Thirty-five years before the mast: learning to love the roiling seas of health, health care, and medicine

Peter W. Vaughan, MD


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In the midst of what seems to be a health care “train wreck,” I hope to inspire others to see the great potential that lies ahead as health care continues to evolve rapidly. As medical leaders, we need the courage to meet the challenges and opportunities afforded by the convergence of biology and technology; yet we must also be realistic about mitigating the risks.


KEY WORDS: health care system, physician leader, change, collaborative leadership


Sometimes I feel as if I’m watching a train wreck — it’s a horrible scene, but I can’t avert my eyes. Doctors in one Canadian province are making headlines cyber-bulling each other, while there are calls from some provincial governments to “ensure that the rules governing self-regulating professionals do not put the interests of industry insiders ahead of consumers.”1,2


I share these thoughts with the hope of inspiring others to see the great potential for change. We as medical leaders need to have the courage to speak up about the challenges and opportunities that the convergence of biology and technology affords, yet we must also be realistic about mitigating the risks. These are exciting times to be a medical leader — carpe diem!


For over a decade, the profession has been musing about its plight. In 2005, Dr. Glen Gabbard3 penned a not so thinly veiled homage to Dr. Raymond Tallis’ wailing lament for the past.4 Gabbard blithely notes, “Few physicians are observed whistling down the hospital corridors.” Although he observes most of us still view “medicine as a noble profession” (p. 1347).3 Top


Finally, Gabbard lets out a long sob about how we “value autonomy and independence from external control, and the vast changes in the roles played by third-party payers, government regulatory bodies, and hospital/health care systems may have influenced physician discontent as well. Physicians frequently complain about being trapped in systems in which they have no say in what is being done to them by forces beyond their control, and loss of the traditional autonomy and control appears to be a factor that contributes to burnout” (p. 1348).3 Physicians he says, feel like “a cog in a machine.”


Medicine is at a crossroads. Biology and information technology are converging faster than our ability to understand the implications. No matter what country you look to, medicine has experienced a significant decline in autonomy in relation to the state.3 Physician leaders are needed now more than ever, especially those with entrepreneurial skills who see the opportunities to improve access through creative social innovation.


Increasingly, as algorithms become the force behind the inevitable standardization of medical care, the role of physicians and other health care providers will change. Many physician leaders in health care today, in many organizations, embrace the future of heath, health care, and medicine — and seek to lead the profession in defining a new and important role for medicine in the 21st century. Top


It is time for bold, values-based conversations and collaborative leadership in the public interest. What is collaborative leadership? Physician leaders who have a clear vision of what health, health care, and medicine will need to look like in five years and are willing to roll up their sleeves to work with other professions, governments, and the public to craft a “shared agenda” with timelines and resources committed to create the better future we want to see.


Now is the time for creativity, and by that I mean looking at opportunities to craft a collective social purpose for medicine building on the work already underway, to harness the potential of evolving technology, to lead the democratization of health care, to grasp the potential for disruptive distributive computing, connecting doctors and patients. And, finally, let’s get on with e-prescribing, e-visits, e-consults, e-labs, and digital information, and in so doing transform access to care. Carpe diem!



1.Boyle T. Ontario doctors ‘distressed’ over wave of bulling, infighting. Toronto Star 2017;Feb. 27. Available: 27 Feb. 2017).

2.Mysicka R. Rein in self-regulated bodies. Financial Post 2014;Oct. 29. Available: (accessed 27 Feb. 2017).

3.Gabbard GO. Medicine and its discontents (editorial). Mayo Clinic Proceedings 2013;88(12):1347-49.

4.Tallis R. Hippocratic oaths: medicine and its discontents. London, UK: Atlantic Books; 2004.



Peter W. Vaughan, CD, MA, MD, MPH, has served as CEO of the Canadian Medical Association, CEO of Nova Scotia’s South Shore District Health Authority, and deputy minister of Health and Wellness in Nova Scotia. In March, he was appointed chair of the board of Canada Health Infoway.


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This article has been reviewed by a panel of physician leaders.