National Physicians’ Day 2020 – Dr. Leah MacDonald

To pay tribute to the many dedicated physicians practicing at Island Health and in honour of National Physicians’ Day, we are profiling some of the doctors leading innovations and delivering high quality service to show the human behind the profession. Dr. Leah MacDonald is a Palliative Care physician and the Executive Medical Director for Primary Care and Seniors Health.

  • Why did you chose medicine and your speciality/field?

“I chose a career palliative medicine after a bit of an “aha” moment on an internal medicine rotation.  Despite all the amazing accomplishments of modern medicine, my impression was that the health care system as a whole had drifted from the traditional maxim to “cure sometimes, to relieve often, and to comfort always”.  Palliative medicine seemed to provide a solution to some of the gaps in care I was seeing. It has proven a good fit for me.”

  • What is most meaningful to you about your work in medicine?

I have taken on administration roles in medicine because I enjoy working on system-level improvement. But it is still the direct patient care part of my job that “fills my bucket”.  In palliative care, we are privileged to be a part of a patient and their family’s lives during a very difficult period. It is meaningful to me to be part of the team trying to make things at least a little more manageable, whether that is through symptom management or therapeutic conversations.”

  • What are your professional interests and notable achievements?

“I am proud of my advocacy for increased attention to advance care planning (ACP) within Island Health. This strategy included the MOST policy and a broader underlying framework around goals of care conversations, particularly for those dealing with serious illness.  It is an incredibly powerful intervention to discuss and document conversations about a patient’s illness understanding and prognosis, their goals and fears, and their views on acceptable quality of life “trade-offs”.   These types of conversations have been shown to increase quality of life, improve the patient and family experience and prevent costs associated with unwanted interventions.  It has been rewarding working with the Clinical Informatics team to integrate MOST and ACP documentation within our electronic health system.”  

  • Who or what do you turn to for inspiration?

“Life, both at work and home, can be very busy and demanding. I try to be intentional about drawing strength and inspiration from an attitude and practice of gratefulness.” 

  • Where do you go, or what do you do, to recharge your batteries?

“I am fortunate to live near Cadboro Bay in Victoria.  I love going for a walk on the beach or in nicer weather, out on my paddleboard to recharge.  If I am lucky, I might get to do this with my amazing husband or one of my kids.”

  • What is the last book or podcast you’ve enjoyed?

“The last book that I read was Margaret Atwood's dystopian thriller The Testaments.   It was sobering to read that Atwood had modelled all the misogynistic elements of the novel on real precedents from humanity’s history, including some very modern examples.” 

  • What core value have you most relied on during the COVID-19 pandemic? 

The value that the pandemic has me thinking about the most is health equity.  We have seen how the virus has more devastating outcomes for those with pre-existing co-morbidities and we know that the social determinants of health contribute significantly to these conditions.  How do we ensure that our health care planning addresses these inequities?  It has been wonderful to see a real focus and investment around some of our most traditionally underserved populations.  We need to maintain this focus and in the long run improve some of the underlying conditions that lead to these inequities.”

  • What is a change you’ve seen to the health system over the last few months that you are eager to see sustained?

As they say, “never let a crisis go to waste”. It has been exciting to see strengthened partnerships between Island Health and our primary care colleagues. A strong primary care system creates the backbone of a high-functioning health care system, in a pandemic and beyond.”

  • What do you wish more people knew about practicing medicine?

I think sometimes the public doesn’t appreciate just how much medicine has become a team-based endeavour. No doubt physicians play an important role, but we are definitely “better together” and often deliver optimal care as part of well-functioning interdisciplinary teams.”

  • What is your hope for the future of health care in Canada?

My hope is that we continue to shift from a predominantly acute care focused system to one that emphasizes an integrated primary and community care model.  Everyone should have access to a primary care provider.  I think public health, including health promotion and prevention, should have a more prominent role. And let’s not forget that we need to find a way to deliver this care within a sustainable portion of our GDP so we don’t leave our debt to future generations.”