Every December, Healthy Debate asks people across the health-care system what they wish for in the coming year. It’s a small ritual, but an important one. Wishes are a way of naming what we value – and what we know, deep down, is missing.
This year, my wish list is shaped by the many roles I occupy: general internist, educator, journalist, editor and incoming president-elect of the Federation of Medical Women of Canada. It’s also shaped by the conversations I have every day – from patients who feel lost in the system, from colleagues who are burning out and from trainees who still believe medicine can be better, even if they’re not always sure how.
Here are four things I wish for our health-care system.
- That we truly value generalists
Canada has world-class specialists and subspecialists, and we should be proud of that. Their expertise saves lives, advances science and pushes the boundaries of what medicine can do.
But my first wish is that we finally extend the same level of respect, investment and structural support to generalists.
Primary care, general internists, geriatricians, hospitalists, pediatricians and emergency physicians – just to name a few – do some of the hardest work in medicine. We show up each day without knowing what – or who – will walk through the door. We manage complexity, uncertainty and risk in real time. We make diagnoses before there is a label, a referral or a care pathway. We are the gateway to the health-care system and can be the glue that holds it together.
Yet, generalist care is routinely undervalued. It is under-resourced, administratively burdened and designed in ways that make high-quality care harder than it needs to be. The conditions under which generalists practice – short visit times, fragmented records, staffing shortages and relentless throughput pressures – often are incompatible with the kind of medicine we are trained to deliver.
Valuing generalists isn’t just about professional recognition. It’s about system design. A health-care system that neglects its generalists is one that struggles with access, continuity and diagnostic accuracy. If we want a system that works, we must invest in the people who see patients first and who see them longitudinally.
- That we stop confusing ‘more care’ with ‘better care’
We live in a country where people often receive a lot of health care – and yet don’t feel cared for. This disconnect is one of the central problems in our system, and we don’t talk about it nearly enough.
Patients describe endless appointments, tests, referrals and forms, yet still feel unseen, unheard or unsupported. They feel like they are moving through a machine rather than being cared for by a system designed around human needs.
Meghan O’Rourke described this perfectly in her essay in The Atlantic: “In the hospital, I always felt like Alice at the Mad Hatter’s tea party: I had woken up in a world that seemed utterly logical to its inhabitants, but quite mad to me.”
Too often, patient experience is dismissed as “soft” or “frivolous,” something to consider only after we’ve dealt with the “real” issues of access and efficiency. This is a mistake. How people experience care matters. It affects trust, adherence, outcomes and whether people seek care at all.
When policymakers and decision-makers design health-care systems, they tend to focus on volumes, wait times and utilization metrics. These are important, but incomplete. We rarely ask what this feels like for the person receiving care. Is it coherent? Is it humane? Does it make sense to the person living it?
We need to design systems not just to deliver care, but to make people feel cared for. Compassion, clarity and continuity are essential infrastructures – not optional extras.
- That we move from describing health inequities to dismantling them
It is unacceptable that life expectancy, quality of care and access to services can differ dramatically based on the colour of your skin, your income, your postal code or your country of origin. We are well past the stage of needing to prove that these inequities exist. The evidence is overwhelming. What we need now is action.
Addressing health inequities requires us to be honest about their root causes. Unequal health outcomes are not accidental. They are the predictable result of unequal allocation of power and resources – who has access to care, whose voices are heard, whose needs are prioritized and whose are ignored.
As someone stepping into a national leadership role in women’s health at a time when reproductive rights are being rolled back in North America, this feels especially urgent. Gains we once assumed were secure are no longer guaranteed. Equity is not a destination we reach and then leave behind – it is work that must be defended and renewed continually.
Reducing health inequities is part of the job for each and every one of us in health care. That means understanding how systems advantage some while disadvantaging others – and being willing to change those systems, even when it’s uncomfortable.
- That we recognize when we are perpetuating futility – and have the courage to say so
My final wish is one that asks something of us as clinicians. I recently learned a term from a palliative care colleague: maladaptive medical coping. It describes what happens when a clinical situation is dire, treatment options are limited and prognosis is poor – but instead of naming that reality, we retreat into complexity and ambiguity.
We hide behind uncertainty. We say there is no single test that can definitively tell us what will happen. We focus on managing numbers, ordering investigations and addressing one problem at a time – while avoiding the harder conversations.
In hospitalist medicine, we see this often, especially when someone has a crisis requiring an inpatient admission. For example, take a person with metastatic cancer. Significant comorbidities preclude aggressive treatment – advanced heart failure; dialysis dependence; frailty; poor functional status. Everyone involved senses that the prognosis is poor, but no one quite says it. The result is a kind of quiet madness: escalating interventions without a shared understanding of goals; patients and families clinging to hope without clarity; and clinicians feeling uneasy but unsure how to break the cycle.
When prognosis is communicated clearly, honestly and in a way patients can understand, people make different decisions. They ask different questions. They prioritize time, comfort and meaning in ways that often surprise us.
We need to be better at having these conversations. Not perfectly. Not with absolute certainty. But with humility, honesty and compassion. Avoiding them does not protect patients – it deprives them of the opportunity to make informed choices.
And one more thing …
If I could add one more thing to this list, it would be this: that we resist cynicism.
Despite everything, I still believe in our health-care system. I believe we can make it fairer, more compassionate and more humane. The people working within it – clinicians, patients, caregivers, policymakers – often are not the problem. The structures we’ve built are. Wishes alone won’t fix that. But it’s a start.
As we head into 2026, my hope is that we stop accepting the system as it is – and start insisting on the system we know is possible.
