie Bryski: Yeah, so even more so than a tool coming into a workflow, it’s really coming into your entire context in which your workflow happens. And I think this is maybe a great opportunity to segue into some of that chat about co-design, right? Because to your point, if this had been considered 25 years ago, our current environment might look very different.
So from your perspective, what are some of the factors that make a good co design experience? Thank you.
Dr. Lisa Bryski: May I jump in? In the emergency, the computer, having it accessible as a team. One of the things we would do for rounds is gather around a computer to go through the patient list. So having it accessible as a community and having it so that there’s notification.
If there is new information, say a consultant is finished at consult, but it’s having trouble finding you to give a notification to you that that’s done. So you can make that human contact as well to clarify. Before acting on what’s written as words.
Dr. Chandi Chandrasena: I think that’s really important, right? It’s that people piece.
So when I look at co-design, I also kind of put change management in there, because I don’t think people understand how important it is to resource and really look at change management and workflow and what’s happening. It’s not just the technology, right? So I think for me, people trust in a common goal is the way I always look at co-design.
Just like Lisa said, right? When you’re in the emerg, it’s a team who’s working towards the care of a patient. So it doesn’t matter what everyone is using, their technology, at the end of the day, it’s about this one person. It’s about people, and it’s about like patients, clinicians, the system, so I think as long as you remember it’s about people, then that’s where you start with your development.
And then the next, I think, is really around trust. If you don’t trust the technology, the people who are creating the technology, who’s teaching you the technology, it’s not going to matter. If I don’t trust you, I’m not going to learn from you. Like, all of us will agree to that. And so I think when you do that, you need that change management and practice facilitation and new tools and that trust and relationship and that piece is really important, right?
Like those peer leaders, those advisors, like people you trust to help you along the way and tweak it. And then the common goal. And I think that’s the problem is that we think we all have a common goal, but we don’t have a common goal. And when we have a common goal, we do co-design really well, but. When we’re like, “Oh, it’s health care. We all have a common goal. We’re all in health care.”
It’s like, well, do we all actually have the same goal within the health care piece? and it’s kind of finding what that is and then figuring out how to get there. It’s always tricky because my co design thing is, you can’t deploy without developing with the people you’re using.
So I think if you’re going to get a tool in the emerg, like Lisa’s talking about, or a workflow, if you haven’t developed it with the emerg team, and some patients who go to emerg, and then emerg docs, and you’ve gone through that process, and then it’s not going to work. It’s going to just be forced on you, and then you’re going to get burnt out in the process in a couple of years after that.
Dr. Lisa Bryski: I’m just like nodding away at Chandi’s comments because they are resonating very hard. I’m one representative within the physician part, and I’m not able to represent my nursing colleagues and their experience, because they are a big part within the EMR system, as well in the emergency, and their use of it I think would be an interesting topic in itself, because how they use is different than the physicians.
There’s overlap, of course, but there are needs on how the system has to run I don’t think I can represent in this conversation, and it’s equally important, sometimes if not more important, as far as documenting and finding out what trends are going within the patient’s health in the emergency when things can change dramatically by just a few numbers or trends.
Dr. Chandi Chandrasena: I love that, Lisa. You don’t want to make your burden less and technology better for you at the expense of someone else. And that’s what happens I think when you isolate groups and get their opinions without understanding the whole piece of it, right? Like, there’s a lot of things I would love my technology to do, but if it’s gonna make it much worse for my front staff, I’m happy to put up with some problems if it means it’s better for them where we can collaborate and figure out what it is.
Shelagh Maloney: Definitely some common themes, and I think one of the things we hear is like, change happens at the speed of trust. And so again, this podcast is about digital health, but it’s also about leadership. And clearly both of you are in leadership roles, and during COVID, Lisa, you were very public facing. Can you talk about that experience a little bit, and what was that like for you?
Dr. Lisa Bryski: Wow, that was, uh, the beginning of the pandemic was a very, I think for all of us, a very interesting emotional, and for some people as well as physically, challenging time. I was on my way out at that point and I decided to come back and help as best I could. I didn’t do the resus shifts within our own department because I had TB and some pneumonias that I’d picked up in the past that led to some lung scarring.
So I helped with covering shifts and I don’t know who found my contact number, but somehow they found my number and contact and asked if I would speak on national news. And I said yes, because at that time I figured, I’m on my way out. Doctors at that time in my province, it was frowned upon for you to speak out, and also because they would assume that you’re representing your hospital or something, so it was a bit of a controversial thing to do.
But I thought, I’m a big proponent of patients having information because it’s their body, their health, and information shouldn’t be hoarded. And the problem always with that is that you want to make sure it’s the right information and at the start of the pandemic, we didn’t know what the right information would be or was.
Going on the news as well, I had some thoughts about the virus. The biggest thing I had difficulty with is that they weren’t calling it airborne. But it didn’t make sense to me because my own medical career, my patients never really read the textbook. I would always have diseases that didn’t quite reach the textbook.
And also that the virus is within the same size of air pollutants that manage to float around and do all their stuff. Why wouldn’t it be any different than that going on? I remember back, I actually reviewed a couple of things that happened in March when I started speaking up, and there was one national news I had with a newscaster right around the time when masks were being discouraged, partly because of resource lack of.
And I was polar opposite to that. But how do you do something that you’re not stepping on somebody’s reputation, and that they have a role to build that you stay collegial, but still to say, hey, we got to think about this a little bit stronger. So I took that stance that, on the national stuff, I would be saying we have to think of how we see masks as a culture.
We have to educate ourselves on how to use them, how to take care of them. And then I put that as an if, when we are called to use masks ourselves – hint, hint – make sure we’re educated on it, because I thought if people educate on how well the countries that were using masks at the time were doing, that it would hopefully change things.
And we did actually quite a bit better, because we looked at the countries that were taking on the virus by multi prong way of attacking it with preventative methods as well. But yeah, it was- I was walking a fine line there, because you don’t want to represent your hospital, you want to say it is your personal opinion, and you also don’t want to step forward and say something that, if you enter the territory of, “I don’t know,” that you’re very clear that I don’t know.
It was a bit of a – it was an interesting time and I actually tried to hand it over to colleagues as quickly as possible.
Katie Bryski: Well, it’s interesting because it sounds like you’re drawing on the experience that you’d accumulated, right? You’re standing up for your convictions and values that you developed as a leader through your career.
As you said, it was quite a time. And I know physicians, I mean, were adopting and implementing new technologies really rapidly. And Chandi, I’m curious as you think back to that time, if there’s key lessons that we should be carrying forward now.
Dr. Chandi Chandrasena: So we pivoted, like our clinic in Ottawa, we’re seven family docs We did not close for one day.
So I know you hear heard the rhetoric about how family doctors were not available. They had all shut down and all patients had nowhere to go. We did not close one day. So that weekend we went to a digital virtual platform. Patient portal, email, like we were there. So we may not have been seeing them as readily in the office in person, but we were available for at least for virtual asynchronous and synchronous care.
I think it’s really important to kind of understand. That when there’s a common goal and everyone is working towards that goal, then it’s easy to make that change, right? So it wasn’t perfect by any means, but you know, as a doc, let’s talk about like access to PPE. That was really tough in the beginning.
There really wasn’t enough, but then it started coming in. So then we were like, okay, we can’t see people in person unless we have to. Yeah. because we don’t have PPE. But what can we do on this side? Okay, well, we could do phone calls, we can do virtual visits, you know, we could do all this other stuff, and we can try and figure out what’s happening and triage.
Okay, so before the pandemic, as physicians, we weren’t allowed to do that because of privacy and security, you couldn’t use email. You couldn’t bill. Like if you didn’t physically see the person in front of you, like physically, you couldn’t bill. So if I saw them on a video, I couldn’t bill for that And so that started getting a little lax, because then it was like “Well, of course you can’t have them in front of you. But you still need to look after these patients.”
And so then these restrictions that were there they relaxed. During that time, it was like, “What do you have to do to treat your patients and to get through this?” And I think, when everyone is thinking like, government, public health, doctors, patients, everyone’s working together to do that. It makes it really easy for change.
And so virtual platforms became really popular. Patient portals, like all this technology. And then it’s like, now that we’re post pandemic and all the administrative burden, that red tape, it’s all come back now. It’s like, boom, now it’s not so easy. And everyone, like, we don’t have a common goal anymore.
I kind of feel we need to learn that we need to figure out what’s the end result and what barriers can we get rid of to get us there, right? And everyone works the same way to get it there. And I don’t know, I just haven’t seen that again, like now it’s a lot harder to do, I find.
Shelagh Maloney: It’s interesting. It’s almost as though we’ve lost that sense of urgency or that sense of let’s all work together for a common goal. And I just maybe come back to you, Chandi, again, just talking about you and the leadership role that you’re playing now. Have you learned anything? Is there something that you would do differently in your career?
Do you have any advice that you would tell your younger self?
Dr. Chandi Chandrasena: It’s kind of funny, right? Because in my brain, I’m two people. I’m a family doc at heart, right? But now I’m chief medical officer like of Ontario MD and it’s very corporate, right? It’s very different, and Shelagh, you and Katie are probably laughing, but doctors don’t learn how to be corporate.
Like we don’t learn any of the language. Like I think it took me six months to figure out what people were actually asking me, like in meetings, because it’s a very different language. It’s a different way of thinking of things. So in the last three years, I’ve learned so much, so much. My husband’s not a doctor, and he’s always like, “Oh, welcome to the real world.”
And I’m like, “Yes, in the last three months, I’ve learned about the real world,” how you approach problems and systems. And I’m so privileged to have learned that. But you know, what I’ve kind of learned is that we do that in medicine, but we just do it differently. We use different terminology and, you know, like change management, you talk about change, right?
We talk about, well, it’s like a QI thing. We try it. If it doesn’t work, we try another drug. If that doesn’t work, we try something else. And then we get to where we want to go and there that’s our path. So I think if I’m looking back. It’s really important for physicians to be leaders, and I really think it’s important for them to be leaders in health care.
Especially digital health, because this is what’s going to dictate how we operate and what we’re going to do in medicine going forward. So you need to be a voice there. And being a medical doctor is such a privilege. Like, I can’t tell you how much a privilege it is that I am a family doctor. And what I’m trusted with and what I learn.
But it’s also allowed me to realize that there’s all these doors. Being a doctor isn’t just opening, you know, hanging up your shingle and seeing patient after patient. You have opportunity for leadership, for learning, for like healthcare systems, for digital systems, working with digital health companies and vendors.
Like there’s so much there. So I’m so glad I’m in medicine and I’m so glad it’s such an amazing profession that opens these doors. And I think what I wish I had learned sooner is this, this language that I’m talking about. Like I wish that somehow we learned that in medical school also and more about the health system and how to work with partners.
Cause we didn’t get a lot of health system type training, right? And that’s what I’ve been learning in the last three years is the health system training piece.
Katie Bryski: And Lisa, we’ve almost had a reverse career where I started in the arts and ended up in health care. You started in health care and are in the arts.
So curious about learning some things that you would do differently or advice you’d give.
Dr. Lisa Bryski: Yeah, I – cell phones, I think I wish I had even more when they first started coming out, and people able to take photos, to include that in my patients even more. It started in the later part of my career, where I’d have them take a screenshot of their x-ray, the actual photo and the report, so that they can visualize and see, and have that information to digest afterwards, and think about, and to share on.
And that it gives them that personal ownership of, “This is me. This is mine. The doctor is part of this.”
The other part of that is I wish that to have more chance to direct them to established and responsible websites for any illnesses that they have, and that’s become I see more in family medicine, more that empowering them with both knowledge of what’s going on in the immediate, but giving a direction for where they can access knowledge that may become important at some point in their dealing with the health issue. And I think that is something I wish that I’d done or had a chance to do more in emergency, and have that in my back pocket. That I think would have been a way that I probably could have expanded more.
The other thing I think is to have the use of social media. Doctors feel more comfortable about putting their teaching on not only for each other, but for the public to check out. There is some that put out EKGs that they think are interesting, and they talk about the clinical aspects of how this person presented with it. No health identifying data, of course, because we want to protect patients’ vulnerabilities.
We are all vulnerable and we are all patients at one time or another.
Shelagh Maloney: So listen, as we wrap up, any final thoughts that you’d like to share with us?
Dr. Lisa Bryski: First of all, anybody who is considering going into health care is very valuable to society, as well as valuable personally. Although I’m speaking from the retired portion, I had 30 years in a bit and it’s life enhancing, life changing.
As well as within your career, you may find it changes. What you start with may not be where you want to head, let’s say 10 years down the line, so just be aware to be flexible within it if that’s where you choose. And digital technology is here to stay. We’re still, we didn’t even talk about Chat GPT here and how that has changed research and how it’s changing, uh, how we approach even patient care directly.
And that’s hearing third hand. It’ll be interesting to see where that goes. It’s challenging to be in healthcare, but the challenges are worth it.
Dr. Chandi Chandrasena: I think that’s absolutely right. I think mine is that we talk about digital health, but digital health is just health. When we talk about virtual health, virtual health is just health.
Like health is health. It’s about people like I know I keep saying this, but health is about people and it’s about problems and there people problems and you know, it’s about workflow and trust and hearing each other’s like pain points and understanding how do we help you, how do we solve that? And then when you look at a health system, it’s still a people problem.
So I think what I’d like to see Is that we don’t talk about digital health anymore. We just talk about health. We need to start understanding that it’s a person we’re looking at their health and that has a digital component because your digital is a tool to make sure that you can help that person or address what we call the clinical, but we need to get away from separating it and we need to start teaching all our new students that it’s actually together.
And same, we need to educate our patients on what it’s like, what technology is and what that means. Like, I think we just need to start looking at the way we look at things. And, and health care’s complex. Like it’s, it’s hard. It’s not easy. And so when people start comparing health care to like banking, you know, why can’t I just get it right now?
And I’m like, health care’s complex. It’s a lot more complex than a banking app. Health is going to be a little bit more difficult, so that’s my personal opinion, but I’m just like, it’s complex, and it’s about people, and we shouldn’t forget that.
Katie Bryski: So the common goal in a complex system, um, I think this conversation, you both really encouraged us to think about how we think about things, but also just grounding us in some of these really, core guiding principles and values, right?
It is a people sector. We are here to help people and I think we all want to be able to do that. So thank you so much for taking the time to chat with us today. This has been such a privilege to be able to learn from you both and we can’t wait to see what you do next.
Dr. Chandi Chandrasena: Thank you so much.
Dr. Lisa Bryski: Thank you, Shelagh and Katie.
Shelagh Maloney: What a great conversation. What were your key takeaways from that discussion?
Katie Bryski: I’m really interested in this idea of that sort of context, right? So, I mean, we talk about workflow a lot. We talk about, yes, the importance of making sure the tool works for the workflow. But thinking about even situating that workflow within the broader context, in which the, the physician or the clinician or the, the end user is working.
So even to Chandi’s point about the computer doesn’t face the bed, right? Like it’s those sort of environmental things that you really need someone on the ground to be able to tell you that. So just that thought about who you have at the table, and then blending that with Lisa’s point about across the health system, there are so many people that contribute to the end goal of taking care of the patient.
So I did think, as she was saying that, I was thinking, “Ah, you know, it’s interesting because we have two physicians here, right, and one is a family physician and one is an emergency physician, so there’s that difference there.” But she’s right, like a nurse’s perspective or a pharmacist’s perspective would be different again. And for you?
Shelagh Maloney: It’s always interesting, and you and I have talked about this before, is how people got to where they were. And so both Chandi and Lisa had personal experiences that sort of drove them to medicine. And the comment that Chandi made around family docs, but then there are so many opportunities. And I think that’s not just with physicians, but in digital health generally, right?
Or just, or getting into healthc are and then getting into a digital healthcare. And it’s such a broad definition and you can take on leadership roles and you can take on leadership roles. Yeah. Different perspectives and different challenges and different issues and so many paths and branches that you can go down, that there’s so much opportunity.
But then no matter what you sort of choose to do at the end of the day, it’s all about people and it’s all about people working with you and you working with people and it’s about you working with the patients. And so it’s really like, it’s about the people, the people that you are working with. And we’ve heard from so many of our podcast guests, right about this importance of teams.
And so being part of a team and working with a patient as part of a team. That really resonated with me. And again, nothing necessarily new that we haven’t heard before, but a different perspective in terms of where these folks have come from and why they came. And then, and it was interesting to hear about how far we’ve come.
And both of them started when we were on paper and it’s kind of interesting. Technology is a way of the world now, and patients, everyone expects technology, and so it’s reflective of how far we’ve come. It’s 2025, and we’ve come a long way, although sometimes we think that our progress is quite slow.
Katie Bryski: It’s really true, and it brings to mind something else Chandi said, which was this idea of embedding that business literacy or health system literacy within medical education, because I think what we’re seeing is As you have technology more embedded into care, as you are enabling these sort of connections and partnerships and new areas to take on within your role as a physician.
It is about more than just your individual clinic, right? Like, it is helpful to have the competency to be able to, say, talk to a vendor and be on a co-design team, or to be able to look at the system, especially as we have data flowing with more interoperability. From the point of view of how can I, as say, a small family physician, be working with the team in a larger hospital?
Shelagh Maloney: Well, and even the environment, and it was kind of interesting, Lisa brought up social media. And social media as a learning tool and as a teaching tool. I think most of us would think, oh, social media is bad for your health, mental health, it’s creating expectations, etc. But there’s also some value in that, and that’s an environment that didn’t exist 10, 15, 20 years ago.
Katie Bryski: Oh, 100%. Yeah. So, a lot of change, a lot to think about, a lot of learning, and as always, listeners who are keen to extend their learning can visit the Digital Health Canada website. We will be back next month with a new episode. Until then, thank you for listening to Digital Health in Canada. The Digital Health Canada podcast.
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