Patients Need Champions, Not Doormats

People love movies about underdogs. We like watching Harry Potter get picked on because we know that he fights back in the end.

Underdogs create great stories, but they do not stay under forever.

Medical schools look for students who seem able to care.

Do they have empathy? Are they lovers or fighters?

Journalism and law schools look for different things.

Med schools err on the side of sensitivity, even if it means that some gentle souls might burn out now and then. Better that than a class full of fighters and advocates.

It wasn’t always this way. In the olden days, good grades guaranteed a spot. Schools didn’t weed out the way they do now. Each class formed a cross-section of everyone who did well in school and wanted to become a doctor.

Medical school interviews changed all that. Doctors trained since 1990 have been selected for sensitivity. They have endured extensive psychosocial training. They have been selected and trained for professional deference.

And patients like it.

What could be nicer than having a caring, sensitive person devoted to your wellbeing? Someone who strains to avoid your displeasure?

It’s like having a Grandma with no rules, a Grandpa without gruff or your own Santa Claus all year long.

After med school, the system itself shapes doctors. Inside Medicare doctors never have to fight for payment. Almost all fees get paid. There’s always a line-up of patients to be seen. A state-run system atrophies competitive instincts.

Professional Doormats?

But as the system runs out of money, doctors need skills they’ve never had to use. They must advocate for their slice of a shrinking pie.

Without fighting spirit, doctors become doormats.

Experts opine freely on the “right” number of doctors in a specialty.

Pundits go unchallenged when they talk about doctors and patients as if they were pylons and traffic. Put docs in the right spots and patients will march to the right access points.

No one ever says, Wait a minute. Doctors are professionals. They run small businesses. Shouldn’t we let them decide when and where to work based on patient need?

Professional doormats do not fight for themselves. The CANMEDS framework – the holy writ of competencies for medical trainees – doesn’t even include doctor as ‘person’.

Docs must be everything else – leader, scholar, communicator, etc. – but not a person. Doormats should serve, not have personalities or needs.

Doctors face competing expectations. They feel guilty to speak out, given the privilege of serving patients. Most people who serve see service as a privilege. Most doctors see medicine as a great privilege, an honour. How dare they complain given this privilege?

Not About Doctors

If this were only about doctors, it wouldn’t be worth mentioning. The problem with doctors as doormats is that they cannot fight for patients. They don’t have the capacity.

They cannot fight even when fighting is precisely the right thing to do.

Some grassroots doctors already get this. Search #ONhealth on Twitter to see edgy, creative advocacy.

Here are a few tweets:

Here’s a creative one from today:

Grassroots docs can be much more direct than me or anyone who is seen as part of a larger organization:

Doctors can change the system. They need to realize that it is okay to fight and advocate. Doctors cannot wait for someone else to do it for them.

We don’t need to be partisan.

We don’t need to be mean.

We don’t need to slam all politicians. Many are trying to fix things.

But we need to speak up and tell the truth about what our patients are experiencing. Patients need champions, not doormats.

 

 

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23 Replies to “Patients Need Champions, Not Doormats”

  1. As always, a very thought provoking blog. Just not sure that the medical school admission process selects applicants who are passive and incapable of effective advocacy. The OMSA seems to have some pretty effective advocates .

  2. “Grassroots docs can be much more direct than me or anyone who is seen as part of a larger organization”

    Here’s an interesting thought: why? Why could the non-OMA tweets not come from the OMA itself? They were pointed, articulate, clear, non-partisan, and wholly within the bounds of acceptable political discourse.

    When you point out (correctly) that people are afraid to speak up, you’re actually pointing out what might be the fundamental flaw in the our so-called “system”: we put the needs and apparent reputation of intangible, and really, arbitrary institutions – whether it’s the OMA, a hospital, or whatever we define as the bounds of “professionalism” – ahead of the people actually responsible for creating and maintaining it.

    What is a hospital, if not for the people performing care and services? It’s a building, and a corporation for the flow of money. What is the OMA, if not for the doctors that are past and current members and the results of their work? It’s a legally recognized entity, nothing more. If either have a reputation, it’s artificial, based on nothing.

    Just because you’re President of the OMA, doesn’t mean you have to subsume yourself in any way to “its” needs, only to the members you represent.

    And BTW, way to put yourself over showcasing your own tweet;)

  3. So the BA principle is accepted & we are looking forward to see how successful the Negotiators (and possibly, how doctor-friendly the Arbitrators) will be, which might become clear by Dec-Feb.
    Meanwhile, is the OMA considering a public informational campaign & an effective strategy for the MDs to influence the public (=> politicians) to create the awareness, sympathy & overall the most favourable climate for the best negotiation results, or we see a suggestion to the grassroots doctors to advocate & fight their little wars, as much as they understand it?
    With 70 mln budget & 300+ employees, the OMA could be the most sufficient power to develop & spread the most effective message & to lead the physicians in their work-places, something more powerful then the anaemic “I’m not an activist” – last year campaign – ?

    1. By the way Shawn, who were the OMA Board Member(s) who submitted the complaints to KGB (CPSO) on Drs D’Souza, Gill & other 40 ideologically different colleagues? The nation needs to know its “heroes” by name

      1. I agree , it took real courage to inform…the use of informants is a characteristic of totalitarian systems to crush dissent …the KGB in the USSR…the Statsi in East Germany ( for those visiting Berlin there is a little museum on the Statsi and their informers)…the handing over of the 40 names bodes ill for the future of our profession….advocacy for the patients / clients is verboten / zapreshchenco.

      2. A little reality check here. Many of the complaints were about conduct…personal and inflammatory insults levied against then-OMA leaders on social media, not differences of opinion. Though I personally don’t think the CPSO needed to be involved, some of it was well outside the bounds of professional.

        1. Tinge of pre school tattletaling , running off to the teacher, creating drama and blowing everything out of proportion.

          Adult tattlers are often very opinionated, controlling and manipulative bullies ….rather than making an honest effort to work out the difficulties, they run over to the authority figure to divulge the perceived horrible deeds and comments of others.

          They deserve rough justice as they did in school days.

          1. Let’s look to building a better future.

            The times are too tough to be distracted by dirt and misbehaviour. We need docs who have a laser focus on improvement. Bad things happened. We all agree. Now let’s build a better future so that bad things do not happen again. We need everyone’s help.

            Thanks to everyone for all their comments!!

        2. Frank, I agree that the CPSO was not the way to go. It may actually demean the profession more than the original misdeed.

      3. I don’t know Frank, the debates can get heated, the words could be strong, thou I doubt if Mark or Kulvinder really attacked their opponents based on ethnicity, religion or sexuality, even if so, it should have been handled by the civic/humane rights courts of law, not by delivering them into the hands of the common opponent (CPSO=Government)… thou wait a minute, apparently those offended Leaders (“bosses”) sided themselves with Government, not the medical profession – ?
        And also how does that relate to the public safety/fitness to practice medicine of the accused in this case?

        1. The CPSO complaints pre-date my tenure. Many of the docs who were named would be happy to tell you who named them. They can be found on social media.

          We need to look forward. Change takes incredible energy, focus and determination. It also takes time. We cannot be distracted by the past; we must focus on fixing things for a better future. A forensic expedition does not help build a better future.

          We need all the help we can get!

          Thanks for sharing your thoughts!

          Shawn

        2. My Spidey Sense tells me Shawn wants this line of debate to close, and it’s his site. Don’t disagree with you Alex, and I’ll leave it at that.

          1. I have watched the events leading up to the election of the New OMA. Frank, you will not need Spidey Sense to know my feelings. The nefarious actions of the Old OMA is one of the main reasons that the New OMA was elected. Shawn is not only the face of the New OMA but was a major player in getting rid of the Old OMA. We have a New OMA and a Binding Arbitration Framework. Dredging up complaints about the actions of the Old OMA only detracts from the good work that the New OMA has already started. Time to move forward.

            1. Thanks Gerry! It took a team to get us here and will take a team to rebuild. We are well along the way.

              I agree: “Time to move forward.”

              Thanks again!

              Shawn

  4. Odd, in the UK of the 50’s and 60’s the “weeding” started early at the age of 11 ( 11+) again around 15 ( O levels) and again around 17 (A levels) ….getting will the qualifications only allowed one to apply to med school….there was one one student for every eight in modern day universities …my late ex partner who qualified from Bristol told me that there were 500 equally qualified applicants for each position ….at the Welsh National school of medicine there were 700+ for 70 places….the whole school had some 460 med students…the selection was such that we had a full orchestra, a full choir, a female rowing team, a female basket ball team, a female field hockey team…a male rowing team, a male basket ball team, a male field hockey team, a male soccer team, two male rugby teams ….not to mention a med school magazine ( we me as the art editor) and a med school pub that we ran….they looked for the Renaissance Doctor.

    Now the UK has 36 medical schools.

    When I arrived at the WHO in London in’68 ( with Mc Wynnie) I was amazed how confident that Canadian students were about qualifying…in our case one year a pass list would be posted ( no internet in those days) and another the fail list….drug reps tended to arise from the fail list.

    Patients used to have MDs as advocates…their hospital based special is such as surgeons and anaesthetists used to be particularly vocal…in recent years the medical profession has been gelded with the vocal facing disciplinary accusations of disruptiveness and un professionalism…it is gathered that the OMA itself has handed over 40 names of deviants to the CPSO who will likely get audited…when the various noxious Bills are applied the government will be able to punish the non compliant deviants in undetectable ways , by not allowing them to sign contracts with their LHIN or Mini LHINS of choice…the health care bureaucracy will have innumerable ways of punishing those that are disruptive advocating for their patients…sorry, ” clients”.

    1. Can’t advocate for patients when you’re a salaried employee doctor…errrr….”provider”.

      There is a certain group of specialists in Ontario who have no choice but to accept salaried work.

      This group of specialists is also very error prone.

      I suspect the absence of practice independence is the primary cause of these errors.

  5. “New OMA” vs. “Old OMA”

    The problem with bullying, “dirt” and “misbehaviour” (terms themselves which diminish the seriousness of the issue) arises in a culture that permits it. The OMA still has a culture that not only permits it, but fosters it. The OMA is NOT the elected members. The OMA is a corporation which has demonstrated a consistent pattern of behaviour over the past 30 plus years. When communications continue to be controlled and censored, outspoken members muzzled and threatened, grassroots voices (not the manufactured ones shown above) are not acknowledged by leadership and defamed on SM—this is NOT progress.

    How else could we see, in 2017, Council elections run by Committee by members whose themselves were running? Refusal to allow a 3rd party to monitor vote counts when originally agreed upon? Tactics that North Korea would applaud.

    Yes, Shawn, your tenure supposedly started after the complaints, yet the complaints continue to flow. You were, however, a member of the executive for quite sometime [Editor’s Note: This is not true. I was never on the OMA executive committee before I became President.] ( and resigned–still waiting for that expose) and at least one member of that executive has been quite active throwing her/his colleagues to the CPSO wolves.

    How can the OMA claim to represent members when they seek to destroy the careers of our colleagues? Independent surveys have shown a mistrust and concern about the CPSO and want the OMA to help address this.

    Until the OMA is structurally eviscerated from an administrative perspective, the culture will not change. Your tenure will come and go and the systemic and structural problems will remain.

    I have no doubt your intentions to improve the OMA are sound, but unless you acknowledge and actively address the backroom antics, your hard work and good intentions sadly, will leave no legacy.

    1. Thanks for taking time to share your strong opinions, Deron!

      I corrected one important factual error by adding an Editor’s note. I appreciate the opportunity to correct such a crucial error!

      As for the rest of your note, I understand why you hold these views. I will try to prove you wrong with my performance instead of debating your positions one by one. After 8 weeks in the position, I am pleased with the changes that I and the new Board have made.

      I hope you take the time to share a similar note at the end of my tenure, if you still feel the need to do so.

      Best regards,

      Shawn

  6. Great Article Shawn. The demands, expectations, and resources have changed and are changing significantly. Doctors traditionally have been considered valuable leaders and are an important voice to help shape a healthier society. I really agree with you that doctors have to be eloquent in articulating the new reality and changing dynamics; you’ve done that well…again.

  7. Pop Quiz:

    There’s a certain specialty whose independent practice rights have all but completely disappeared in Ontario.

    This specialty is primarily employed by hospitals, not contracted or working at arms-length like all other doctors.

    This specialty cannot advocate for proper patient care without high risk of being fired or replaced.

    This specialty is “error prone”, likely due to their perpetual muzzling.

    Name that specialty!

    Now, how do we get that specialty back to practice independence?

  8. I agree with many comments made.
    The resignations of Dr’s Gill and D’Souza have raised scepticism of the OMA once again.
    I truly believe that reform/governance change/progress within the OMA cannot occur until physicians in Ontario are no longer forced to pay mandatory dues [Rand],making it an accountable voluntary association.Many provinces function well in that system …. the OMA could announce that in 2 yrs,doctors will not be forced to pay dues,but any benefits accrued from negotiations will require a payment to be accessed.There are MANY ways to make all Ontario physicians pay for benefits from negotiations without forced dues.Rand has resulted in a bloated ineffectual $ 50 million corporate bureaucracy.

    The OMA should do the right thing and …. ‘let it’s people go’

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