Category: Politics

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

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.