Category: System

If you follow health news, one thing is clear. We must never ask a doctor how to fix healthcare. MDs say strange things about patients and medical supplies that do not sound like system-speak. Therefore, they must be mistaken, biased or arrogant.

Dozens of articles prove that doctors do not even follow guidelines.  If we listen to media and politicians, we might wonder whether doctors know how to practice medicine at all. Physicians are the last people with ideas to improve medical services.

Even so, the Ontario Liberals found a doc who’s practiced everywhere except Canada to promote their grand design. Only he can be trusted. He knows.

Solutions

Everyone has ideas about Medicare, but no one says doctors should lead.

The Conference Board of Canada suggests we need family health teams, IT, pay for outcomes, more elder care and focus on prevention. Others say doctors should just stop over-prescribing. One group thinks we might try to cut care at end of life. Another tells us to build care networks.  And nurses want more power, and more nurses.

Americans print their own solutions: Harvard Business Review,  Wall Street Journal. The WSJ article puts one paragraph at the end about physicians setting rules for care, but that’s it. Organizations like the Institute for Healthcare Improvement seem to agree.

Canadian Experts on Healthcare

Canadians trust Roy Rowmanow when he talks about changes to healthcare. A lawyer and former NDP Premier of Saskatchewan, Romanow carries more weight than any physician. Maybe it rubbed off of Tommy Douglas, another former NDP Premier of Saskatchewan, who held social views that most of us shun.

Would lawyers ever accept a physician as the national expert on the legal system? Would dentists accept pontifications about dentistry from medical docs?

Doctors Should Lead Medicine

Physician organizations should directly advocate for physician leadership and sharply critique system mismanagement. Here are previous posts on this theme:

Leadership: Who’s in Charge of Medicare? (Not doctors!)

Myth: Physicians Lead Medicare

Over-Regulated Medicare Stifles Innovation

Canadian Chaos: Medicare’s Misaligned Incentives

How to Fix Medicare: If Publicly Funded, Then Privately Run

Medical Anarchy, Mindful Structure

Quality Care Requires Freedom

Healthcare Control Using Fear

Inexperienced Experts

Why Medicare Fails

Physicians must speak up. They know how to fix healthcare. Doctors need to figure out how they want things to change and then advocate strongly.

Doctors should lead medicine, not politicians. Not bureaucrats. Not nurses. Not lawyers.

Patients expect that dentists lead dentistry and lawyers lead the judiciary. Doctors must fight to regain the leadership they’ve lost. Patients deserve no less.

photo credit: ottawacitizen.com

No one writes articles criticizing close friends. Who publishes critiques about office associates? We share some responsibility for the behaviour of those around us. For these reasons and many more, the Ontario Medical Association almost never prints meaty criticism about healthcare mismanagement.

But times have changed.

The Wynne Liberals slander and lie about doctors. Notable doctor-bashing bureaucrats now hold prominent positions of power and lash out with impunity. The OMA-MOH relationship is in tatters.  Even talk about engagement, a nauseating pretence for partnership, has disappeared.

OMA as Health Critic

Doctors have a rare opportunity to speak frankly about waste and mismanagement. Physicians work around it every day. We apologize for it continually. Most of the time, we own some of the system’s performance. Not anymore.

Doctors of Ontario need to speak up, soon. In a few months, politicians will realize they risk even bigger mistakes in completely ignoring doctors. By then, doctors will be back into some sort of working agreement, and we’ll have lost our chance.

Healthcare Mismanagement

We need to educate voters on the rot inside healthcare. We should share examples. We don’t have to expose our own hospitals. But at least we can talk about global problems.

Let’s avoid asking for more beds, more MRIs, more drugs, etc. Asking for more just empowers government to take more control.  We need to show how centralized control created mismanagement in the first place.

For example:

• The ministry of health got public hospitals to spend millions on their own information technology systems but never cared if hospital IT communicated with any other system. This leaves patient records fragmented and in many cases almost useless. Any real business knows its first priority must be to communicate with its business partners, like other hospitals and providers. But hospitals don’t need to worry about pleasing partners like a real business.

• Diagnostic imaging results are not available for many days. Scans get reviewed within hours. But results often drag along days to weeks later with many still arriving by fax.

• Archiving systems for digital images (PACS) are not shared and available to all hospitals in the province only small groups of select hospitals.

• Family doctors make referrals only to find out weeks later that that particular specialist cannot accept any more referrals for months. Other provinces track referrals to consultants so that patients and primary care providers can follow referrals along in the process. Providers know which specialists are accepting new referrals.

• Specialty services have long wait lists or are unavailable in many communities. For example pediatric psychiatry, neurology, and neurosurgery are notoriously difficult to consult.

• Government massively increased the number of physicians 15 years ago. Now the government refuses to provide an opportunity for trained specialists to work despite long wait lists of patients needing care.

These are just a few examples of healthcare mismanagement that government could have prevented or could fix now.

Politicians dread talking about healthcare. They know it’s impossible to control a complex system from the top down. But they insist on trying anyways. Politicians want nothing more than to keep media distracted, even scandals are better than having to show their ineptitude at healthcare mismanagement.

Government cannot run healthcare all alone. It needs help. It needs doctors intimately involved with managing the system in the best interest of patients. I hope doctors take the opportunity to speak up. Please feel free to share more examples in the comments!

 photo credit: thestar.com

For different resolution, try this link: Angelina Jolie’s Cancer Surgery | Access to Health Care | Sunday Panel – The National – CBC Player.

Highlights:

• How dare Angelina Jolie have access to better care than everyone else.
• Private healthcare is like closing 1 lane of a highway.
• Private healthcare is like adding 1 lane to a highway.
• Every country in the world allows people to purchase care, to treat their own bodies as they see fit (except Canada and N. Korea. Cuba changed recently).
• Everyone gets decent care in Canada. Stop whining!
• People suffer on wait lists. Some are paralyzed for life.
• We need a government sponsored, universal system as a base.

Let me know what I missed. I found it rare to have the CBC allow Medicare doubters any airtime. Is the CBC sensing the inevitable?

I’d love to hear what you think!