Grownup children sometimes ask the impossible.
“Whatever you do, Doctor, you must never mention the C-word to Grandma.”
I listen with a concerned frown.
“You know… Cancer,” her grandson whispers.
“Grandma’s scared to death of it,” her daughter says.
“It would kill her if you said anything. Promise you’ll never tell her, Doctor.”
I nod and say, “Maybe we should ask Grandma if she wants to hear the truth?”
Grandma usually takes it quite well. The children were scared to death of cancer, not Grandma.
Patients want doctors to help them understand as much as possible. They want doctors to speak up when something is wrong.
But many people want doctors to hide the truth. A number of docs are campaigning against cuts to medical spending in Ontario. At the same time, other powerful doctors, who work in government, or lead hospitals and medical schools, bully MDs and students to keep quiet.
“Be careful,” they say.
“Keep writing articles or giving interviews and we might not renew your hospital privileges.”
“We saw what you wrote on social media. It goes against our rules and regulations. We will dismiss you if you do not keep quiet.”
“You wouldn’t want to ruin your chances of getting a good residency spot, would you?”
Leaders who get money from government cannot allow their staff to publicize government failures. Does this cover-up benefit patients?
Leaders who bully others into silence do it to protect their income. Patronage demands that we keep our benefactors smiling on us with favour.
Afraid to Speak Up
Free speech is all but dead in Canadian healthcare. Not just limited, weak, or dying: dead.
Everyone on the inside must speak in generalities. Sure, you can report private clinics closing. You can also leak stories to the press, who then write about them second-hand.
But the people who know cannot speak. They dare not.
Here’s a short list of allegations I’ve seen or heard about:
- Delayed vaccine supplies…were they delayed to coordinate a dignitary’s photo op?
- Hundreds of thousands of dollars spent on technology that never got turned on, or used for only a few days.
- Over a million dollars spent in a rush at year-end on unproven programming, “Otherwise we won’t get the same funding next year.”
- Reporting different sets of financials than the ‘real’ ones used to run an organization.
- Houses built for executives by the builder who won the contract for a public facility.
- Departments insisting that only the product offered by the company they have a relationship with can be sold in other departments of the hospital.
Allegations can be explained away. The list above avoids breaking laws. But explaining nonsense does not mean it’s not nonsense.
Privilege, patronage, and waste always litter monopolies like garbage on sidewalks. Monopolies have no reason to clean it up.
We could pass a whistleblower law and demand that people speak up when they see waste or unethical behaviour.
But why would someone speak about an organization that pays them? Government might close the operation and put the whistleblower out of work.
We could tell the new patient ombudsman. Could they manage the volume?
We could empower patients. Give them transparency and choice. That way, if someone delayed a vaccine, patients could get it somewhere else, as soon as it’s available. A dignitary would lose a photo op, but patients would get care sooner.
The need for silence grows as healthcare runs out of money. Governments ration services to control spending, but they cannot fix the inherent waste in a monopoly.
Doctors must not publicize details about waste, rationing, and cuts. Voters might panic.
Maybe we should ask voters whether they want to know what’s really going on?
I suspect they would take it quite well. Maybe only the government fears the truth, not the public.
photo credit: www.mirror.co.uk about Grandma Betty.
It is almost impossible to get people to put their careers at risk. Whistle blowers in all fields can wind up in the news after being fired.
Here are couple of other things to add to your list:
A physician told me that he had disgraceful things to say about his hospital but he had such a hard time finding a position at any hospital that he would not dare tell anyone. Just to be clear, this physician was not an ophthalmologist.
Now with ophthalmology, hospitals regularly fudge wait times so that they do not go over government-mandated times. For example, a patient needs cataract surgery and waits 1 year for his surgery. The two cataract surgeries are done two weeks apart. The hospital reports the wait for the first surgery as 1 year and for the second surgery as 2 weeks. For this patient, his wait time averages out to 6 months per eye. Voila, hospital meets government standard of 6 month wait time and then government has nice wait time figures to publish.
To make things look even better, some hospitals won’t even let their surgeons put patient names on the wait list until closer to surgery. The surgeon has to keep the patient on his own in-office wait list until the hospital releases the schedule closer the actual surgery date.
It took months for this Montreal health care disaster to become public. Even in a case where I believe there should be some consideration to charging the Health Minister of Quebec with manslaughter, there were many who would not associate themselves publicly with it.
http://montrealgazette.com/news/local-news/death-of-er-patient-sparks-outrage-at-st-marys-hospital
or
http://bit.ly/1QcshtM
No matter how you play the numbers, a failing health care system is a failing health care system.
Great additions, Gerry!
Thank you so much. I hope others share stories, too. But be careful! As you said, it’s not worth risking your ability to support your family.
Sure appreciate your thoughts; they always improve the post.
Best
Shawn
Another point, Shawn. The public would NOT take it well. The public wants to believe what the politicians say about health care.
Those of us who dare tell the truth about the failings of our health care system are often vilified by the idealogues, although this week’s by-election in Whitby-Oshawa, showed that sometimes the voter can be convinced to direct its anger at the government instead of the whistle blowers.
I assume that you mean the public would not be happy, as opposed to the public being unable to handle hearing such things?
I think the public needs to know. But even that does not solve things. We need to offer patients options to access the care that our universal system promises. The promises have failed. A little bit of competition might drive big changes in efficiency, service, and performance. Right now, it’s all about controlling the message, the spin.
Thanks again!
Good timing on your piece. I was cautioned yesterday for voicing concern about what the cuts had created in our ED during my shift that day in particular.
Hey Daniel,
Most doctors find it very stressful to be ‘cautioned’ or ‘warned’ about what they say. Even a hint of reprisal makes most doctors clam up forever. Not good. I hope you weathered your caution well. Maybe it will inspire you on to being MORE outspoken! 😉
I sure appreciate you taking time to post your thoughts here!
Best regards,
Shawn
In my mind physicians should be encouraged to speak their mind but we also have to mindful of how we do it. Its not so much that the message is incorrect in many cases, but rather it might be shared in anger or frustration. Understood, this is hard during times of stress but just means that we have to work even harder to portray our points of view in a way that others can consume. Physicians have not been trained in public relations skills but many of us are fine communicators and these talents can be honed to translate from the work we do physician to patient toward the conversation between physician and system.
Think… consult… ask for guidance from trusted peers… then speak! This is a recipe for success.
Thanks for thhis Shawn, Daniel and others. Thought provoking!
Great comments, Darren.
You make solid points about perspectives and opinions. Where I struggle – and maybe you could help here – is with issues of fact: how do we communicate the truth when the truth will impugn an organization? Usually, I wimp out and try to find some positive lining somewhere, some opportunity to improve. But sometimes facts demand that someone blows the whistle. How do we handle those situations?
Thanks for offering some solid advice!
Cheers
Shawn
Don’t answer, Daniel, but who would caution you for questioning a patient issue? Maybe someone else can answer, someone who doesn’t have to worry about repurchasing. I worry that Daniel has already gone too public