Since calling it a day after 34 years at UHN, the plaudits for Emergency physician Dr. Joel Lexchin have been streaming in.
"A legend in the Canadian emergency medicine landscape...he literally wrote the book on evidence-based treatments of just about everything in emergency medicine," says Dr. David Carr, an Emergency Department (ED) colleague.
"He has had global impact by his countless publications on pharmaceutical policy," says Dr. Anil Chopra, UHN's Vice President of Medical Affairs.
"He is the model of how physicians can use research and policy advocacy to effect change both within and outside of the Emergency Department," says Dr. Jennifer Bryan, ED physician and UHN Research Director.
Ever humble, Dr. Lexchin is modest when it comes to his legacy.
"I would like to be remembered as a good clinician," he says. "Somebody who cared about patients, somebody who cared about colleagues, somebody who cared about the institution."
Memories of his first day at Toronto Western Hospital back on July 1, 1988 may be a little faded – "I remember the staff was quite welcoming, easy to get along with."
But Dr. Lexchin is clear on the evolving demands on UHN's ED over the decades. He guesstimates patient volumes have doubled since he started. And, as UHN's program specialties expanded so did the complexity of patient needs coming into the ED.
"We get the people from the Princess Margaret coming over with their oncology related issues," he says. "We get transplant patients, complex cardiology patients.
"We didn't really see a lot of that early on, so we do more and we're recognized as being able to manage a much wider range of things."
Pioneered greater accountability of the pharmaceutical industry
While patient interactions in the ED may be short – "You know long-term relationships in Emergency Departments are half an hour," he quips – Dr. Lexchin has clearly had a lasting impact on the practice of Emergency medicine.
"I remember when I was a resident, Joel, through our National Association of Emergency Medicine, put out a handbook on how to treat Emergency medicine encounters," says Dr. Carr. "The book covered everything from infectious diseases to hiccups."
"It was intimidating when I started in residency to realize that my supervising physician was also the one who had written my go-to reference for medications in the Emergency Department, one of the few books I carried around in my pocket on shift," says Dr. Bryan.
"I've been incredibly fortunate to be able to work alongside Dr. Lexchin in the Emergency Department over the past eight years."
Dr. Lexchin's writing was not confined to practice. Over the decades, he helped pioneer greater accountability of the pharmaceutical industry in areas such as drug safety and after-market drug monitoring.
He wrote about "regulatory capture" when it came to the relationship between government and pharma; industry influence on prescribing habits in the medical profession; and, advocated for greater transparency and reporting of adverse drug events – something he has long lamented is well under-reported.
"I'm a child of the '60s, and when I was in university I got politically involved," says Dr Lexchin. "So, it was translating student activism into the pharmaceutical industry as I got into medicine."
'I feel guilty'
Dr. Lexchin's contribution on this front is prodigious. He has more than 200 publications, including books with titles such as: "The real pushers: A critical analysis of the Canadian drug industry," and "Doctors in Denial: Why Big Pharma and the Canadian medical profession are too close for comfort."
Stanford University ranks Dr. Lexchin in the top two per cent of the world's most cited scientists.
Dr. Lexchin has presented numerous times before the House of Commons Standing Committee on Health. And, to ensure his work in research, policy development, and advocacy lives on, UHN's Emergency Department has named an award after him: the Dr. Joel Lexchin Research Excellence Award for Best Research Publication by a Senior Investigator will be given annually.
At age 74, Dr. Lexchin is a little torn to be stepping away from clinical work.
"I feel guilty," he says.
But he's looking forward to the birth of his first grandchild, and new activities.
"A couple of years ago, I bought a pedal assist electric bike so I've been biking a fair bit with some friends of mine."
Thankfully, Dr. Lexchin has agreed to keep up his advocacy work and mentorship.
"I'm still doing the pharmaceutical policy stuff, and I'm still doing a little bit of teaching at U of T," he says.
Dr. Lexchin recognizes he's stepping away from the frontline at a critical time in health care. His advice for navigating the rough waters?
"The most important thing in the health care system, it has to be patient need."
