Canadian Medical Association Journal 1995; 153: 459-460
Anyone meeting Dr. Jack Armstrong for the first time will encounter not only a soft-spoken and generally optimistic physician, but also one who is strong in his convictions.
Armstrong, the CMA's incoming president, was interviewed in May as Manitoba held a provincial election -- an appropriate date given his involvement in medical politics and his personal interest in local government. Thinking ahead to what his year in office will hold, Armstrong shared his views on the role the president plays in the 45 000-member CMA.
"I think it's important that you don't go into this position with any grandiose ideas or expectations of making any huge changes," he said. "You have to be a part of a team. My job is to try to be as good a spokesperson as possible, along with the other team members, for the physicians of the country."
His perspective on the many issues affecting medicine reflect his years of involvement on boards and committees of both the Manitoba Medical Association (MMA) and CMA. Perhaps more importantly, his perspective has been sharpened by his 24 years as a practising pediatrician in medicine's "trenches": Jack Armstrong has paid his dues. Ultimately, that perspective keeps him focused on what is best for patients.
"When I sit in on meetings and discuss current management or organizational trends, [I know] it's an understatement to say that we're in a period of rapid change. But I think we need to guard against rushing to make changes that won't be productive or in the patients' best interests."
He acknowledges that today's fiscal realities must be addressed, but questions the way health care budgets are being cut and whether provinces will be able to provide basic levels of health care if the budget slashing continues. Although many provincial governments espouse community-based care and the "wellness" approach to health care, Armstrong suggests they may be using this approach to justify cutbacks in hospitals and other health care institutions. And, he adds, too often changes are legislated before the community is ready to care for patients.
The incoming president expresses frustration at governments' extensive examination of various aspects of community care -- examinations that are often followed by a lack of action on completed studies and a subsequent willingness to establish new committees to study essentially the same issues. "There are so many studies done and so many committees," he complains. "The money spent on the committees might be better placed going into specific health care funding. I agree it's necessary to study things, but these committees have become an industry in themselves."
The practice of preventive medicine, community care and the use of a population-health approach can't occur just by talking about it, he adds. "I think there is a certain amount of hypocrisy when governments continue to talk about the important role of health determinants and population health, and then they cut back, for example, on funding to help young aboriginal people get an education to better themselves and to act as leaders for their community, while at the same time providing meaningful services for all of us."
Aboriginal-health issues are of particular interest to Armstrong, who has an adopted daughter of aboriginal descent. "Some of the most important work I've done was to chair the Committee on Aboriginal Health at the [MMA]. Thanks to its capable members, we developed some better links and understanding between First Nations people and those who are providing health care to aboriginal people."
Although he has a particular personal interest in aboriginal issues, Armstrong's interests concerning the medical profession are wide ranging. The deterioration of communication among different health care professionals is troubling, he says, and even though it occurred in part because of institutional systems that hinder collaboration and communication, the end result is that patients suffer as professionals worry about protecting their turf.
However, he cites positive experiences from his own pediatric practice: "There are individuals who know what's going on with a patient [who] share that [with the doctor] -- it can be a psychologist or a social worker or a teacher talking about a young person's behavioural difficulties."
Within the medical profession, Armstrong believes the fears of students and young physicians, whose morale is low in the face of an uncertain future, must be addressed. One persistent question is whether it is appropriate that medical students must choose their area of specialty training at an early stage in their education.
He also worries about the threat of young graduates and experienced physicians leaving the country to practise in the US. "It is essential that we maintain a strong cadre of primary care physicians," he says, while at the same time strengthening the research and academic components of medicine.
The CMA, Armstrong believes, is in the best position to address these interests and concerns of the medical profession, and he speaks highly of the association's committees, the physicians who chair and serve on them, and the staff who provide support. Regionalization, guidelines for practice, ethics, physician-resource management and health care financing are among the important issues that the CMA is handling competently, Armstrong points out.
The depth and breadth of the incoming president's interest in medicine is mirrored in his personal life. His taste in books, sports, art and music are eclectic -- broad interests that may stem in part from his university days. Armstrong earned a liberal-arts degree in addition to his medical degree, and spent time during those university years working with troubled adolescents who lived in inner-city Winnipeg. That experience led to his lifelong interest in "people experiencing adversity."
His involvement in medical organizations has not been limited to work with the CMA and MMA. He has served on the steering committee of the Health Advisory Network created by Manitoba's minister of health, and was recently appointed to the Board of Directors of Manitoba's Centre for Health Policy and Evaluation. Somehow, Armstrong has also found time to work with nonmedical organizations, including the United Way and his church. He has served on the Board of Directors of the United Way of Greater Winnipeg, as well as several of its subcommittees, and is a former chair of the Board of Directors of the St. Vital United Church.
As well, he and his wife Glenda -- they have two daughters -- were one of the founding families of Project Opikihiwawin, an organization that provides support to families that have adopted aboriginal children. It links the families with the native community to promote better understanding of and pride in their children's heritage.
"Glenda has always supported me," Armstrong says. "She relinquished some of her own goals to allow me to pursue some of my interests. Through her work as a nurse and her involvement [in the project] she's had a full understanding and been supportive of my interest in aboriginal health. And her woman's intuition probably led me along the way to make some decisions or develop some understanding that might not otherwise have been attained."
As he prepared for General Council and the CMA's 128th annual meeting in Winnipeg from Aug. 13-16, Armstrong was looking forward to his upcoming year as president with typical quiet enthusiasm. He said he is "humbled" by the opportunity to lead the organization.
Armstrong's installation ceremony will be held Aug. 16. He will succeed outgoing president Dr. Bruno L'Heureux, a family practitioner from Laval, Que.