A broken outdated foundation
Every few months we hear another troubling statistic about Canada’s health-care system. Emergency departments are overcrowded. Family physicians are burning out. Recently we heard about one in ten emergency room doctors leaving their jobs. Wait times continue to grow. Prince Edward Island has one of the highest rates of people without a regular primary care provider.
The usual response is for the government to ask for more funding, more physicians and more hospital beds. Those are important. But they won’t, by themselves, solve the problem.
Part of the challenge lies in how we think about health.
For more than a century, Western medicine has been remarkably successful at treating disease. Vaccines, antibiotics, surgery and modern medications have saved millions of lives and dramatically increased life expectancy. When someone has pneumonia, a heart attack or appendicitis, modern medicine is extraordinary.
But many of today’s greatest health challenges are different. Mental health and substance use disorders are now the No. 1 cause of disability worldwide, followed by chronic pain disorders such as back and neck pain. For these drugs and surgery are rarely curative, and these conditions add a huge burden to our struggling health system. And they likely also undermine the resilience of our medical workforce.
We need to rethink health and well-being, and the foundation we have built our healthcare system on. Recent discoveries about the two-way connections between the mind and the body, and how the brain can rewire itself, are showing us a better way forward. They show us how to identify and better understand and address some of the factors contributing to illness and recovery.
This new approach addresses the whole person, one’s history of trauma, beliefs, environment, and relationships. This is known as the bio-psycho-social-spiritual model of wellness and healing. This broader approach should complement and expand the biomedical model, particularly in treating chronic pain, mental illness, substance use and other complex conditions.
Over decades of practice in family and occupational medicine, I have seen patients for whom a predominantly biomedical approach did not adequately address the complex factors contributing to chronic pain, disability and prolonged recovery. A relatively minor shoulder strain, for example, in someone with childhood trauma, may progress into chronic disabling pain when psychological, social and other factors affecting recovery are not recognized. In such cases, medical interventions alone may not address the factors contributing to persistent pain.
How do we begin to rebuild our healthcare system on this broader foundation?
A better foundation to rebuild on
Today’s primary care reform to the Medical Home Model is a large step in the right direction. Here a team-based interdisciplinary approach can explore and address the psychosocial factors from the outset and even help prevent illness. By bringing physicians, nurse practitioners, nurses, mental-health professionals and other providers together, these teams are better positioned to address the medical, psychological and social factors affecting a patient’s health.
But unfortunately, many frontline healthcare professionals have yet to receive sufficient education in trauma-informed care and its application to chronic and complex conditions. This approach changes the diagnostic focus from, “What’s wrong with you?” to “What happened to you?” One’s childhood or adult trauma is known to significantly impact physical and mental health. Understanding and addressing one’s ongoing stressors, relational discord, work circumstances, physical activity, and so forth, has been shown in published studies to significantly improve outcomes.
So, we must begin with education in medical and professional schools, as well as in continuing medical education conferences for the various disciplines. There are many published papers in the medical literature, as well as lay books and digital media by renowned physicians and psychologists who are leading this movement.
Canada will continue to need more physicians, nurses and other healthcare professionals, and governments will continue to need to invest in healthcare. But we should also ask whether we are making the best use of those resources. Broadening our approach to health, particularly for chronic pain, mental health, substance use and other complex conditions, could improve outcomes for patients while reducing some of the pressure on an already strained system. That conversation deserves a place alongside the debate about funding, staffing and hospital capacity.
Hendrik Visser, MD
Published in The Guardian, August 20, 2026
