I was a fledgling medical student when I received my first PSI award to work on medical science. The financial amount was modest, yet the positive personal affirmation combined with the general scientific endorsement was a critical boost needed for my fragile stage of development. Indeed, most clinician scientists in Canada lead precarious professional lives and a PSI award can be distinctly more supportive of adventures than some conservative funding agencies in the United States. I applaud the PSI Foundation for this willingness to support unconventional thinking and exploration.
Over the years, support from PSI and other agencies has helped establish my laboratory as a world leader in medical decision research that applies the basic science of cognitive psychology to everyday problems in Canadian health care. The findings have helped create new laws in all Canadian provinces; changes to the fee schedule for physicians in Ontario; more effective traffic policing internationally; and new methods for health services research. The goal is to lessen human suffering, with particular attention to major trauma caused by human error. Thank you PSI for supporting this mission!
One specific study tested how physician warnings for medically unfit drivers can bring major benefits in traffic safety through integrating clinical expertise with government authority (N Engl J Med 2012). The core theory is that patients respect their physicians and respect the law; hence, the combined effect of the two forces exceeds their influence in isolation. The main finding was that physician warnings to carefully selected patients may lead to a 45% reduction in the risk of a subsequent life-threatening traffic crash (yet may also compromise a doctor-patient relationship if done tactlessly). This study informed policies and reimbursement for physician warnings in Canada (and beyond).
Our continued work in traffic medicine has had diverse applications. One of our latest studies (CMAJ 2014) highlighted how pregnant women are usually excluded from fitness-to-drive guidelines, that prenatal care is near-silent on traffic safety, and that a normal pregnancy can cause changes that might increase the risk of a crash (such as insomnia, distraction, back pain). The main finding was that pregnancy is associated with a 42% increased risk of a serious traffic crash during the second trimester that may justify a reminder for driving safety. The findings have now helped inform prenatal care guidelines.
My latest PSI award involved returning to Northern Ontario as a visiting professor for knowledge exchange among the peoples of Canada’s First Nations. As a doctor and a researcher, this experience exemplifies how thoughtful collegial dialogue allows all parties to learn from each other and improve future clinical care (and ultimately medical care throughout Ontario). It also helps highlight what is distinct to Ontario and what is shared broadly. My hope is that more physicians can partake in such opportunities in medical science supported by resources of the PSI Foundation.