Category: Politics

Three and 1/2 days in bed left me cut off from news and social media.

The flu made reading impossible, scrolling unbearable. It was exactly what I needed.

I decided to start social media/medical politics rehab.

All addicts need conviction, a resolve to stick with treatment. So, I sat down to write a blog about political addiction:

“The Ontario Liberals first attacked doctors in 2012 with a 5% cut…“

That sent me howling down 2 long paragraphs reminding everyone about tyranny and usurpation.

This is not healthy.

A battery of Google alerts on medical issues fills my inbox twice a day. I scan Twitter feeds, Facebook, LinkedIn, and medical blogs. Every day, I review comprehensive news-scans from two large organizations.

When I wake up in the middle of the night, I can’t resist a quick peek to see if anything new came in on my smart phone.

It needs to stop.

Content Creation vs. Consumption

Citizens must protest stupid political decisions. Power and control corrupts, even while we sleep. But expression makes us more interested in the topic we rant about. We risk spending more time reading-searching-debating the issues, than making noise.

Doctors should keep making a fuss. The government is wrong. They should not cut spending on medical services every year since 2012. Patient care is suffering (see clinics closed). If anything, docs have been way too quiet.

But it takes more than doctors.

Hopefully, the courts will declare this unjust. When they do, it will be too late. Judges need another 3 years to figure this out, and the government will need another year to settle on a process. Throw in an election, or some other distraction, and this could take 3-5 years before we see any justice.

So by 2021, we will have suffered under cuts, claw backs and caps for 9 years. Medicine cannot recover from that. At least I can’t.

Life after Twitter

In 2012, experts advised, Get on social media: Twitter, LinkedIn, Facebook – anything you like – just get the word out there.

Social media runs on dialogue, comments, likes, and re-tweets. It takes time, a tonne of it. It feels great to meet others on social media. But it fills your brain; complicates life.

It is time to manage the addiction. While AA suggests total abstinence, I decided to try a modified approach:

1. Stop Google alerts.
2. Delete my news feed app.
3. Unsubscribe to blogs I never read.
4. Focus on content creation.
5. Drastically reduce, retweets, likes, shares, etc.
6. And the hardest one: delete my Twitter, Facebook & messenger apps from my phone.

After a mild tremor and stomach upset on the 1^st day, I feel a bit more settled, 24 hrs into rehab. Recidivism rates are high, so do not judge me if I slip up.

What makes us change our thinking, anyways? Does the logic hidden in a 140-character tweet do it?

I will keep blogging. It helps me think, and I love hearing from thoughtful readers. They teach me. But news and social media have to decrease.

Overly polite responses to self-serving politicians waste our time. Let’s just call it, without being rude or gratuitously blunt. People will respect us, even if it makes some colleagues cringe.

We need to tell politicians, over and over,

Enough already. Tell the truth. Honour your commitments. Obey the law.

Saying more, no matter how fun, or addictive, probably doesn’t change much. There is life after Twitter.

photo credit: lotr.wikia.com

[Mea Culpa: The first draft of this post gave the wrong message through my flu-tinged haze. I hope this works better.] 

Fans love The Force Awakens and forked out millions to see it. The newest Star Wars movie played true to its roots and offered hope for something better.

Producers know what to deliver next, as fans wait for the next episode.

Doctors need the same clarity.

Agreed to Walk Together

One of ‘Canada’s best writers’, George Jonas, died this month. He was an ardent defender of freedom, a critic of tyranny.

Jonas said Canada was modern Europe’s transatlantic outpost, “the glossiest, the most sophisticated, and the most up-to-date version of the illiberal state.” (see Beethoven’s Mask)

What does that have to do with modern healthcare? Liberty, or the state, elicits a few patronizing smirks in medical politics.  Liberty is out of style.

Wicked Nonsense?

If government wants to walk south, and doctors want to walk west, is it compromise to walk southwest? Or is that walking in an entirely different direction?

Wicked questions ask, “How can we walk both South and West at the same time?” As much as we love them, wicked questions sometimes lead to absurd ends, nonsense.

Decimation

Doctors bore a decade of deep cuts, clawbacks, and arbitrary caps in the 1990s’ social contract years in Ontario. By the early 2000s, over 2 million patients had no family doc. Those lucky enough to find one often drove over 90 minutes to an urban clinic.

Students avoided family medicine: they even left the country to train in any another specialty.

People talked about the end of family medicine. Doctors took jobs anywhere else but in comprehensive care. It was beyond desperate – hopeless decimation.

Negotiations’ Enigma

From a position of demoralized desperation, doctors came up with a plan to negotiate with government.

1) Find out which direction government wants to go.

2) Get as much as possible out of government for agreeing to the government’s plans.

Compromise worked. Many hail the 2004 and 2008 contracts to have rescued Family Medicine, in Ontario. After a decade of cuts, doctors’ business earnings started to catch up with inflation.

Doctors ignored where the government was headed. Why worry about old-fashioned things like autonomy and professionalism? Legislation, regulation, and simpler contracts seemed irrelevant, quaint.

But 2012 marked a sharp change. The government started cutting and has continued to cut fees every year since, erasing gains from 2008.

Of course, government did not reverse contract details that worked to its benefit. The golden goose took back most of its eggs but left its droppings.

A New Hope

Doctors need a clear vision on where they want to go from here.

• Do MDs believe in old-fashioned ideas like the doctor patient relationship?
• Do doctors believe in politically incorrect ideas like liberty, hard work, and reward for delayed gratification?

Doctors need to get very clear about what we believe and figure out an attractive way to package it. We need to invite attacks to our ideas about innovation and prepare to defend them.

Docs are often too scared to discuss system change, because someone might accuse us of being self-serving.

Doctors cannot let government rule by inciting a frenzy of envy each time we try to discuss system innovation. Government owns the congenial myth of wealthy doctors. Let them have it. We’ll never win on that front.

We are paralyzed worrying about what the public thinks. It gets us nowhere. Patients love us when we care for them. No amount of public support will carry doctors through cuts that compromise care.

We need a new hope. We need a vision to fight for: something that doctors articulate, not something that government dictates.

We need hope that stays true to our medical roots, as a profession sworn to help patients and not compromise by letting bureaucracy come before patient care.

Our patients want something to look forward to. Let’s hope we come up with our own vision soon.

Congratulations! Your interest in medical politics sets you apart from most practicing physicians.

I was asked to share some thoughts for doctors entering politics. I tried to focus on a few favourite concepts.

We can discuss process details, or issues about specific organizations, in the comments section.

No One is an Expert on Everything

You can learn a tonne about medical politics, but you will never be a superstar at everything. Medical politics is not like Biology. You cannot aim for 98% on the exam.

I suppose the OMA President might almost be an expert on everything, for a few minutes, sometime near the end of his/her term. But even Presidents soon find they must defer to someone else.

Do not set out to learn everything. You will despair. Let it sneak up on you.

Everyone is an Expert on Something

Find one thing that interests you: IT, immunizations, HSFR, whatever. Pour yourself into it, even for just a few minutes.

You are now, with almost certainty, an expert on this issue in your local community.

Share what you know. Ask others what they think. Learn more about it. You will be the ‘go to’ person in your hospital or clinic on that topic.

As an expert, you add value every time you share your expertise. Get addicted to adding value. Your addiction will make you crave more expertise.

Your medical politics hobby will soon take over your life as you seek to learn more and more. And you will love it. Make sure your family approves!

Experience Counts in Medical Politics

Doctors perform in a strange play. We train to act with confidence, while knowing we have incomplete knowledge.

We learn to trust our training. Doctors must act with as much certainty as colleagues with years of experience. No matter what grades you got in medical school, every graduate gets called ‘doctor’ and bills the same fees as experienced doctors.

Most of the world does not work like this.

Other industries bow to experience. An MBA does not mean you can run IBM. You need a few decades to learn how to lead.

Of course, some doctors bring an interest in politics from grade school. They volunteered on political campaigns and followed politics their whole life. But they are rare. And even wunderkinds need to value experience and humility.

Experience makes you a better leader, but even more importantly, valuing experience increases your influence and teaches you defence skills. Find experienced leaders and suck every bit of wisdom you can get out of them.

A New Logic

Doctors learn to diagnose and treat. (Let’s forget about the ‘educate and motivate’ of modern medicine for now.) Patients usually give us the diagnosis on history and physical. Then, we treat; delayed treatment is unethical.

Diagnosis works the same in politics, but treatment is completely different. The process of arriving at a political solution means even more than the final solution itself. Many doctors hate this.

If the solution is to ‘do X’, then we should just do it. Why take so long to get it started?

Political solutions require people to buy in to an idea. People need to weigh the risks that a solution presents to their personal vision of how things should work. People want to feel they had a part in crafting the solution.

For many reasons like these, medical politics requires a new decision making process, a different logic.

Obsessed with Issues, Blind to Vision

Doctors never need to think about vision. They accepted the medical vision long ago: doctors help people. The rest of our life is spent fixing particular issues. For doctors, reflection on vision demands flexing an atrophied muscle.

Issues are to doctors as squirrels are to dogs: irresistible!

Doctors find and fix issues. That’s why patients value doctors. But after decades of getting rewarded for fixing issues, we often struggle to concentrate on other things.

Medical politics is loaded with issues, important ones. But issues should not define our goals. Doctors need vision in medical politics.

• Where are we going?
• What do we sacrifice by supporting this solution?

Doctors need to work, like guide dogs in a park, and stay focused on where we are going, without chasing the squirrels.

Clone Yourself

You should think about succession planning as soon as you get elected. Do you know anyone who:

• Enjoys being overwhelmed with new material?
• Gets excited about ideas?
• Respects experience but strives for change?
• Has patience for process?
• Loves discussing vision, not just issues?

Today, strong political forces push doctors away from working as independent professionals, towards employed technicians. We need doctors at the centre of medical politics.

Again, Congratulations on stepping into a fascinating world! Find a mentor and then teach them what you learn. Patients need doctors interested in the weirdness of medical politics more than ever before.

Note: I am not the official spokesperson for any organization. These thoughts have not been vetted. Errors are my own.

photo credit: www.parl.gc.ca,  www.disney.wikia.com