How CanMEDS is destined to become Can’t MEDS
Evidence-based medicine and the preeminence of merit among Canadian doctors will soon be consigned irrevocably to the dustbin of history.
“Victor Laszlo published the foulest lies in the Prague newspapers until the very day we marched in. And even after that, he continued to print scandal sheets in a cellar.” So ran the accusation by Colonel Strasser in Michael Curtiz’s impeccable 1942 film noir, Casablanca.
Strasser was vilifying the upstanding resistance leader who challenged the prevailing regime in Morocco that attended France’s surrender to Germany in the summer of 1940. Today, in Canada, more than three-quarters of a century later, this enduring scene begs comparisons to a new, looming rebellion, this time between doctors and their regulatory agencies, and one that bears all the same hallmarks of defiance.
Last month, I sat down with one of the emerging resistance leaders in Canadian medicine, Dr. Mark D’Souza, a family physician and an affiliate of Queen’s University's School of Medicine, to discuss the professional competency framework for Canadian doctors. The framework, named CanMEDS, is articulated from on high by the Royal College of Physicians and Surgeons of Canada, in collusion with three other major Canadian bodies governing medical practice nationwide.
It is essentially a set of guidelines that delineates the professional attributes expected of all doctors in Canada, a notion illustrated in the Royal College's own propaganda sheets by a pictogram of a bloom sprouting six petals labelled ‘Communicator, Collaborator, Leader, Health Advocate, Scholar, Professional,’ with ‘Medical Expert’ reassuringly placed at the flower’s centre. The first impression is one of childlike naïvety, reminiscent of kindergarten, and not at all what you’d expect from a cadre of top doctors. You might think the college means well, even accounting for the dumbing-down—but you’d be dead wrong.
As Mark tells it, these woke wünderkinder are busy building their careers—not on evidential research about disease, because that is an arduous, snail’s-pace affair—but instead, by soul-searching over the pervasive white supremacy they deem is baked into modern western medicine, and the oppressive patriarchal Enlightenment notions (read: modern science) that fails to recognise the contributions and value of Indigenous knowledge.
Today, CanMEDS is undergoing an ideological makeover before our very eyes, one that marks a complete departure from the empirical basis for medical practice. By ‘empirical,’ I mean the well-established convention for physicians to make decisions based on their observations of the patient, and from the amassing of objective evidence. This is the modern medicine we all know, the medicine that is informed by science.
The revolutionary new proposals for physician competencies, including two potential frameworks that D’Souza shared with me, are both derangements of the first order, encapsulating as they do a collection of unsubstantiated and unfalsifiable beliefs that ought rather to be the preserve, not of the medical profession, but of the priesthood. The conceit is for the devoted disciples to nail another ideological petal to the ‘blossom of medical competence,’ one that will force all doctors to integrate political activism into their daily practice. And that means every single Canadian should be worried.
Now, I have written previously about Canada’s teetering Jenga tower of medicine; that article, amongst many other strident reactions, prompted Toronto-based hospital physician Raghu Venugopal to post on his X (formerly Twitter) account a new version of the CanMEDS medical flower, one which he had defaced with the addition of a petal marked ‘Equity, Diversity, Inclusion and Accessibility.’ So my prediction is realised, and it’s mind-blowing to be lured into this kind of intellectual duelling at 2:00 a.m. on a weeknight a with an emergency room doctor. Venugopal posts so incessantly, it makes me wonder how he finds the time for social media battles in his doubtlessly hectic schedule.
But the Aesculapian pontiffs who are championing the impending CanMEDS revolution are calling for the decentring of medical practice away from traditional evidence-based medicine in favour of foregrounding virtues of social justice activism; at once demanding that Canadian doctors regurgitate critical race theory and prioritize patients’ lived experiences. This inevitably greenlights a patient’s inalienable right to dictate unilaterally their desired treatment—informed by, well, Google searches.
The CanMEDS protagonists, it transpires, are led by a colleague of mine, Ritika Goel, assistant professor at the University of Toronto. On X she self-identifies as a “South Asian woman. Family doctor and Activist. Immigrant and Settler. Mom of two. Tweets on health, politics & social justice.” Some will inevitably read this and recoil, nervous about the intersection, say, between politics and life-and-death decision-making.
Of the other nine members of the CanMEDS Anti-Racism Expert Working Group, four are Black—translating to a representation rate 10 times the national proportion. And then there is the other elephant in the examination room: one-third of Canadians are white men; yet on this committee, not a sausage. Naturally, it will be argued that for inclusivity, diversity and equity to succeed, these self-appointed grandees must actively exclude white males. This effectively silences the disquieting voices of the patriarchy, unifies the monotonous narrative, homogenizes opinions and demands everyone nod in acquiescence. Democracy, free thought and, perhaps most crucially, the recognition of merit be damned. Very soon, then, CanMEDS will become “Can’t MEDS.”
They don’t like it, you see: the deeply colonial, evidence-based practices that prop up systemic societal prejudices in the West. Some of the more unhinged statements on record stretch as far as the editor-in-chief of the Canadian Medical Association Journal (CMAJ), Kirsten Patrick, whose editorial declaimed as far back as March of 2021, “I am writing today to state categorically ... that systemic racism exists in Canadian society and within its health care systems,” and went on to pledge, “I will work to further an antiracism agenda at the journal.” These are deranged, unsubstantiated assertions and someone will inevitably be called upon to oust this stooge.
Just this July, a CMAJ article appeared whose sole intellectual contribution to medicine was to scathe governmental bodies for funding research focusing on South Asian populations because the studies weren’t conducted by a posse of doctors with the correct skin tones. For the three female authors, it’s blindingly apparent that far too many white doctors are unconscionably imposing their systemic racism upon a victimised ethnic community. In their words, “White ... senior authors in leading medical journals ... can misrepresent White academics as experts on South Asian health.” This is monumental bigotry, of course, and constitutes the acceptable face of modern racism in Canada in 2024.
Indeed, such unconcealed prejudice is emblematic of left-leaning intellectuals who have imbibed the sacramental wine of the antiracist ideology, a demented religion espoused by proponents such as Ibram X. Kendi—now widely discredited for his academic financial improprieties—and the perilous White Queen of critical race theory herself, the cashmere-clad Robyn DiAngelo. These academics urge the guileless listener to look past their unashamed champagne authoritarianism and embrace the toxic tenets of their cultish belief system, beliefs such as the mythical White Fragility that is the title of DiAngelo’s bestselling book. White fragility is a Catch-22 concept that reinterprets a white person’s denial of their own racist beliefs and behaviour as de facto evidence of racism. Any normal Canadian would instantly call this out as a buffoonish bear trap. The fact that DiAngelo reportedly bills US$20,000 per hour for her insights is merely a sideshow; move along, people: nothing to see here.
The distillation of these facts is to realise that Canada is now on a trajectory to prioritise a doctor’s social justice and political activism over their competence in anatomy, physiology, pathology, biochemistry and medically informed intuition. D’Souza pointed me to a recent embarrassing discovery that emerged in the esteemed New England Journal of Medicine, no less, which declared with some considerable vigour that apartheid, the segregation of racial groups into different cohorts, for the purposes of teaching physicians was “the future” of medical school training. I’m lost for words.
What this means for everyday life in Canada is a ‘physician class’ that will be expected—and likely required—by their governing body to prioritise social engineering over and above their knowledge of medicine. Patients who present as, let’s say, arthritic seniors, will need to be evaluated for their social status and privileges at least in parallel, if not ahead of, an assessment of their symptoms. These pensioners might well also be subjected to cross-examination about their current gender identity. No joke: in a 2022 interview for the College of Physicians & Surgeons of Ontario, Alex Abramovich, a transgender man, urged colleagues to discuss pronouns with longtime patients: “Gender identity can change over time … I think it’s important to also let long-time patients know that you are open to speaking about changes in their gender identity.”
Mark, whose new book Lost & Found: How Meaningless Living is Destroying Us and Three Keys to Fix It launched this month, told me that a large number of doctors—nobody knows quite how many—have already complained to the Medical Post, a physicians’ periodical, only to be gaslit by the establishment elites, dismissing these as a troublemaking minority who fail to grasp the true intentions of the new CanMEDS framework. No, these doctors understand perfectly well; mercifully, they are unwilling to acquiesce without a fight.
With only four months left to go, the machine that is reimagining CanMEDS seems like an unstoppable juggernaut, slated for implementation beginning in January next year. It will fall to workaday Canadians, doctors not least among them, to resist. A lucky few could, of course, deploy emigration parachutes. Pessimists might welcome our increasingly permissive euthanasia provisions, MAiD, as an existential blessing in disguise. What is certain is that in Canada, in 2025, there will be nowhere left to hide from the social justice reinvention of medical practice.
They say all of life’s problems are answered in the movies. When Casablanca’s Captain Renault finally rejects his authoritarian overlords and tosses the bottle of Vichy water he’s about to pour into a waste basket, it marks a major turning point. It’s time to demand that our politicians reform the Canadian medical establishment, to insist that the ideologues be cast down. Only when the current regime has been deposed, only then might there be the beginnings of a beautiful friendship.
I wrote to the RS people managing this thing, as a member of the public, saying I disagreed with their new approach deprioritizing competency. They replied with non committal word salad. I can send you their reply if you like.