What Was Already There

In 2024, Queen’s University introduced a lottery into its medical school admissions process. Applicants who cleared the academic minimums—GPA, MCAT, CASPer—would be chosen at random to proceed to interviews. The volunteering, the research publications, the curated extracurricular lists that had become a rite of passage for every pre-med student in the country were set aside.

The reaction was immediate. Reckless. Irresponsible. Russian roulette with patients’ lives.

But almost nobody asked the prior question: what was the current system actually selecting for? If the answer was merit, the lottery was dangerous. If the answer was proximity to opportunity—whose parents could fund the unpaid research summer, whose neighbourhood had a hospital that took student volunteers—then the lottery wasn’t lowering the bar. It was exposing what the bar had been measuring all along.

That gap between what a system claims to do and what it actually does is the thread running through this issue of Lounge. In each case, something was already visible—an injustice, a principle, a technology, an evidence base—and the system either could not see it or chose not to. Not out of malice. Out of the ordinary cognitive inertia that comes from having looked at something so long that you stop seeing it.

Nadia Aumeerally, drawing on her experience with the Dalhousie admissions committee, makes the case that Canadian medical schools are building a physician workforce that does not match the country it serves, and that the process selecting for this mismatch has been hiding in plain sight, protected by the concept of merit.

Joanne Gallant writes about procedural pain in women—not a new discovery, not a contested finding, but a fact that has been visible for decades but unaddressed. The assumption that certain procedures don’t require analgesia became so embedded that it stopped being a decision and became a default. The most dangerous kind of blindness is the kind that feels like clarity.

Frank Rudzicz argues that the clinical AI tools now entering Canadian hospitals are not just software purchases but structural choices about who owns the cognitive infrastructure of medicine—choices being made right now, in procurement offices and vendor contracts, by people who may not realize what they are deciding.

And the historical essay that closes the main section traces the lineage of magnetic brain stimulation from ancient torpedo fish through a Paris laboratory in 1896 to the rTMS clinics operating across the country today—a story of an idea that was right, and ignored, and right again, across a span of centuries.

Four essays, four versions of the same pattern: the catalyst for change was already there.

William Harvey sat on the circulation of the blood for twelve years before publishing, because he knew his contemporaries couldn’t receive it. William Osler, in the address we reprint at the close of this issue, called it “mind-blindness”—the tragic fate of reaching, after years of patient search, a condition in which the truth is not recognized, even though it stares you in the face. He was speaking to Canadian medical students in 1905. He could just as easily be speaking to us now.

The question for this generation of clinicians is not whether we are living through a period of transformation. That much is obvious. The question is whether we will be the ones who see what is in front of us, or whether we will be the ones the next generation writes about with polite regret, wondering how we missed what was already there.

The catalysts for change have arrived. Will we recognize them?