Introduction by Colin Hung
When Dr. Rajiv Singal and I met during the last #hcsmca tweetup in January this year we spoke at length about his work with the Movember fundraising and patient advocacy. Dr. Singal had recently completed yet another successful campaign in November – raising over $38,000 for prostate research (disclosure: I donated to the campaign).
During our conversation, Dr. Singal asked a series of questions that I had never considered before – should physicians get involved or even lead philanthropic fundraising efforts for the diseases they treat? Is it is expected of them? Should they be obligated to donate? Is it ethical? Should physicians be active in patient advocacy?
I was intrigued by what Dr. Singal had to say – so much so that I immediately invited him to be a guest on #hcldr to discuss this very topic.
It should come as no surprise that most doctors, nurses and others who work in healthcare have a philanthropic streak. It is, after all, a profession that at its core is all about helping others. Byron Bangert of Indiana University wrote a paper in 2005 entitled “Moral Issues and Motivations in Medical Philanthropy”, that explored the question – why do doctors get involved in philanthropy? The following is a quote from one of the doctors that was part of the study:
I think that we, you and I, have certain gifts, and I think that we do have an obligation to use those gifts in a way that’s meaningful and contributes and, as well, I think that there is a bit of an imperative to reach out to those who are less privileged or less fortunate that you and I are. I believe in that very strongly.
Personally I think it is fantastic that people in healthcare give back to their local communities and to communities around the world. I do not believe there is anyone who would view this type of philanthropic initiative as controversial. However, as I was researching this week’s topic, I discovered that there are two forms of philanthropy that fall into a “gray zone”. One is fundraising for the institutions healthcare professionals work for and the other is patient advocacy.
Prokopetz and Lehmann published a paper earlier this year called “Physicians as Fundraisers: Medical Philanthropy and the Doctor-Patient Relationship” that articulates this problem succinctly:
Physician participation in development activities can create tension between their roles as caregiver and fundraiser, potentially undermining the trust at the heart of the doctor-patient relationship. We identify three main concerns. First, patients may feel undue pressure to make a contribution if their caregiver is involved in making the appeal. They may worry that declining to give will damage their relationship with their physician or have an adverse effect on their treatment, particularly if the physician’s care encompasses other family members or life-threatening conditions.
I must admit my eyes were opened after reading the Prokopetz and Lehmann paper.
Doctors as patient advocates isn’t a new concept – the College of Physicians and Surgeons of Ontario even has a page dedicated to the subject (though it is a bit brief) – but in recent years as healthcare has become more complex, the call for more support from healthcare professionals has grown.
In 2002, the Journal of Medical Ethics published an article “Is there an advocate in the house? The role of health care professionals in patient advocacy” that talks about doctors as advocates and nurses as advocates.
Nurses are medically educated, professional members of the team. They tend to spend the most time with hospitalised patients and are therefore more able to assess their needs and aspirations (beyond medical needs).
Needless to say the role that physicians, nurses and other healthcare professional should or should not take in philanthropy is as complex and nuanced as their day jobs. I’m very much looking forward to this upcoming #hcldr when we can hear directly from Dr. Singal and see through his perspective how physicians can successfully be involved in philanthropy and advocacy.
Blog by Dr. Rajiv Singal
Having been in practice for 18 years, I have always been conscious of the many intangible roles that we play as physicians. Specialty care certainly involves delivering care but there is an expectation I believe to also provide some leadership. With every new study that enjoys wide media attention there is a natural impulse to ask those who provide care to provide some perspective. In a round-about way this is a way physicians can advocate on behalf of patients.
Supporting fundraising initiatives is another way to advocate for our patients and the diseases that they often struggle with.
Fundraising is an important aspect of modern healthcare. There are foundations for virtually every entity from kidney disease to heart and stroke and cancer. The goal of each is certainly to raise money for research and clinical care but also to shed a light on the nature of the problem. Next weekend’s Becel Heart and Stroke Ride for Heart in Toronto will certainly raise many dollars abut also promote a discussion on screening for cardiovascular disease and encourage those at risk to improve modifiable risk factors. Over the last ten years the Canadian organization Dignitas International has raised a tremendous amount of money to improve the access of Malawi, a small country in Africa appallingly burdened with HIV to anti retroviral access. On a wider scale this has forced a dialogue on how to deal with the massive problem of HIV in Africa. The Bill and Melinda Gates Foundation has done much to advocate for the sick and vulnerable in its support for many global health initiatives. It seems to me that physicians, in their role as central caregivers can bring scale to the conversations that are generated by any of these fundraising initiatives.
Recently, 100% of the physician staff at Toronto East General Hospital, where I have been fortunate to work for 18 years, donated to the current building campaign of the foundation. This show of support has allowed the foundation to go out to the larger community and amplify the story of the hospital as well as funds raised.
I first joined the Movember campaign in 2009. As a urologist I commonly look after prostate cancer. While I have been successful in raising a lot of money what it primary has facilitated is a discussion about mens’ health. A nervous patient in the office waiting to be seen is surely put at ease seeing his doctor sporting an unsightly strip of facial hair. I have written about my motivation before in BJUI. Going to page 12 of the AUA’s spring 2014 Global Connections publication provides further insight. The 2013 TEGH Movember team ended up having two urologists from the US and one from Newfoundland. One colleague on this team of course was Brian Stork, an #hcldr stalwart. This teamwork, across borders by urologists who share a common goal of treating men with prostate cancer yielded an outcome that went far beyond the money we raised.
Physicians must always take the lead in advocating for their patients. With so many causes that are worthy of support, taking an active role in what matters to your own patients is imperative.
It is in this vein I would like to initiative this week’s #hcldr chat. I would propose the following questions for discussion:
- T1: What ways have you seen physicians and healthcare staff be active in patient advocacy?
- T2: To what extent should physician take leadership in philanthropic fundraising in the diseases they treat?
- T3: Do you feel it’s ethical for physicians and staff to be active in fundraising for their institutions?
- CT: What’s one thing you learned tonight that you can take back and use to help a patient or your organization tomorrow?
Biographical sketch – Rajiv Kumar Singal MD, FRCSC
Dr. Singal currently leads the Surgical Robotics Program jointly run by Toronto East General Hospital and Sunnybrook Health Sciences Centre. He was Head, Division of Urology, Department of Surgery at the Toronto East General Hospital from July 2001 until October 2012 and is an Assistant Professor within the Department of Surgery at the University of Toronto. He supervises the Clinical Endourology Fellowship program at TEGH under the umbrella of the University of Toronto and also teaches undergraduate and postgraduate medical trainees. His clinical interests include the surgical management of urinary stones, minimally invasive urological surgery and the surgical treatment of genitourinary malignancies including prostate and kidney cancer.
Dr. Singal is a graduate of the University of Toronto School of Medicine in 1990 (9T0). After a surgical internship at Mount Sinai Hospital he entered the urology Residency Program at the University of Toronto and obtained his certification with the Royal College of Surgeons of Canada in 1995. He then did a one-year clinical and research fellowship in Endourology and extracorporeal shock wave lithotripsy (kidney stone diseases) at the University of Western Ontario.
He joined the surgical staff at Toronto East General Hospital in December 1995 and has been in active practice at the hospital since July 1996. Dr. Singal has held various leadership positions at TEGH including President of the Medical Staff Association in 2003-4 and sits on various committees including serving as Chair of the Infection Control and Laser Safety Committees. He has worked on Cancer Care Ontario initiatives including Disease Pathway Management for prostate cancer. He has published several articles in his areas of interest, and is a principal investigator in several ongoing clinical research studies for diseases of the prostate.
Follow him on Twitter at @DrRKSingal
Association of Healthcare Philanthropy, http://www.ahp.org/Home/About_Us/Home/About_Us/About.aspx
“Physicians as Fundraisers: Medical Philanthropy and the Doctor-Patient Relationship”, Julian Prokopetz and Lisa Soleymani Lehmann, PLoS Med, February 11 2014, http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.1001600, accessed May 16 2014
“Grateful patient philanthropy and the doctor-patient relationship”, Journal of General Internal Medicine, December 10 2012, http://www.springer.com/about+springer/media/springer+select?SGWID=0-11001-6-1398341-0, accessed May 16 2014
“Philanthropy and Medicine”, Anthony DeMaria MD, MACC, Journal of the American College of Cardiology, October 2006, http://content.onlinejacc.org/article.aspx?articleid=1138004, accessed May 16 2014
“Moral Issues and Motivations in Medical Philanthropy”, Byron C Bangert, November 2005, http://poynter.indiana.edu/files/4013/4513/1994/m-bangert.pdf, accessed May 16 2014
“Is there an advocate in the house? The role of health care professionals in patient advocacy”, Dr. L Schwartz, Journal of Medical Ethics, May 25, 2001, http://jme.bmj.com/content/28/1/37.full, accessed May 25 2014