Dr. Jessica Liu: From Pandemic Challenges to Leading Internal Medicine at Uhn — An Evening at McKinsey

Sources: Uhn Foundation And Dr. Jessica Liu
with Notes From Fete Chinoise Editorial Team
photography: Andrew Downs Photography

In 2021, during the prolonged pandemic lockdown, we had the privilege of interviewing Dr. Jessica Liu, then the Site Director of Internal Medicine at Toronto General Hospital. Now the Division Head of Internal Medicine at the University Health Network (UHN), Dr. Liu recently participated in a panel discussion on the critical role of Internal Medicine and its system-wide impact. “Nearly everyone, or someone they love, will be admitted to an internal medicine ward at some point in their life,” she shared. “We ensure every patient receives the best possible care.”

Read Dr. Jessica Liu's full insights, along with event highlight images, below.

L-R. Members of the UHN Internal Medicine Team: Dr. Tom MacMillan, Dr. Tarek Abdelhalim, Dr. Jessica Liu, Dr. Vanessa Zannella, Dr. Laura Rodger, Dr. Richard Dunbar-Yaffe, Dr. Lauren Lapointe-Shaw, Sabrina Bennett (Clinical Lead, Internal Medicine), Dr. Ryan Luther, Dr. Peter Wu, and UHN Department of Medicine Physician-in-Chief Kathryn Tinckam

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Dr. Jessica Liu and Patient Partner panelist, Kate Daniels

At University Health Network (UHN), Internal Medicine (IM) physicians are specialists in the diagnosis and management of complex multisystem diseases. Often called the “doctor’s doctor,” IM physicians are expert diagnosticians who care for some of the hospital’s sickest

and most complex patients, including patients with end-stage liver disease, sickle cell disease, heart failure and cancer, as well as chronic conditions like high blood pressure, emphysema and diabetes.

With our aging population, the health system is caring for an increasing number of patients with multiple conditions who require urgent access to health care—and IM is committed to creating models to better meet patients’ needs. Our 40 UHN IM physicians are skilled clinicians who navigate our health care system every day. This allows them to clearly see the pressure points and challenges, but also the opportunities. As dedicated health system researchers, they bring expertise, vision, and a deep commitment to developing innovative solutions.

Genevieve Roch-Decter (UHN Internal Medicine Champion), Isabella Delaney, Brittney Kelleher (UHN Internal Medicine Champion), David Delaney, Camilla Balbis

FUNDING PRIORITIES
IM’S CRITICAL ROLE IN ENDING HALLWAY MEDICINE

At UHN, all IM inpatients are admitted through our busy Emergency Departments (ED) at Toronto General Hospital (TGH) and Toronto Western Hospital (TWH). With 200 inpatient beds, Internal Medicine is UHN’s largest and busiest on-call service, with our physicians assessing over 1000 patients from the ED every month. The IM service is never closed and never turns away a patient in need. Our team admits or discharges a patient every 45 minutes, 24 hours a day, seven days a week.

Unlike other services at UHN, IM has no limit on the number of patients it accepts. On an average day, the IM team has nearly 300 patients admitted to the hospital, despite having only 200 allocated beds. Unfortunately, our patients often wait in the ED, sometimes for manyhours, and often in hallways, resulting in the so-called “hallway medicine” phenomenon. There is a significant role for IM in helping end hallway medicine. UHN IM physicians are all frontline doctors with firsthand knowledge of the day-to-day challenges of our health care system and have the skills needed to create meaningful change. They are uniquely positioned to find innovative solutions to health care’s most pressing challenges, including hallway medicine.

Monica and Rod McInnes, Barclay Crossley. A special thank you to Monica McInnes of Carisma Restaurant for the evening's food and wine.  

An example of a notable innovation in IM that is positively impacting patient care is a new referral pathway at TWH that streamlines patients from ED to our Rapid Discharge Clinic, often in under 48 hrs. By enabling rapid referral, patients who can be safely discharged avoid prolonged hospital waits and are promptly directed to an IM specialist. This clinical pathway is part of our broader TWH Clinic, which aims to streamline care for some of UHN’s most complex patients, reducing long ED wait times, preventing unnecessary admissions and helping patients return home sooner.

We are grateful for UHN’s commitment to this priority, which includes an infrastructure expansion planned for fall 2024. Philanthropic support will enhance the clinic’s space with design improvements and technological innovations, allowing us to expand our reach with virtual clinic appointments and create an e-consult service for family physicians seeking IM expertise and educational rounds. Furthermore, providing dedicated research time for a medical lead—such as a Professorship or Chair in Innovations in Clinical Care—would be transformative in demonstrating the impact of our Rapid Referral Program.

TRANSFORMING HOW WE DIAGNOSE CANCER

IM cares for a large number of patients with cancer at both TGH and TWH. But this team also plays a significant role in caring for patients in the critical time before a formal diagnosis of cancer is made—and before patients are referred to our trusted colleagues at Princess Margaret Cancer Centre. The IM service admits an estimated 600+ patients a year for a possible cancer diagnosis. As patients face lab tests, CT scans and questions about what the future will bring, both they and their families face incredible uncertainty and stress. In the time surrounding a cancer diagnosis, we know days can feel like months.

Fireside chat and Q+A panelists. Dr. Jessica Liu, John Kelleher (moderator), Kate Daniels (patient partner). 

This is why our vision for the future includes a transformative Rapid Cancer Diagnosis Program. By expanding the capacity of our outpatient IM clinic, cancer diagnostics can be transferred from the inpatient wards to the clinic setting. This allows patients to remain at home as they undergo the testing needed for a clear diagnosis, and then seamlessly connects them to treatment with the IM team overseeing every step along the way.

IM AS UHN’S “HUB”: DEPLOYING INNOVATION TO ACCCELERATE CHANGE

IM is the central hub of the very complex health ecosystem that is UHN. The IM team cares for the largest number of patients at UHN (40% or over 260 patients daily). The sheer size of the IM program, coupled with IM patients’ acuity and complexity, creates a tremendous and immediate impact on all other departments.

When IM is under stress, it is instantly felt across all of UHN. However, the reverse is also true—innovation within IM quickly permeates into nearly every function and department at UHN, including radiology, pathology, surgical services, critical care, the ED and cancer care. IM’s role in leading the COVID-19 response is an example of an innovative model of care design having an immediate and widespread impact across UHN. Under extraordinary circumstances, IM swiftly designed and implemented the model for acute inpatient COVID-19 care. Every single one of our IM physicians became COVID-19 physicians and provided at-the-bedside care for 70% of all admitted patients with COVID-19 at UHN.

Anish Taneja, Matthew Kelleher and Leila Rafi.

It is IM’s vision and mandate to do more. With our aging population and the ever-growing medical complexity of patients, our health care system will face increasing challenges in the future. There is an urgent need for investment in research and the pragmatic innovations uniquely offered by IM physicians. Philanthropic support would accelerate health systems innovation, recruit top talent and inspire visionary leadership. Investing in a vibrant IM Division would allow for rapid design and implementation of new initiatives within IM and result in a better health care system for all.

CREATING CHANGE BY LEADING AND INNOVATING WITHIN THE HEALTH CARE SYSTEM

UHN IM physicians are experienced health system innovators and researchers who design new models of care and evaluate outcomes. This scholarly work is powered by our research think tank, the TG Health Quality and Innovation Hub. The mandate of this IM research group is to create innovative, data-driven solutions to improve patient care. Key successes of this hub include the rapid mobilization of the COVID-19 response, evaluation of initiatives to ease transitions between hospital and home, as well as the design and implementation of pragmatic randomized clinical trials to improve inpatient care.

Steve Kaszas, Dr. Jessica Liu and Gord Martineau

Program support (five years of seed funding) for the TG Innovation Hub would allow IM to meet a critical need to design, implement and evaluate new models of care to fix our most pressing health care challenges. Support for TG Innovation Hub research fellowships and Chairs focused on transitions-of-care research and health quality outcomes, along with the development of robust TG Hub research infrastructure, would position this new research innovation hub as a leading centre in innovative health systems transformation.

ADVOCATING FOR PERSON-CENTRED CARE

IM physicians are skilled at understanding complexity, whether it is medical complexity resulting from multi-organ disease or from our patients’ unique circumstances. Patients are more than the sum of their parts and we consider our patients’ whole bodies and lived experience. This includes factors such as poverty, under-housing, mental health issues and addictions. For example, several of our IM physicians have specialty expertise in addictions medicine, health equity and women’s health issues such as osteoporosis. Supporting the research of our team and their research initiatives in programs such as Addictions Consultation Services would create transformative growth of these programs, and help balance inequities.

Julie Quenneville (CEO, UHN Foundation)

CREATING CHANGE: TRAINING THE NEXT GENERATION OF PHYSICIANS

Health care system change starts with innovative thinking from the very beginning of physician training—and IM physicians at UHN are leading teachers and educators in the art of diagnostic thinking and excellence in bedside care.

Brittney Kelleher (Internal Medicine Champion),  Melinn Godfrey, John Kelleher.

The IM residency program is the launchpad for every medical subspecialty. IM trains every future cardiologist, respirologist, infectious diseases physician, gastroenterologist and endocrinologist at UHN, to name just a few. Much of this training is conducted at the bedside on our Clinical Teaching Units at TWH and TGH. Additionally, TWH’s Centre for Excellence in Education & Practice (CEEP) serves as our educational research institute and think tank. Its mandate is to drive change and develop new approaches to patient care by enhancing medical education at the bedside through innovation and scholarship.

Philanthropic support for CEEP will fund educational research, fellowship programs and innovations in our training programs, laying the foundation for developing the next generation of physician leaders. Ultimately, a strengthened Division of IM will enhance the health care system for everyone. Together, we can create a more effective and equitable future, ensuring better care for all.

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