By Calee Lucht
Tom McLaughlin MPP 2019 focuses on the nexus of medical care and policy to improve health outcomes for children and families.
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A pediatrician from Canada, Thomas McLaughlin MPP 2019 loved caring for children and families at the Hospital for Sick Children in Toronto and BC Children’s Hospital in Vancouver. But he also saw what he couldn’t fix from his doctor’s office: determinants of health like housing quality, the unavailability of child-friendly medications and insurance, even hospital processes and procedures. Recognizing the value of his vantage point, McLaughlin’s interest in policy—and desire to heal, not just treat—was amplified. We spoke with McLaughlin, a recipient of Harvard University’s Frank Knox Memorial Fellowship, about his intersecting pursuits of medicine and policy.
Q: As a pediatrician, what led you to pursue a public policy degree?
Medicine is a combination of hard science and people—it’s the application of science to humanity—and I like that duality. As a pediatrician, I treated children with medical issues, but some of those issues stem from social or developmental factors—at their roots, they aren’t actually health issues. During my residency in Toronto, I saw how medicine sometimes falls short. Medicine doesn’t address root causes; we can prescribe an inhaler to a child with asthma, but the asthma may be caused by poor housing quality or second-hand smoke. We have to address these upstream factors as policy issues, not just medical issues. I was becoming more involved in advocacy, but I realized I needed new skills for that. I wanted to learn how to work with legislators and policymakers, how to build coalitions, and develop budgets. So, I started looking at policy programs and really liked the core curriculum offering of the Master in Public Policy at Harvard Kennedy School. The MPP program has a rigorous structure while also allowing us to dive deep in our area of interest.
Q: Can you give us a couple examples of your endeavors at the intersection of medicine and policy?
Doctors have a unique insight into societal issues, but are not trained to impact policy. We can affect the life of the patient in front of us—at the micro level—but we get tripped up at the broader step of changing policy—the macro level. For example, in Canada, children have less access to medications than adults; companies don’t make as many drugs tailored just for children, and insurers don’t focus on children. It’s an issue of regulation and insurance, which happens at the provincial and federal levels in Canada. I’ve been advocating for Health Canada (Canada’s counterpart to the FDA) to improve access to medicines for children. This could be immensely useful in moving the needle for children’s medical care at the macro level. Another example: I did my MPP Policy Analysis Exercise (PAE) with Delaware Health and Social Services (DHSS), where I focused on improving services for high-need children and families. The communities in some parts of Delaware have a high incidence of mental and behavioral issues and violence—these are some of the upstream, social determinants of health. My PAE recommended the core idea of “wrapping systems around people” in order to improve outcomes. That is, instead of having to go to several different agencies to get the services they need, we flip the model to make services child- and family-centric. It’s an iterative process, and DHSS and other agencies are now thinking about how to finance and incorporate the program. I’m hopeful.
"Doctors have a unique insight into societal issues, but are not trained to impact policy. We can affect the life of the patient in front of us—at the micro level—but we get tripped up at the broader step of changing policy—the macro level."
Q: Which courses made a particular impact on you?
“Fundamentals of Negotiation Analysis,” taught by [Mohamed Kamal Senior Lecturer in Negotiation and Public Policy] Brian Mandell, led me to realize that many of our interactions in life are actually negotiations, whether we realize it or not. Learning how to create common value is so important—at the same time, sometimes we need to advocate strongly for a position, and learning that skill was useful. [John D. MacArthur Professor of Health Policy and Management at HKS and Harvard T. H. Chan School of Public Health] Joe Newhouse has been a part of every major health care policy for the past several years. His course, “The Economics of Health Care Policy,” gave me true insight into how the broader health care system works. And one of the great things about studying at Harvard is that we are able to take classes at other Harvard schools. I took “Health Care Quality and Safety” with Tom Sequist (MD 1999, MPH 2004 and chief quality and safety officer at Partners HealthCare). I learned that micro-policies matter: things like using statistics to determine whether a change in hospital management led to an improvement in patient outcomes, or decreasing bias in physician decision-making through standardized forms or checklists—these small changes can help inform the big picture. I hope to take these concepts back to my hospital.
Q: Did you have time to take part in activities outside the classroom?
I did! I co-led the Canadian Caucus student interest group. We organized a trek to Ottawa to expose Canadian students to careers in government; some students got job offers out of it. We were able to bring Canadian students to see [former Prime Minister] Stephen Harper when he was on campus to speak about leadership. We also organized social events, where I’m proud to say we became infamous for our “twin Justins”: cardboard cut-outs of Prime Minister Justin Trudeau and Justin Bieber.
Q: How do you envision combining medicine and policy after you graduate?
I’ll return to BC Children’s Hospital, where I’ll split my time between my clinical work as a pediatrician and quality improvement and health policy work. Long-term, I always want to be doing clinical work; I love helping children and families. But now I want to help them in a more holistic way. Being at the nexus of clinical and health policy making, I have an in-depth view of the challenges they face—not just the medical ones. I want to be a health systems leader working towards broader access to medical care, and more equitable care. Having the opportunity to study at HKS has been a special time for me to focus on my own development, and now I have a responsibility to do good things with this degree.
