Don’t let chubby little fingers fool you. Babies pinch harder than some adults. Parents learn quickly that it’s easier to childproof their valuables than to pry them out of tiny, sticky fists.
Freedom, accountability and professionalism stand at the centre of almost every problem in healthcare. We can read freedom and responsibility into the heart of every fiasco and each proposed solution.
Unclean needles for EEGs?
Not enough oversight and regulation of facilities.
Bad outcomes for liposuction?
We need stricter guidelines on credentialing, advertising and oversight.
We need narcotics registries, monitoring and regulation.
High billing by doctors and fraud?
We need fee restrictions, more rules and greater oversight by the MOH.
Sexual abuse by physicians?
We need greater control, oversight, regulation and harsher punishment.
Inefficient hospital care?
We need strict adherence to guidelines, protocols and preprinted orders.
Poor quality in hospitals?
We need checklists, standardized procedures and increased oversight.
Each solution limits freedom. Each one presupposes that freedom contributed to system failure in some way. Healthcare needs childproofing.
But let’s not blame individuals. We could just make the system stronger, bigger and more rigid, so that individuals find it almost impossible to make mistakes. In an ideally safe system, physicians would hardly have to think at all, almost impossible to err.
Accountability
But adverse outcomes and perverse doctors still exist despite regulation. Can accountability save us? Why not hold doctors accountable to specific outcomes?
Perhaps doctors should not be paid unless they can convince patients to agree to the right clinical treatment, according to the most fashionable, current guidelines?
Accountability probably holds promise for improved outcomes. But healthcare pundits forget something. Accountability requires freedom. You cannot hold a pole-vaulter accountable for his performance with his shoes tied together, a three-foot pole and wearing CAS approved safety gear. Accountability is too easy by half.
Professionalism
Complexity mocks simplistic solutions. However, professionalism could offer an answer to almost every problem healthcare faces. Professionalism was faddish 8-10 years ago and got overshadowed by more appealing, measurable things like ‘value’ and then ‘quality’. People tired of quality and will soon tire of accountability too.
• Professionalism is not simple. In fact, professionalism meshes with almost all the features of a complex system.
• Professionalism resists rigid definition. We all know it but struggle to define it.
• It can lead to unpredictable responses to rapidly changing environments. But the responses are what we would want. Professionalism chooses the high road.
• Professionalism stands beyond prescriptive moralism. It surpasses proscriptive regulation.
• Professionalism lives on freedom but places self-restraint on freedom in direct proportion the amount of professionalism allowed. It limits itself and increases limitation as it grows stronger.
Professionalism embodies the marriage of freedom and self-restraint. It needs to be fostered but also allowed to grow. It curtails its own behaviour more severely and to a greater extent than any regulatory body could ever dream of achieving. Professionalism thrives on freedom to act that would make anarchists and libertarians salivate.
Freedom, Accountability and Professionalism
If professionalism offers hope, we need to figure out a way to increase it. We also need to decrease regulation, and increase freedom, to foster professionalism.
Maturity assumes – perhaps, even requires – failure. We need to encourage growth of professionalism while assuming there will be failure. If we want doctors to mature in professionalism, we need to do what parents have known forever.
Childproofing must stop for maturity to germinate. Parents must let go or risk sending their kids dangerously unprepared into the world as adults. Government cannot keep treating doctors like babies and expecting grown-up results. Will government ever loosen its authority over medicine? Or will it insist on regulating a doctor-proof system?
photo credit: webmd.com
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