📷 Temerty Faculty of Medicine
Journalist: Haleema Ahmed
Haleema Ahmed:
Hello everyone and welcome back to SciSection. I’m Haleema, your journalist for this week, and today we are delighted to have Dr. Latif Murji. Dr. Murji is a family physician and lecturer at the University of Toronto. He is also the founder of Stand Up for Health and VaxFacts Clinic. Thank you for joining us!
Dr. Latif Murji:
Thanks Haleema for having me. I'm really excited to be here.
Haleema Ahmed:
Before we get into specifically the work that you do present day, I have a couple of rapid fire questions. Firstly, what does your day to day work look like as a physician?
Dr. Latif Murji:
That's a super interesting question because for me, I do clinical work every couple weeks in Northern Ontario, so there's no fast way to answer that. Some days, my job is to travel up North. I can show you a typical day of what my life is like there: I wake up, go to the hospital and round on my inpatients. That means talking to the inter-professional team to see how they did over night, seeing the patient themselves, assessing them and reevaluating my assessment and plan through looking over their blood work and investigations. Then, I would potentially do a family medicine clinic or emergency shift. If it's family medicine, I go home at the end of the day and work on Stand Up for Health or VaxFacts or do some kind of excursion up North. But if it's an emergency shift, then I would be there for 24 hours. Otherwise, I usually live in Toronto and I can be working on VaxFacts or Stand Up for Health or teaching at UofT at the Scarborough hospital. I'm really into music so I spend some time on that too.
Haleema Ahmed:
It's incredible to see how different your days can look. Given that, what aspect of your job do you love the most and what do you like the least?
Dr. Latif Murji:
As you can imagine, there is so much variety and flexibility in what I do and I love that I get to do something new everyday. I get to interact with different people. The least would be the paperwork, writing notes and the administrative work that comes with having so many different jobs.
Haleema Ahmed:
Previously, you mentioned how when you are in Toronto, you spend a lot of your time working on Stand Up for Health. Stand Up for Health is a nonprofit that diverges from the typical way of learning about the social determinants of health. Typically, students experience lectures and graphs but this method really lacks a lot of that lived experience. Your team employs a really experiential way of teaching people and health professionals, specifically, about the social determinants of health. What's the story behind that organization and that approach?
Dr. Latif Murji:
I grew up in Scarborough and I experienced a lot of the social determinants of health firsthand. I also saw it around me with a lot of my friends. Having that lived experience really shaped who I am today. When I went into undergrad, I was really lucky to take a course about the social determinants of health. It was really eye opening and resonated with me because my whole life experience started to make sense theoretically and practically at the same time. Yet, I noticed that with a lot of my peers, it wasn't resonating in the same way. I was kind of confused about this. This is such a human experience? What is missing here? That was literally the answer. It was the human experience that was missing. We were learning about the social determinants of health in terms of these facts and statistics and numbers and graphs. But we needed a human experience to connect that. I started creating a simulation of what it might be like to experience some of these challenges and that developed into what Stand Up for Health is today; a non-profit organization run with volunteers. We run our simulations and other learning products at universities and other institutional settings. We train medical learners, whether they are medical students, residents, even physicians, and other health professionals on the social determinants of health and connect the emotional experience received through the simulation with the actual stats so that their experience ends up sticking. We also have discussions around this so that when people see patients in real life, they have more to consider. We encourage and channel that energy to encourage advocacy at a level that's broader than just the individual level. We want to see, not just micro, but meso and macro advocacy; that is community and population level advocacy since that is the way to have the most impact.
Haleema Ahmed:
Given your background, what sparked your interest in pursuing a career in medicine specifically centered on the social determinants of health versus going down a different route?
Dr. Latif Murji:
That is a great question. I think the physician-patient relationship is something that really drew me to medicine and then subsequently, to family medicine where you have a longitudinal physician-patient relationship. I really enjoy that as part of my job. Having a connection with someone, building a rapport with someone and connecting beyond just hearing their problems and providing medications. I am a member of the community and understand you and we can work together to build health and wellbeing. Medicine is really rewarding in a lot of ways and probably for me, the biggest is that interpersonal relationship that I have when I see patients many times.
Haleema Ahmed:
The kind of communal approach that you take to taking care of your patients is very different from the traditional view of a physician; a person in a white coat telling you don't eat this, take this medication etc. What you are trying to do is very communal and aims to develop relationships between patients. What issues do you think patients face when we only consider the physiology of their presentation?
Dr. Latif Murji:
We can run into a lot of problems if we are ignoring the social factors and the social context of our patients. First of all, I don't even wear the white coat because I want to connect with my patients and I feel like that can sometimes be a barrier in understanding what my patients are experiencing and how there disease integrates into their lives.We work towards solutions that might include medicine, but it might also be lifestyle changes or connecting them with income or community or group supports. If you are just providing a medicine and you don't consider the context that the patient is coming from, they might not be able to afford that medication. If they are homeless, they might not have a place to store the medication. Then, they return to the context in which they got sick in the first place. We really need to consider where our patients are coming from. We know that social factors are responsible for over 50% of health problems to begin with and biological factors are about 25%. So, the social determinants of health is really where you get your bang for your buck and how you can actually impact the patient's wellbeing. Yet, we are not seeing that reflected enough in the way that we treat our patients. I'm trying to be a part of that movement to prioritize the social determinants of health.
Haleema Ahmed:
Now more in the present day, you started the VaxFacts Clinic earlier this year which is now a national service that provides people an opportunity to speak confidentially with a physician one-to-one in a judgement-free phone appointment, and ask any questions about the vaccine. Why did you think this was necessary, and what impact are you having?
Dr. Latif Murji:
VaxFacts is a super fun idea we started a few months ago and it has really blown up. It was first a service that we started for healthcare workers in Scarborough so that they could have a space to ask questions one on one with a doctor in a judgment free space. It was so successful that soon, we scaled it to the entire community in Scarborough and then it went to all of Toronto, all of Ontario and now it's national. We are a first of its kind education service for the vaccine. We are the only physician led model for vaccine confidence conversations. What we are finding is that patients who are hesitant about the vaccine really appreciate having a doctor, someone that they trust, sit down with them and hear their concerns and have their concerns validated. People are genuinely concerned about their own health and the health of their loved ones. They want to make a choice that is best for them. It is important for us to understand that these are reasonable people. They are not hardcore, anti-vax people and they genuinely care about their health. It's actually a great thing that they are coming to a trusted professional, who is an expert in the field especially given how much misinformation there is. This is a great opportunity to connect patients with physicians who are experts and get the facts straight. Regarding the impact we are having, our latest numbers show that we are about 82% in terms of patients choosing to get vaccinated after speaking with the physician. Remember, these appointments are often long and complex. They last 20 to 30 minutes just on the topic of the vaccine. There are so many questions patients have and despite how challenging having these conversations can be, this goes to show that patients and support can go a long way.
Haleema Ahmed:
I'm really glad to hear just how successful the program is because we need to get people vaccinated to get rid of this pandemic. I'm really glad that the community and the country at large is really taking it up. How did you infuse your passion for health equity into the creation and operations of the VaxFacts Clinic?
Dr. Latif Murji:
As soon as we decided to start the VaxFacts Clinic, as Coordinator of Health Equity at Scarborough Health Network, I knew the importance of infusing that lens of health equity into the service that we were bringing to our community in Scarborough. For example, we have appointments available from 9:00 AM to 8:00 PM, so that if people are working or have multiple jobs, hopefully there's a time that they can call in and speak to a doctor seven days a week. Any day that works for the patient will work for us. We also have over 200 languages of live interpretation services so anyone who speaks any language can call in and have their questions answered. We also made sure that OHIP is not a barrier. People who don't have OHIP or are refugees can call in and not have to worry. All you need is a name and a phone number. Since OHIP is not required, anyone in Canada can call in because we are the only ones who are running a physician-led clinic about vaccine confidence in Canada. Now that we have gained the eye of other provinces, we are accepting calls from across the country. We are all in this together so why not?
Haleema Ahmed:
Evidently, your work takes into account all aspects of a patient's life, such as their income and education, when supporting them with their health. How do you think we can better improve medical and healthcare education to embed this approach in the web of Canadian healthcare to improve empathy and patient outcomes?
Dr. Latif Murji:
I am a proponent of thinking upstream in healthcare. In medical education, Stand Up for Health is all about that through experiential learning. This means immersing medical trainees and learners into the shoes of our patients so that they can get a feel for what it may be like to experience those challenges. This also means thinking upstream for solutions and I guarantee you, through Stand Up for Health, the solution is not a medication. There are a lot more structural issues that need resolving. Any kind of experiential learning or community service learning would be beneficial to our patients. Hearing from patients firsthand or having clinical experiences often shed light for our learners. We can also think about advocacy campaigns in real life and connecting with community organizations in the field so that our learners are really embedded in the healthcare system of their community. Those are the people who they are ultimately responsible for bringing care to.
Haleema Ahmed:
On that note, thank you so much Dr. Murji for speaking to us today about Stand Up for Health, VaxFacts Clinic, and medical education. Be sure to follow him on Twitter @Latif_M to keep up with his incredible work!