Doctors’ Blame & Shame – Ontario Bill 29

Steve ClarkThe Toronto Star loves Steve Clark.  The Conservative MPP sings from the Star’s hymn book with his Bill 29 – An Act to Amend the Medicine Act, 1991.

Clark crusades on total transparency. He calls for full reporting of all complaints against physicians, all deaths reported while under their care; including complaints and deaths from other jurisdictions.

Transparency – what could be more wholesome?

The public deserves to know about every single death.  It’s condescending to think the public needs protection from the facts. The public needs protection from nefarious physicians. If there’s any chance the information might help one patient, the information should be public. Right?

Blame and Shame for Death

Who gets attributed with a patient’s death?

When a patient dies of cancer, does the family doc who knew the patient for years get labelled? How about the surgeon who operated 2 weeks before?  Maybe the intensivist?  The palliative care doc?

Or should it be the naturopathic doc who attended to the cancer for 18 months before the patient sought medical attention?

Physicians who practice palliative care will have a high number of patient deaths.  Does that make them bad doctors?  Even if a palliative care doc is a murderous physician, how would the public know based on the reports?

Would Bill 29 encourage physicians to care for the very sick, those in greatest need? Most attempts to rescue the dying rest on slim hope. Shall we reward these deaths with blame and shame?

Blame and Shame for Complaints

Many patients write complaints, not just thoughtful people from the Toronto Star.  Often, patients with major mental health challenges have the most time to craft complaints.  Aside from the obvious ones, many complaints require investigation to reveal that psychosis, delusion, or other cognitive challenges determined the content.

Many complaints focus on things out of MD control: wait-times, legislated reporting to the Ministry of Transportation (patients hate this!), no beds available in the emergency department…

Blame and Shame – Help or Harm?

The most important question is How will this impact patients?  Will Bill 29 improve quality and safety?

The Patient Safety and Quality Improvement group from Duke says,

“This ‘shame and blame’ approach leads to hiding rather than reporting of errors, and thus is the antithesis of a culture of safety. Recent efforts have tried to change this—to encourage people to report problems rather than hide them, so they can be addressed.”

The World Health Organization writing on safety cultures notes that blame and shame does not work.  It does not improve safety.  The Canadian Patient Safety Institute says the same thing.

Here’s one of dozens of academic articles suggesting better alternatives to blame and shame – Relationship between safety climate and safety performance in hospitals.

Healthcare wrestles with creating safe places for providers to talk about ways to improve care by sharing their concerns without fear or shame. Bill 29 takes us back decades.

What’s been your experience? Does a culture of blame and shame improve performance anywhere?

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Terrorism, Canada, Crisis

1023 Shooting 284.JPGOur minds spin. Our world marred.

Watching terrorism in Canada, we take comfort knowing security forces live for this.  They exist to manage emergencies.  We expect they will be there when we need them.

We watch armoured vehicles mobilize on Parliament hill.  A medic performs CPR on an honour guard. Police in black facemasks and ballistic vests point revolvers at rooftops as politicians dive into tank-like trucks.

We need Canadians in uniform.  We honour their commitment and sacrifice. As civilians we never understand the toughness required to run into danger to protect our freedom, our way of life. If asked, we would do almost anything to support them.

Canadians inherit pioneering toughness. New Canadians know courage, risk and resourcefulness coming to a new country, a new life. Third and fourth generation Canadians know grit when death and financial ruin were realities of climate and landscape. Perhaps some heritage Canadians have never known vital challenge – never needed self-sufficiency – but they are few.  Canadians know how to manage.

Crisis reveals the limits of our system, and it gives government reason to take more control.

Living in the North requires confidence to take personal control in crisis.  A nanny state that turns Canadians into undeserving recipients of state beneficence insults the fabric of Canadian identity.  It undermines the core nature required to thrive in the North. But in national crisis, we risk compromise of identity for state solutions.

Terror on Parliament Hill. Ebola threatening. Acute care overwhelmed.

Canada will emerge stronger from all of this. Thank God for soldiers who sacrifice for us, for our way of life. Let’s hope our leaders avert crisis without crushing our freedom, our passion, and our Canadianism in the process.

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Ontario Debt: I Want It NOW!

i-want-it-now-300x300Children choose dessert before supper.  They stay up late, sleep in ’til noon, and leave homework for tomorrow.  They never choose to spend less of Mom’s money.  If my kids could, they would eat and play and spend until it was all gone.

Ontario debt rests in the hands of voters.  Will they act like children?

Arrogance makes us think riots only happen in other countries, less civilized places.

Ignorance makes us think we can keep spending other people’s money, increasing debt and handouts.

We’ve almost run out of other people’s money to spend.  Ontario has $300 billion of debt.  ($300 freaking billion!) We cannot fix our finances by taxing the rich; they already fund most of the taxes.  Industry won’t risk investing in Ontario if they think tax hikes loom next year.

We must spend less.

Ontarians must insist that politicians spend less.  We must cut any service we can live without until we can pay for it debt free.  We must stop all discretionary spending and choose the cheapest options for necessities.

If we do not, capital markets will turn on us.  Interest rates on our debt will sky rocket.  We will become insolvent, unable to cover our liabilities.

Solutions include: austerity measures, issuing debt bonds, heed the 350 recommendations of the Drummond report, increased class sizes, no funded kindergarten, and consider every opportunity for privatization.  Bureaucracy is a luxury we cannot afford until things improve.

Childish instant gratification threatens to ruin Ontario…and the rest of Canada with it.

I hope Ontarians vote like adults.



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