Recognizing a pain pioneer

We almost take for granted the premise that individual pain experiences can limit patients’ recovery from injury, but just thirty years ago, perceptions of pain weren’t central to patient care. Many clinicians informally asked their patients about pain but there was no formal process for collecting this information.  

Joy MacDermid – at the time, a hand therapist at the Roth | McFarlane Hand and Upper Limb Centre (HULC) at St. Joseph’s Health Care London – knew there had to be a better way.

“I saw such a big need for it,” MacDermid says. “I saw many people coming in with a distal radius fracture [a bone break in the wrist] – they all had the same injury, but they had very different experiences. We needed to incorporate their perception of how much pain they're having into clinical treatment programs.”

MacDermid, now the co-director of HULC’s Clinical Research Lab, has been recognized with the Order of Ontario, the province’s highest civilian honour, for her contributions to patient-centered care. MacDermid is also a scientist at Lawson Research Institute and a Distinguished University Professor of Physical Therapy at Western University.

MacDermid sought a method to capture patients’ first-hand experiences. She became a pioneer of patient-reported outcome measures – tools that collect patients' perceptions of their health. These measures have become a critical component of care and have changed treatment standards and delivery here and across Canada.

For example, keeping records of a patient’s experience allowed pain to be tracked over time and led researchers to realize we don’t have a great memory for pain. MacDermid recounts speaking with a surgeon surprised when a patient remembered being unable to place an object on a shelf before surgery, but didn’t recall the pain that accompanied their attempt.

“People do forget pain when it's relieved to a certain extent. There were people who after their surgery would totally forget that’s the reason they came for treatment. They'd say, ‘well, I didn't really have pain.’ Really? Here's your scale, and you said your pain was 9 out of 10 preoperatively.”

Patient-reported outcome measures counteract this forgetful quirk of the human mind and make evaluating treatment more accurate.

“If you're going to have surgery, you want to know it was effective. Having those records to look at how people's outcomes improve over time is important for good clinical decision-making. But it's also important for patients to understand their recovery journey,” MacDermid says.

The Order of Ontario recognizes Ontarians who have left a provincial, national and global legacy in a variety of fields. At St. Joseph’s, MacDermid's legacy has grown alongside HULC’s since its founding in 1992.

When MacDermid came on board, a new role of clinician scientist was created for her. She spent half of her time practicing as a therapist and the other half on research. MacDermid soon founded HULC’s clinical research lab, which has been driven ever since by her focus on taking research beyond the lab and to patients.

“I’m in implementation science which means part of my work is looking at how we take things from research and move them into the real world," MacDermid says. “I'm really interested in how we make sure research does benefit people by resulting in improved programs and policies.”

MacDermid has found another outlet for this passion as the scientific director of FIREWELL, a platform that provides resources, training, and research focused on firefighters' health and safety. Firefighters are at risk of many health conditions, including musculoskeletal and mental health problems. They reached out to MacDermid for support and one project led to another, she says.

“I really feel proud of that work because it's protecting people who protect the community. They protect us and if, as healthcare providers, we can do something to protect them, we should do that.”

MacDermid’s other contributions to health care include bringing attention to gender inequity in care and research, and being a founding member of the Canadian Institute of Public Safety Research. Finding herself amongst a group of accomplished recipients at the investiture ceremony meant a lot to MacDermid. 

“A lot of the people I saw at the service were leaders in their field. I appreciate that they recognize what I did was innovative and that it did make it a contribution.”