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COLLEGE OF FAMILY PHYSICIANS OF CANADA/CANADIAN ASSOCIATION OF PHYSICIANS FOR THE ENVIRONMENT NICOLE BRUINSMA AWARD

Dr. Scott Findlay
November 8, 2002

There is a famous remark, attributed to Oliver Cromwell, that the role of government is not to give people what they want, but rather to provide what is good for them. This simple principle - apparently forgotten by many of those holding public office today - is the touchstone not only of good government, but indeed, of good governance.

Physicians live this principle daily: you all know that medical advice or prescribed treatments may be unfavorably received by patients, but it is dispensed nonetheless because in the physician's professional opinion, such advice and treatment will improve the patient's health.

The problem, from my perspective, is one of scale. By virtue of their medical training, the physician's professional focus is highly circumscribed: the medical history, the differential diagnosis, the prescribed treatment, are all set out for the patient perched on your examining table: the next patient may well be something completely different, and you are taught - and rightly so - not to generalize.

But whatever the truth in Jungs's assertion that the (medical) shoe that fits one person pinches another, this does not imply that the fitting of individual shoes is the best way for a physician to alleviate widespread podalgia. Better still would be to use one's podiatric expertise to educate people about the problem, and to provide resources which would allow those afflicted to fit their own shoes.

Physicians are particularly well situated to employ this sort of strategy, for two reasons. First, they represent a (generally) highly respected segment of society: I have noticed - with considerable envy - that like Wood Gundy, when physicians talk, people listen, even if the subject is something about which they are no more qualified to speak than anyone else. Second, health is a hot button for everybody. As an environmental scientist concerned with (among other things) the impacts of pesticides on wildlife, I constantly fight against a general public ambivalence (or worse) towards frogs and fish: no such ambivalence exists for human health.

There is increasing scientific evidence that environmental degradation is having important human health impacts; the full effect of which may not be felt for years. Particularly at risk are our children, though they may currently show no signs or symptoms. As such, you will not see them in your examining room, but as President Bush is fond of saying, "make no mistake" - they are your patients nonetheless.

To me, the physician's responsibility is clear: she must use her privileged position in society, her credibility and her medical expertise, to assist in putting in place institutions, laws, regulations and policies designed to minimize environmental degradation and mitigate the health effects of that which cannot be eliminated. In doing so, she must adhere to Cromwell's principle of good governance and give people not what they want to hear, but what is in their best interests to hear. And these conversations must occur both inside and, more importantly, outside her examining room.

Although not explicitly stated, these are the principles on which CAPE was founded. They are also - not surprisingly - principles to which Nicole cleaved throughout her professional career as a family physician, but especially in the years following her diagnosis of breast cancer. Although I have not yet had the opportunity to meet him, I think it safe to say they are also principles held by this year's recipient of the Nicole Bruinsma Memorial Award Dr. Allan Ablesohn. I hope they are also your principles, and that you will either act upon them, or support those who would act for you.

Thank you.
C. Scott Findlay, spouse

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