My son’s hockey team kept losing, even though they had one outstanding player. They got an early win when their superstar was away. The team started passing, worked together and won.
Team unity beats divided talent every time.
The OMA presented a contract to the doctors of Ontario in July. Even at first glance, people could see that it would divide doctors.
We should not fear dangerous ideas. But ideas must come out at the right time, in the right place.
Tackling divisive issues in a tentative contract is like starting a team brawl in the locker room, just before a game. You will lose.
Divide and Conquer works well. Politicians know that.
Government is Not the Enemy
Doctors need government. Teams cannot play without goal posts and referees. Doctors cannot provide care without government to enforce contracts and maintain order.
As much as many of us hate to admit it, we need a little government bureaucracy.
But sometimes, government is the enemy.
Government must take ownership for their actions. At the very least, we would not be in this crisis, if government hadn’t insisted on ramming through a contract, in the middle of summer, so that they could talk about peace with doctors, in September.
Common Enemy
Doctors and patients win, when doctors stand together as advocates for patient care. Patients win when we engage them, before we try grand schemes to improve sustainability by cutting services.
What do patients think? should not be a radical idea.
Pick any common enemy: patient wait times, useless legislation like Bill 210, over-regulation or bureaucratic inefficiency.
We avoid talk about common enemies because some people benefit from bad ideas. They would rather identify ‘divisiveness’ as the enemy, instead of tackling nonsense or underperformance.
People who say that there is no crisis in healthcare are blind to the ideologic battles raging around them.
Doctors need to see themselves as a group, a nation within a nation (see Identity Crisis). Modern politics is a Hobbesian war of all against all. The sooner doctors realize this, the sooner they will pull together to make things better.
Collaboration requires two different teams, working together, towards a similar end. If the teams are identical, it is not collaboration. It’s collusion.
Bureaucratic inefficiency : Last Wednesday, I experienced another exacerbation from COPD at 11 PM which required an ambulance ride to LHSC in London. I remained in the “pod” until Thursday afternoon at 4 PM. I was instructed at this time, I was going to be “admitted” and a room “JUST BECAME AVAILABLE ” on the 5th floor, (respiratory) A porter arrived, and off I went. I was placed in a ward across from the Nurses station, 3 out of 4 beds remained empty while across the hall in a private room, another empty bed. If this is an example of the Liberal’s new and improved “system”, heads should roll !
Yikes! I hope you feel better now, Scott?
At least they wheeled you out of the emergency department. Most hospitals leave you in the ED for over 20 hours (at the 90th percentile).
Oh yes, the open rooms you saw might have been ‘closed’ beds. That is, they might not have had a nurse assigned to them. Having said that, those rooms might also have had a nurse assigned, but s/he just didn’t want you in it yet.
Only people on the inside, patients especially, can see the tremendous waste, inefficiency and bizarre processes in healthcare. These are human issues that can all be solved with the right incentives.
Thanks for taking time to read and comment!
Best
Shawn
The government should function more like a traffic policeman enforcing the Highway Code…that we drive on the right side of the road , follow the speed limits ,stop at traffic lights etc, and leave the rest for the populace to decide for themselves with the traffic police should keeping their noses out of their everyday affairs ….it should not try to coordinate the movements of the population on the highways and byways, when people are allowed to leave their homes , when they can go to the gas stations , go shopping , come and go to work, go to the movies or visit each other….it would require a vast bureaucracy with as dive computers and tracking devices to micromanage the movement of the millions of people and one could anticipate colossal traffic jams , pile ups , massive confusion and absolute misery.
The government should function more as a policeman enforcing the Canada Health Act…and let the medical profession and their patients to interact together without interference….instead it intends to micromanage the interactions of the medical profession and that of their patients with a massive bureaucracy armed with computers, when they can do this, when they can do that, if they can have this, if they can do that, and we can anticipate massive line ups, queues , mass confusion and absolute misery.
As Lau Tzu put it , governing a people should be done lightly much like cooking a small fish….our government , instead, intends to overcook and burn the fish to a crisp.
Those who burn the food are the enemy of all who wish to follow a healthy and sensible diet.
My own school was small, but for its size had a magnificent rugby team…our motto was ” you may beat us but you’ll never defeat us”…if our heads went down, socks slipped to the ankles, shirt hung loose, looked the slightest downcast when behind on points, exhibited pain when hurt…we were dropped for the next game.
The government may well beat us, but we must not allow it to defeat us.
Thanks for such an encouraging note, Andris!
I love your mention of Lau Tzu, “governing a people should be done lightly much like cooking a small fish….our government , instead, intends to overcook and burn the fish to a crisp.”
I hope readers take time to digest the first 2 paragraphs of your note. Most people think that dystopian, central control happens only in books and movies by slightly deranged people. Actually, it happens in real life by well-meaning people, who believe they can help by running our lives for us. It does not work. Unless we stay vigilant to any concentration of power, it will be too late to correct once it takes hold. That’s the driving force behind our bicameral system of government. That’s why we have a federalist/republican system. All we can do is keep reminding people, I guess.
Thanks again for taking time to read and comment!
Best
Shawn
As a physician, I find that very few colleagues across different specialties and organizations have any real interest in quality improvement or systematically looking at patient outcomes (let alone satisfaction). If there is any collaboration going on it’s maybe in silos of early wave fhts or within UofTs incestuous morass. Huge numbers of doctors took the cheap options when Ontario md EMR funding came just so they’d end up getting paid more. So I’ve learned that the government paid them >20k to be on EMR in name only. And we complain that we don’t have an epic or crps type EMR solution for the province…
Our economy sucks and presently is chiefly based on a housing bubble. We have to take the pain, like everyone else. Otherwise, rewrite Canada health act to permit means testing of Medicare or copays. Oh right, The limousine liberal class would never soak themselves like that (see Toronto property taxes = Alabama property taxes).
You raise a number of important points, Dzh, in a very short space.
Doctors were tempted into capitated practices because that’s the only thing government would pay for. Government absolutely hates fee for service, despite the fact that it’s simple and focussed on service (assuming there aren’t massive shortages of MDs). We need to talk about how bonuses and baubles get used to drive political agendas, to reshape the system. Do doctors agree with the direction of the reshaping? Do we think a different direction would be better for patients?
You mention housing bubbles, liberal elites, process improvement, proper IT and more. I can’t respond properly to all these ideas, but thanks for raising them. All important!!
Best regards,
Shawn
Each physician decides in his or her own mind what their own priorities with regard to delivering health care are; in fact, these priorities themselves are ranked within our minds. Without going into specifics, external forces and internal forces mold decisions. Hospitals issues, LHIN issues, physician clinic group issues, family issues, our own health issues and so forth all interact in our minds and we finally make a decision. I believe that I learned the types of motivation from your book, Shawn:
1. promise of reward
2. fear of punishment
3. appeal to morality
4. social pressure
Bottom line. It is complicated and physicians can never be united.
From the events of the last few months around the Deal between the government and the OMA, many members of the OMA are still shaking their heads and trying to figure out the motives of the OMA Executive. For some of us, the analogy for these events is closer to what happened in the movie Major League in which the owner of the team wanted the team to lose for her own personal reasons. You can read the summary of the events of the last few months and make your own decisions:
coalitionofontariodoctors.ca/wp-content/uploads/2016/08/coalition_aug25.pdf
Unfortunately, Shawn, we are living in interesting times. Among the approximately two thirds of physicians who voted against the recent agreement, many believe that we have at least two enemies: the government and the OMA executive. I do not see any way that Ontario physicians can be truly united. When you believe that have more than one enemy things get really confusing.
Thanks for sharing such sobering comments, Gerry. I think you are correct: Doctors face a crisis of trust on all fronts.
I tried to work out my thoughts in a blog and ended up writing something a bit muddy. I think I was trying to get around to saying that we need to not be so afraid to attack something. The something I had in mind was the Wynne government. However, once I started writing, it sounded too harsh, too pugilistic. Over the last few days, I think my thoughts are starting to coalesce around something more concrete. Hopefully, I can put them into a more coherent blog.
Thanks for mentioning the spheres of motivation! 🙂 I do not think the fact that we all respond to different reasons for change precludes the fact that we can all have a common enemy. For example, we all need food and shelter, even though each of us tends to be motivated by different reasons for change.
Still, your point is well taken. If an external enemy does not strike at a very basic need on Maslow’s hierarchy, for example, at personal safety, then we will have a much greater challenge motivating a group to fight together against it. I guess basic needs trump spheres of motivation. If we can present the need for change in terms of survival, it trumps all the other levers to motivate change. [Thanks for this!!]
Thanks again for taking time to read and offer such thoughtful comments. I always love them, and I know other readers do too!
Cheers
Shawn