Angry Doctors – Bad Idea or Inevitable?

oncall4ONGreat captains pick fights they cannot win to inspire their team. People do not follow leaders who avoid all risk. They want someone who will shout back at a bully and be willing to take what that brings.

Some people never cry in movies but get misty-eyed at financial statements showing better than expected earnings. Things move us differently.

Emotional messages move a fraction of the audience. Purely logical speeches leave most of the audience cold. We do not respond to the same spheres of motivation.

Inspire Your Team

Leaders must move everyone. They must speak to many spheres of motivation: reason, reward/punishment, conscience, social pressure and emotion.

Audiences get sick of messages that do not speak to their concerns. They tune out or start their own conversations.

Leaders start to resent teams that don’t respond. Leaders believe they did a good job. But many times, they just repeated data or concepts over and over with increasing frustration. Their message left out most of the team. They failed to inspire.

Angry Doctors

Why do union bosses get angry? They believe their cause is just. They want to inspire their members. They hold an intolerant, easily offended disdain for bullying by government or industry. They know they could lose their job.

Doctors avoid anger during talks with government. Is it because they:

  1. Are too proud to show emotion?
  2. Have no emotion to show?
  3. Don’t see a team to inspire?
  4. Don’t believe anger will work?
  5. Cannot lose their jobs no matter what happens?
  6. Believe it’s useless to fight?
  7. Have been burned before and are too scared to try again?
  8. Feel it goes against their nature?

Doctors say anger never works. But they get angry all the time. Challenge doctors about how smoking laws limit freedom, or some other favourite ‘social justice’ issue, then sit back and watch the fireworks. No, many doctors think anger works just fine for some things.

But should doctors get angry in fights with government?

Risk Both Ways

News reports about cuts to any profession – teachers, nurses or policemen – always show some emotion. There’s anger. Passion. But from the pictures of doctors in the papers, you’d hardly know anything has happened. A popular photo of a surgical team on call almost shows a bit of emotion (Oncall4ON).

Picking the wrong fight, at the wrong time, can ruin a leader and the team. Misusing anger can create remorse that takes a generation to forget. But letting it build threatens an explosion.

At some point, ‘calm and thoughtful’ starts to look like unfazed and ambivalent. Is it time for doctors to show a little emotion over cuts to healthcare? Or should doctors never show emotion? What do you think?

47 thoughts on “Angry Doctors – Bad Idea or Inevitable?”

  1. It’s time for anger from OMA. It’s time for them to lead job action, or give us the tools to do it ourselves.

    1. Thanks Geoff! I lean towards wanting concrete action, too. I think you fingered the issue: will people interpret job action as anger? Is there any way to take concrete action without it being fuelled by anger?

      Or is it best to just avoid all anger at all costs?

      Thanks for taking time to comment!

      Cheers

      Shawn

      1. Hi Shawn,
        I believe the governemnt is having a good laugh at our expense right now. They believe that we are not capable of getting angry. I mean really angry. I have never seen anger from the OMA and I hope we do, channelled the right way of course. If that happens, then the government will hopefully take notice. Until then, I am afraid we are virtually helpless to this runaway train.

        1. You nailed it, Andrew. Lorrie Goldstein wrote a great article in the sun on why Docs Won’t Win Fee Battle with Wynne. He said we will lose, like we always do. I hope he’s wrong. I hope we get enough passion to prove him wrong.

          It will be really interesting to see the results of the physician action survey.

          Thanks for reading and writing!

          Best,

          Shawn

  2. Doctors ARE showing anger, or better said frustration, if you followed the groups on Facebook you surely know this, as you know that doctors are starting to get ready for action. I don’t know if this will make any difference, but I think action is needed and we should take it all the way. And if OMA doesn’t catch up with us, and jump in the wagon, I’m afraid they will be even more bruised, and will completely lose whatever credibility they still have

    1. Thanks Delia! I agree, we are showing frustration. I think frustration drives us to action, and that’s a good thing. I think the FB group has inspired enormous change.

      I think doctors are holding their breath for the next step. This week should prove very exciting indeed!

      Thanks for sharing your comments!

      Best regards,

      Shawn

  3. Shawn
    I think the bigger issue here is the silent disengagement. Yes there are 11,000 vocal on Facebook but there are many more very reasonable people and leaders who are simply disengaged. The OMA townhall meetings are poorly attended. They feel that it is useless to bother with this government. Our youth are leaving or thinking of leaving. I lost four partners in the 90’s for the same reason. Many do not understand the concept of a hardcap and most who have never experienced it think it will not happen. A few are waking up now but many are too tired or burnt out.
    So anger is palpable and is not being channeled by the leadership into positive solutions. I have heard no solutions offered from physicians to the issues that the MOHLTC identify nor problems such as ER crowing that physicians identify. I hear about cuts to income. I hear about cuts to patient care. So how do we fix it? How do we channel our physician energy to being the leadership solution for our tanking system?
    Cathy

    1. Excellent questions, Cathy! Action coordinated towards solutions promises more than just action to vent frustration.

      Your observations about the disengaged ring true, too. What would it take to capture their attention, to inspire them? Would a rant help?

      Thanks so much for taking time to share your thoughts!

      Cheers,

      Shawn

  4. Hi Shawn! Happy Thanksgiving! From my experience reaching out to members in various OMA elections I have noticed the greatest voter response is to candidates that are not afraid to take a stand and show emotion and passion about what they believe in. I truly do believe our membership wants that from their board leaders. Shout from the roof tops that this is wrong and we will not stand for this, leaders that show their anger and resolve to right it. This will make it easier for all members to justify their emotions behind their leadership – anything else leads to frustration and disconnect with the leadership and the organization.

    1. As usual, you make a great comment that makes me feel uncomfortable, David! So true. If members cannot find justification for their passion in their own organization, they get frustrated and feel even more disconnected.

      Thanks again for reading and commenting!

      Kind regards,

      Shawn

      PS. Happy Thanksgiving to you, too!

  5. Shawn, channeled anger can be a useful tool. Many Ontario physicians have already channeled their anger. Others, many of whom have never been in a situation like the current health care mess that the Ontario government has created, are still looking for ways to channel their anger.

    1. Very wise, Gerry: “channeled anger”. Anger without purpose is a temper-tantrum. We need better.

      Thanks so much for staying so engaged! And after being forced into retirement no less…

      Talk soon,

      Shawn

  6. inevitable. Justice Winkler predicted this collision course between docs and government unless something changed drastically. because physicians have been compliant and reasonable to now, he predicted we would be more likely to bend than the government. unfortunately, the docs cannot watch the government compromise care any longer. our role is to be patient advocates. to be pioneers in healthcare reform. dumping random services on the government’s chopping block is NOT healthcare reform. it balances the budget at the cost of patient and physician well-being. patients are noticing for just as physicians warned, actions like this have led to the closure of many family doc and specialist clinics across ontario since October 1st!

    damn right i’m angry. i am angry that i am forced to compromise my integrity and clinical judgement to balance a budget that has been squandered by government scandal and ineptitude.

    1. Brilliant comments, Nadia! “Dumping random services” and “compromising care” seem very solid ground for “patient advocates” to get really angry. It almost begs the question, Why haven’t we seen more passion yet?

      Thank you so much for giving people a venue, organizing change, meeting with government, partnering with the OMA, engaging members and so MUCH MORE! I think this week will prove to be the tipping point. By the weekend, we will have fizzled forever or have a solid action plan.

      Highest regards,

      Shawn

      1. I do not think that this week will be the tipping point. Many physicians are just starting to realize what has happened. It will take much longer to engage patients. Do not be disheartened, my friend, if the process takes a lot longer than you hope.

        1. Thank you, Gerry. I know what you mean and agree, as usual. I think I was trying to comment on what I think seems to be a turning point. Not the end, just a turning point. Without some concrete action – something special in the legislature, legal action, a change in tone, something! – I fear the worst.

          Having said that, I sure appreciate your encouragement! You worked through the 1980s and can say, “the process takes a lot longer than you hope” with authority.

          Kind regards,

          Shawn

    2. The government has been able to use doctors’ integrity against us. Time to take a stand. It looks like this is it.

  7. Shawn your comments are spot on. Doctors are scared of the CPSO so can’t do anything. The OMA needs to man up and say the truth . They need to encourage us to take concrete action. What are they scared off? They won guaranteed representation didn’t they? They get a guaranteed income don’t they?That intact should make them fearless so the Govt realizes that this works both ways. The OMA needs the empower doctors not limit them. And if they cannot be good leaders then they need to step away.

    1. Thanks for sharing such clear comments, Zoey! You’re right. Doctors cannot do much individually. We need a strong champion. We (the OMA) have done a great job at ramping up communications, especially with inspiration from the FB group. But doctors want more.

      Let’s see what happens this week. It will be pivotal. I hope you can make it to the leaders’ meeting this Saturday!

      Best regards,

      Shawn

    2. Do not be afraid of the College. There are lots of things that can be done that are ethically correct but effective in voicing displeasure at government action.

      The government will probably pressure the College but remember that administrators cannot deliver health care. They can just ask others to deliver it.

      1. To give you a little more confidence, I would like to quote Lorrie Goldstein who worked at the Toronto Sun in 1986 and is still there. He wrote this in his column this weekend.
        After the dispute ended, I asked a senior Liberal cabinet minister who was a key figure in the passage of Bill 94, what the government would have done had the doctors shut down the entire system.
        “THEY WOULD HAVE WON,” he told me.
        He said while such a strike could have been declared illegal by the legislature, nothing the government could have done — mass prosecutions, imposing fines or revoking doctors’ medical licences — would have solved the problem of the unacceptable risk to patients.

        Gerry

  8. I just noticed this at the bottom of your page:”1000 front-line physicians have more practical wisdom than 100 of the smartest central planners.”

    That is a ratio of 10:1

    I would say it is 1:10

    Gerry

    1. Too funny! I can trust you, Lee, to always make me smile and think at the same time. Thank you!

      I agree. Required viewing for Saturday. We could all use Luther to interpret our presentations.

      Talk real soon,

      Shawn

  10. Doctors are angry, but I think we are unfocused. So many thing were thrown out at us at once that it is hard to know where to look first! I think that was deliberate.
    What I have come to see through this is that the gov’t has just flipped healthcare in Ontario 180 degrees. It has been, so far, driven mostly by patient demand. If you are sick and need to see the doctor, that is what you do, and it is paid for. Simple, really.
    HOWEVER, with the hard cap, it is being flipped around so that it is driven by how many patients the government will allow us to see. Patient demand will always be there. This is not, to my mind, the correct way to reform health care! In Canada, HEALTHCARE IS A RIGHT NOT A PRIVILEGE! That is what is currently making me so angry!!
    Fee cuts, etc, are really all just distraction!! If the gov’t had just said “we are limiting you to 15 patients a day-that is all you can bill for” it would be crystal clear what we need to be angry about! They just said it differently, and basically hid it among a bunch of other things to distract us. Doctors will fight harder for their patients than for themselves, a lot of the time. This is sneaky way to slip into government health care reform that is not going to be good for anyone! So, heck ya, I’m mad!!

    1. Margaret, what a genius insight! I think you are 100% correct. These cuts are just rationing by any other name. They are cuts to spending on medical care. Cuts to vulnerable patients who need help. Even if doctors poured all their effort into mitigating the impact, our patients will come to harm. Heaven help those who do not have a doctor.

      You make a great comment about focus. I suspect we will coalesce around one soon. Not soon enough for many…

      Thank you so much for sharing such an insightful comment!

      Best regards,

      Shawn

    2. I disagree. The government is trying to deliver on its promise of unlimited health care but does not have the money to pay for it.

      The government was counting on the integrity of Ontario physicians to accept their imposition of another cut. I believe they are shocked at physician reaction.

          1. This is the teflon party. Police investigations, scandals, waste, flagrant disregard for basic democratic values… Yes, I suspect a little dust up with doctors won’t keep them off balance for too long. Maybe ‘recovering’ was not the right word…

            Now’s the time for us to push forward, I think. But that’s just me. Let’s see what the several hundred other physicians think at the meeting on Saturday.

  11. The OMA needs to develop a plan with the expectation that it will be slow slogging at first. The organization needs to have an organised plan that should be shared with its members.If the members are lead and the defeatism that exists not only in the individual physician but is perceived by the lack of strong direction from the OMA a willingness to partake in action against the Wynne government will happen.Otherwise the existence of the OMA serves no purpose and exists due to the RAND. The members will turn on the OMA and for good reason!!

    1. I love your call for strong direction, Tim. You touched on the core issue: are we willing to take action against Wynne?

      I believe the OMA is in a fight on two fronts. It must beat government and win the respect of its members. I hope we are up to the task. If not, there will be others happy to take our place. Would RAND fall at a special meeting of council? It has its own legislation…doubtful…

      I take your warning seriously! I know others will read down and see it too.

      Thanks so much for taking time to read and comment!

      Best,

      Shawn

      PS. I hope you are coming to the meeting on Saturday?

  12. Leadership is a combination of courage and wisdom , neither of which are of much use without the other.

    The OMA has exhibited neither.

    1. Great comment about leadership, Andris!

      I’d push back a tiny bit by suggesting there’s more wisdom and courage than we see. Having said that, all the wisdom and courage in the world doesn’t change the outcome in an impossible situation! We need system change.

      Thanks for taking time to share!

      Best

      Shawn

  13. The medical profession is not the property nor the servant or slave of the state no matter what it says.

    The ideological root of statism and collectivism is the belief that the state is the supreme and omnipotent ruler, that owns the lives of its subjects which it may sacrifice for what is the ‘ common good’ ( it’s own good) whenever it pleases.

    Unilateral pacificism is merely an invitation to aggression as both Obama and the Ontario medical profession should be discovering, but seemingly neither can’t.

    As Ayn put it ” if some people are entitled by right to the products of the work of others, it means that those others are deprived of rights and are condemned to slave labour”.

    ” An alleged ‘ right’ of one person which necessitates the violation of the rights of another , is not and cannot be a right”.

    Canadians are free to pursue good health , are free to stop smoking, free to stop overeating, free to stop drinking, free to avoid harmful and addictive drugs, free to exercise ….they and their elected officials are not free to enslave the medical profession to provide themselves with health care which they treat with contempt and those that provide it with equal contempt.

    1. Shawn, I learned some excellent insights from Andris many years ago on the online Ontario Forum. He tells it like it is.

    2. I sure find your libertarian-ish (objectivist?) comments stimulating, Andris! Too few people know the history that informs your thought, geopolitics from only a few decades ago.

      You touch on negative and positive rights following Isaiah Berlin’s essay. Positive rights place duties on someone else to deliver the right. It requires the majority to take away the freedom of those who cannot fight back. This is not representative democracy.

      I agree, our freedom extends to negative rights, the right to be left alone. We could use more discussion about privilege…

      Unfortunately, these kinds of discussions come across as cold and heartless, if we do not champion voluntary charity. So few believe in it anymore that the mob insists the state legislate it. Ironically, legislation snuffs out the last vestiges of voluntarism.

      I always enjoy your comments, Andris! We could start a whole thread about political philosophy, freedom, rights, trading, beneficence, etc.

      Thanks so much for taking time to read and comment!

      Cheers

      Shawn

  14. Hi Shawn. Your last comment was finally provoked by the basic truths expressed by your old friend Dr. Andris L. I used to be suspicious of Libertarians, equating them perhaps unfairly with the ‘right’ to bear arms, which is different from the ‘right’ to somebody else’s money, work or conscience. I have been looking for a libertarian bumper sticker with a peaceful porcupine. Mostly they are stylistic ‘American’ red, white and blue stars and stripes in the shape of a porcupine ( also the normally peaceful rattlesnake, easily misunderstood). The slogan is “don’t step on me”, or even better “don’t step on anyone!” I have seen a more real picture of a cuddly porcupine on a flag somewhere.
    I have posted previously on your site that the CPSO is supposed to represent OUR self-regulation. If they really DO want to “protect the public” they should be on OUR side Against the government cuts to health care. Why, unlike the OMA, do they not have a “Member Satisfaction Survey” with that invasive questionnaire in our ‘Annual Renewal’. How about we demand that?
    Watch to see which way my quills are facing on Saturday! Look forward to seeing and hearing from you!

    1. Great comments, Roger!

      I worry about labels because no one knows what they mean once they become popular. I find classical liberalism or minarchism most attractive. As you said, modern ‘libertarians’ get portrayed as uncaring or violent, so I find the term less useful.

      I LOVE your suggestions about the function of the CPSO. I don’t think you or I will live to see them come true.

      Please come over and say hi at the meeting tomorrow! I usually sit over on the left of the room near the front; second row if I can get it. 🙂

      Thanks so much for reading and sharing!

      Talk soon,

      Shawn

  15. Shawn …. you’ still da man …

    Some random thoughts, to help clarify fthings a bit ….. things not well understood, which I learned while on the Board ….

    First, some facts to keep in mind.
    We are the OMA …. and we can’t strike … and the employer hasn’t locked us out, and is still paying us ….. rather poorly, I concede ….and we’re still working ….
    and at no time since 2012 (until now) has the OMA placed a tentative collective agreement (PSA if you like) before us (very important, see below).
    Even retired Chief Justice Winkler urged us to accept the 2014 tentative PSA, but the OMA declined to present it for ratification, for reasons well explained.

    So ….

    When a labour negotiation gets to the point where the employer side says this is their final offer, the employer is also entitled to put a reasonable time limit on the offer. The bargaining agent then has two choices:-

    1) The agent can decide that the deal is not good enough and refuse to present it to members for a ratification vote. In this situation (rejection by the bargaining agent), both employer and employee group are then free to do whatever is permitted by law and the rules of the process ….. like nothing …. or strike, or lock out, or return to work at the same or reduced pay (which the Minister did to us twice in 2015) ….. or take the matter to mediation and/or arbitration if law or contract permits.
    or
    2) The agent can decide that the deal may be ratifiable, and agree to bring the offer to the members for a vote. In this circumstance, the agent is expected/required by the employer to present and explain the offer to the members, and to endorse the offer. Not to do these things is in law considered to be acting in “bad faith”, and may cause the bargaining agent to be penalised ( fined, or worse ) for the bad faith behaviour. Penalties are enforceable by the Labour Board where it has jurisdiction, and/or by the Courts.
    Having made the decision to bring this deal to us, I imagine that if the OMA does not present this offer with a suitable degree of “endorsement etc “, the MOH would consider that to be ‘bad faith” and record the information to be used as argument in any future legal action.
    Reality is, because of the Relationship Agreement to which both parties are signatories, both sides have legal obligations to each other.

    This still begs the question “why did the OMA bring this offer to us in the first place, rather than rejecting it” ….. which is a different question from the one we’ve been focussed on …. and it got me thinking.

    My first reaction on reading the tentative PSA was that, on balance it was a poor deal. It does have some positives, which the OMA leadership emphasise as they are required to do. But it is still a bad deal for me, and the OMA is being self serving, and the negotiators are acting in their own narrow self interest, and all the other conspiratorial thoughts one indulges in at times like this.

    But here’s the thing. These are people in leadership who I have worked with, smart hard working very motivated people whom I know well, and admire, and people who my gut tells me would not normally act in such a blatantly self serving way. So why would they bring such a poor deal to the membership.

    A possible alternative explanation occurs to me.

    The answer, I suspect, may be in part that our expert adviser (Mr Burkett) believes that the MOH can justify this offer as reasonable (in present economic circumstances) before the Superior Court when our future Charter Action finally gets there. And that the MOH can and will also argue that the OMA has been acting unreasonably and in bad faith all along by not putting this or the 2014 final offer before members. Remember, again, that the highly respected Chief Justice Winkler recommended to us in December 2014 that we accept governments offer! The MOH would further argue that the OMA has from the beginning acted unreasonably with the sole purpose of getting binding arbitration, rather than what should be the bargaining agent’s primary purpose, which is to get a fair and proportionate collective agreement for its members.

    The other part of the explanation may be the politics, and the media spin which government would have used had the OMA declined to put this new “final” offer before its members.

    A bit speculative, I concede, but I think it’s plausible. And it doesn’t mean that we the members can not reject this offer.

    If we do reject, and if we do so without recrimination against OUR OMA, we send a powerful message to government which the OMA can voice on our behalf. That doctors are consistent: That we support a publicly funded health system. But that the system must be adequately funded. And that we do not, nor should we have the tools to control utilisation. But that we are prepared to suck it up on behalf of patients (even if patients don’t seem to care much) until we have both government respect …. and independent binding dispute resolution.

    WE can do this, without blaming the OMA for the dilemma which it is in; a dilemma, I observe, which was deliberately created by an unscrupulous and manipulative government.

    One thing is sure.
    This Minister and his Premier are going to be right pissed if we refuse this “generous” offer.
    They will want to be vindictive, but they have already cut our pay by so much that they’re having great difficulty deciding where to make the next cuts without starting to have a significant effect on service provision.
    And the election clock is ticking.
    And soon, tongues will wag about liberal incompetence and their inability to manage healthcare.
    Politicians really really hate being thought incompetent.

    Mike

    1. Hey Mike,

      Thanks for posting this here, too! Awesome. Keep writing!

      Talk soon,

      Shawn

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