Category: Politics

Many physicians should see a doctor. They are irritable, tired, despondent, unsatisfied with work, and avoiding responsibilities.  They report physical symptoms: headaches, GI upset and poor sleep.

Experts say doctors are burned out:

• Half of doctors burned out – Forbes 
• Burnout increasing in doctors – Washington Post
• 10 signs you’re burning out – Forbes 
• Job burnout: how to spot it and take action – Mayo Clinic

Abuse, Not Burnout

But one doctor calls BS on burnout. Dr. Pamela Wible, ‘America’s Leading Voice for Ideal Medical Care’, says,

“Please stop using the word burnout. You are not burned out. You’ve been abused. Let’s get the diagnosis right.”

“…medical students and physicians are collapsing because they are suffering from acute on chronic abuse.”

She wrote a popular blog piece: Burnout is Bu-lsh-t.

And she wrote a best-selling book: Pet Goats & Pap Smears: 101 Medical Adventures to Open Your Heart & Mind. (Thank you, Dr. Boyce!)

Despite her outrageous book cover, Dr. Wible makes a solid point. Victims of abuse often report symptoms like burnout.

Symptoms rarely indicate one disease. Fatigue, mood swings and stomach aches can mean almost anything. High calcium causes stomach aches, muscle cramps, and psychosis. But we do not say patients have stomach, muscle or mental problems when their calcium is high. They have a calcium problem.

Diagnosis

Many doctors show signs of burnout. But could it be abuse? If doctors are suffering abuse, not burnout, then calling doctors burned out just blames the victims.

Doctors often serve and recharge by practicing medicine in a developing country. No doctors ever tell how happy they are to return home to catch up on the latest legislation, regulation, and tick-boxing requirements of medicare.

Doctors recover from their symptoms of ‘burnout’ soon after escaping abuse. They go on to work even longer hours with energy and joy once freed to do so.

Waking Up

Disillusionment is good. It hurts to lose a dream, to realize what we thought was true is not. But life under an illusion cannot be full and rich. Dreams feel bizarre.

Many doctors talk about delaying gratification until middle age. The dream of being a doctor pushed them through 24 years of school. It promised relief when they finally got out of debt; finally got out of working night shifts; finally became financially independent; finally started a family.

Gambling on the dream, many doctors lived far below the poverty line, long past medical school. But most grew tired of frugality sometime in residency, in their late 20s and early 30s. At that age, debt works so much easier than pinching every dollar.

So after years of being poor – really poor by every measure of poverty in Canada – doctors finally start earning a decent income. Something almost as good as a school principal.

At this point, they usually take on even more debt. They buy a house and build their practice. The Wealthy Barber taught us that we must earn two dollars to spend one. Debt is even worse.  We must earn $2.50 to pay off $1 plus interest (depending on rates).

Sometime in their late 40s or early 50s, doctors expect to arrive, to be debt-free, to loosen up a little and enjoy life. But depending on how many kids (and spouses) they have, doctors often end up delaying this dream, too.

Over the last year, doctors tell me that they find it harder to make a living. Not maintain their posh lifestyle.  To make a living. Just when doctors thought work would get easier, they have to find new jobs, work overtime, and downsize their middle class lifestyle and expenses.

Doctors are frustrated. And with good reason. Even if doctors were earning huge incomes, which many do not, 10 years of heavily taxed earnings, after 35 years of poverty and debt, hardly balance out.

Treatment

Recovery starts with facts. It starts with the right diagnosis. Recovery will never come by telling doctors to maintain better mental health, or to get more exercise. It certainly won’t come from the common response, “Well, you chose to become a doctor!”

Recovery starts when doctors wake up from the dream. They need to find other doctors who feel the same.  Thousands of doctors are waking up to understand, in a personal way, that they cannot run a business when government has too much power and control.

This is not just a rant about political theory. It’s a reflection on current events. This will happen again, no matter what truce doctors may sign. Government will get desperate, again, and treat doctors like they have no civil rights.

Will doctors make the right diagnosis? When will they call this abuse, not burnout, and get on with treatment?

 

Remembrance Day summons powerful images. Sacrifice for a greater good; submission for country and neighbours; conviction that we can fight evil and win.

Governments earned public trust between 1939-45. Even though they were tiny by today’s measure, governments ran a near impossible war effort. We won, and our government enjoyed two decades of unchallenged support.

If government can coordinate a whole country to win a war, surely it can do other good things? Small, empowered bureaucracies proved they could move raw materials, have industry make combat boots and parachutes, and send thousands into battle.

Nothing establishes credibility like success. Victory crushed any debate about whether government could act as a force for good with civilian problems. Armed with public support, governments set to work on popular social issues.

More work required a bigger crew, and government mushroomed to the task. No one thought to ask whether we had won the war because government was small, not in spite of it.

Devotion is often blind. Once lost, it requires another war to regain. Government waste, scandals and personal failures have obliterated public trust today.

In recent focus groups with baby boomers, a large public affairs firm found people expected government bungling. Boomers got angry about many things, but shrugged with familiarity at government scandals.

What is Government Good At?

D Savoie, from the University of Moncton, reminds us that public servants used to work for the public good in What Is Government Good At?: A Canadian Answer. [Credit Savoie for the next few paragraphs.] Public servants served ends that markets could not in areas where markets could not reach.

The public service was supposed to be best at “equality, efficiency, merit, fairness and justice.” This remained unquestioned, until government got big.

Government has tried to do more and more and now struggles in multiple sectors to implement anything. It tries to balance stakeholders and ends up disappointing.

Modern public service manages instead of setting policy. Margaret Thatcher started a trend to reshape bureaucracy. She wanted efficiency and accountability but forgot that bureaucrats do not have levers to move performance. The public service wants to look and sound like the private sector, but it cannot drive change.

The public sector has no bottom line, no market to generate revenues, no one to report to, and public servants never lose their job unless they embarrass their superiors.

Since the 1980s, government has been trying to invent a bottom line and somehow create market forces within the public sector. This has caused a shift to performance-based accountability, new oversight bodies and new program evaluation efforts. It has made bureaucracy today far more top heavy.

Most public servants now work in the central office as opposed to regional offices delivering services to citizens.  Bureaucracy slowly sinks under bloated reporting burdens.

Accountability and transparency make the public sector keenly attuned to blame. Blame get shifted to the top, to those with increased authority. Senior public servants spend most of their time managing political issues, public impression and voter support.

Those with little power or ambition get assigned to implementation. The New Public Management, or Managerialism, creates change masquerading as improvement (Rod Rhodes).

All this happens while media and parliament hold people accountable “as they see fit and on their own terms.”

Government should prove what it’s good at and get out of the rest.

Government Cannot Implement

It can measure, reward and punish, but government needs doctors to implement its fancy designs. That’s why bureaucracy will always resent doctors. It can turn nursing into a technical profession where nurses are judged by whether they ticked all the boxes on their 6 pages of progress notes. But government cannot understand why it fails with medicine.

The last 3 years of cuts have forced a generation of doctors to consider the limitations of government. Normally apolitical physicians must now consider politics as a force impacting patients’ health. And doctors are not impressed.

For the first time since the start of Medicare, many doctors have started to imagine healthcare under an Australian or European system. It reminds some people about the birth of Medicare, something we all hoped to forget.

 

Addendum: In light of the terror attacks in Paris last night, apparently the organizers have decided that the rally will join with the vigil at Nathan Phillips Square. Those who still show up will meet at Queen’s Park until 1330 then walk down to the Square. Aside from the pictures, the post below remains unchanged from the original. I add this just in case readers were attending based on this post.

I talked with a doctor this week. She works hard, spends way too long with patients and supports a large family.

“I can’t do it anymore. It’s just not working out. My billings are already down 30%. I wish I could get out, find something else. Anything!“

I heard from another doc. His RRSPs won’t support a lower middle class retirement. He cannot work harder. His accountant expressed concerns. But this doc is spent. He once had fire. Now he’s exhausted, demoralized.

Of course, some doctors feel almost no financial pain from Premier Wynne’s cuts. These rare docs earn a tonne, have a low overhead and live well within their ample means. But they’re angry too. Cuts make it harder to get patients needed care. Cuts make a difficult job almost impossible.

Doctors want action. Many feel desperate. Even if they find success with the Charter Challenge, what can they do now? And next year?

Queen’s Park Rally

A large group of grassroots physicians and concerned citizens have pooled their energy.  They organized a rally to start at 12 noon tomorrow, in front of the Ontario Parliament at Queen’s Park. They did this with no outside funding or help. It is not a strike, just a peaceful event to raise awareness. Doctors cannot strike.

 

Pay attention to the media this weekend but don’t hold your breath. Given cozy ties between the Liberal party and the CBC, we cannot expect positive coverage from them, if any at all.

Some outlets will take this rally at face value and report facts: Premier Wynne cut spending on medical services and now docs find it really hard to provide care. Clinics have closed (infographic). Docs have retired. New graduates plan to leave or have left already.

Many doctors tell me they need to take action and do something. Anything. Apparently, a huge crowd of doctors and concerned citizens will show up at Queen’s Park tomorrow. If nothing else, it will probably make them feel better. And who knows, maybe government will realize people have had enough?