It is mistakenly believed that those who pursue the medical field simply take a linear path: they decide early on that they will be physicians or surgeons and work toward that goal. Others are led to the vocation from other pursuits. Dr. Angela Carol MD, CCFP, FCFP is a family physician who works closely with vulnerable populations, a focus that began early in her career, when she functioned as a social worker as well as a child and youth worker.
Now, she practises medicine in the heart of Hamilton, Ontario’s Code Red Zone, where the life expectancy of the populace is 20 years less than anywhere else in the city. Her goal has always been to advocate for patients and break down barriers that prevent access and wellness. As a result, she has helped shape governmental as well as clinical policy by working with key stakeholders like provincial bodies of government, the U.S. Federation of State Medical Boards, First Nations, law enforcement, fellow clinicians, scientists, medical regulatory authorities, public health workers and the media.
You started in social work and ended up a medical doctor. Can you please tell us about what inspired that substantial shift and notably challenging path?
Dr. Angela Carol: When I began as a social worker and a child and youth care worker I began to see the overwhelming need and so much of the stigma that goes with mental illness, dependence, chronic pain and poverty. I was working with individuals placed in difficult and desperate situations and left feeling, to some degree, that my hands were often tied. I was left at a crossroads: become jaded, completely alter careers, or find a way to help in which I could really generate understanding, compassion and change. I chose the latter, and I haven’t looked back. Do I have difficult days? You bet. Is it still worth it? Absolutely.
Why do you think there is such a stigma and why do you think it extends into the healthcare system? Shouldn’t that be the one place where people should be insulated from judgement, per say?
Dr. Angela Carol: It’s one part human nature and one part how the system has been established. Put on top of that an opioid epidemic that continues to plague communities and it is, essentially, a perfect storm. It is a storm in which those in poverty, those who were overprescribed opioids and those who have been unconsciously overmedicated for chronic pain are left at a stark disadvantage for survival.
So what are the available solutions? How do you effectively treat without causing greater pain or enabling people who have problems to continue along that same path?
Dr. Angela Carol: The solution is as complex as the problem. In fact, government policy and clinic treatment protocols are dynamic and change anytime a better approach is discovered. It is– and must be–a collaborative effort. As to government policy, we must have the resources made available to facilitate the kind of change that is needed. As for the clinical approach, we must strive to be thoughtful when we prescribe medications and aware of when a patient is beginning to show signs of dependence. More specifically, for those patients who have already become dependent to medications–and those medications like opioids can naturally transition to dependence of narcotics–there are harm reduction strategies, opioid replacement therapy, working toward a safer opioid supply, distribution of naloxone to people who will need it, including bartenders and cab/Uber drivers who may find themselves around someone who is overdosing. There needs to be more safe needle exchanges sites, and to reiterate and bring this full-circle: more effective opioid prescribing.
Your efforts are extensive and include numerous board positions and seats on steering committees. You are clearly dedicated to your work. What advice do you have for young people considering the medical profession?
Dr. Angela Carol: The system is not perfect. No one can deny the role that physicians played in paving the way for the opioid epidemic. I think that young people sometimes look at the medical profession, specifically at doctors and surgeons, unrealistically. Maybe they see an incredible financial investment in schooling, but then nice dinners and lavish vacations. In some ways, I think that television shows have, weirdly, provided a more realistic perspective. It is gritty and dirty work. It will break your heart. There will be days that will exhaust and gut you and you might question if you have the resolve to show up again the next day. Yet, you do. That day, and the next day, and the following day after that. And you go not for the nice dinner you might get if all things go well, and not for the long-overdue vacation. You go for the people. You go because you care. You have to have a heart for this work. If you don’t, then you should pursue another career.
