Doctor Derangement Syndrome

Some people hate cows.

Cow haters often have good reasons for feeling so.

Perhaps they had a bad experience with a scary cow. Now they tell everyone that cows are smelly and bad for your health.

Occasionally, cow haters pretend to support the dairy industry, but only if it leads to increased regulation of cows in general:

Cows are such a precious resource that we need government to control them.

Other people love cows above all else and put them centre stage at every state fair. They push for more pasture, just for cattle. They re-write food guides to support the dairy industry.

***

Some people hate doctors.

No doubt, doctor-haters have deep reasons for feeling so. Perhaps they had a bad experience with a scary doctor.

Now, they write nasty columns in the Toronto Star about doctors.  All the inspiration they need is a tweet, by a famously unpopular Premier from the 1990s.

Occasionally, they write something positive, in a roundabout way,  but only if it leads to stiffer regulation and control of doctors.

Other people love doctors above all else and put doctors’ issues at the top of every agenda. They push for higher taxes just for doctors. They re-write legislation to support big medicine.

Doctor Derangement Syndrome

Like those who hate everything to do with cows, some people, especially in the liberal media, have doctor derangement syndrome.

At the same time, some doctors put doctors’ interests above all else. They have selfish-doctor syndrome. Both syndromes are deranged.

Irrational hate for doctors and irrational worship of doctors both lead to patient harm.

In politics and mental health, some people label things all good or all bad. Psychiatrists call this splitting, a common feature of a borderline personality disorder.

Mainstream media needs villains and heroes. Hollywood’s favourite villain is the wealthy, immoral business-owner. The Toronto Star’s favourite villain is the hard-working doctor, otherwise painted as a greedy, selfish, hypocritical capitalist.

Pro Patient = Pro Doctor

You cannot be pro-patient and anti-doctor at the same time. You cannot beat up doctors without harming patient care.

If you care about great patient care, you need to be pro-doctor….and pro-nurse, pro X-ray tech, etc. You cannot abuse the people who provide care without harming patient care.

To be fair, not all people who fight for doctors and nurses have the best interests of patients in mind. In fact, some people jump at a raise, even if it means less care for patients.

For example, the OMA heavily promoted a deal, last summer, which offered doctors bonuses for restricting growth in medical services. Doctors stood to get a bonus for limiting care.

Nurse unions do the same thing: Generous wage increases mean hospitals have to fire all the new nurses, who were just hired, to pay for the raise.

But even if we use the worst examples of selfish-doctor syndrome, we still cannot escape a fact: Cutting doctors means cuts to patient care. There is no way around it.

You cannot attack doctors without harming patient care.

Doctor derangement syndrome harms patients. If you starve a cow, you get less milk.

Some people regard private enterprise as a predatory tiger to be shot. Others look on it as a cow they can milk. Not enough people see it as a healthy horse, pulling a sturdy wagon.  – W. Churchill

28 thoughts on “Doctor Derangement Syndrome”

  1. I wonder if the nature of the articles written by the reporters at the Toronto Star suggest that the authors have borderline personality disorder.

  2. “Other people love doctors above all else and put doctors’ issues at the top of every agenda. They push for higher taxes just for doctors.”
    Do you mean lower taxes just for doctors?

    1. Great question, Lindsay.

      I’ve had some doctors argue that the government needs to raise taxes to pay doctors! I couldn’t think of a worse idea.

      Thanks for asking!

      Shawn

      1. Ohhh, reading comprehension fail. I read it as “raising taxes paid by doctors only” which seems pretty mean-spirited, even within the current climate. Raising taxes for everyone to pay for healthcare (including doctors) doesn’t seem crazy to me, but I can understand that it wouldn’t exactly be a popular choice.

        1. What we really need to do is redistribute the taxes currently being paid from the bureaucracy to the care givers.

          Government Sacred Cows like eHealth, teleHealth, CCO, CCAC and LHIN among others need to go.

          Kathleen.

      2. The Ontario ( and the Federal) government will increase taxes and slash doctors’ incomes.

        Churchill stated that ” Some regard private enterprise as a predatory tiger to be shot. Others look at it as a cow they can milk. Not enough see it as a healthy horse , pulling a sturdy wagon”.

        The Ontario government certainly wants to milk the medical profession— it thinks that it can restrict its feed whilst extracting more milk — and if the planned milk productivity increase is not achieved, it will beat it whilst holding a gun to its head—and if that doesn’t work, it will shoot it.

        It looks as if President Trump to our south sees businesses as sturdy horses who should be well fed and kept healthy so that they will pull the sturdy US economy along— he also intends to have well cared for healthy cows to produce a constant quantity of high quality milk—our Canadian medical colleagues who migrate South as a consequence of Bills 41 and 87 , might well find it a far more amenable professional environment and more appreciative of their skills and hard work.

        1. Andris,

          You always have the best quotes! You have read so much that most of us can’t keep up with all your knowledge and experience from other countries. I’m going to add the Churchill quote to the bottom of the blog post. Excellent!

          Thanks again,

          Shawn

        2. ha ha : selective car pulling will not improve healthcare for the country, yet healthcare for some and wealth of insurance companies.

  3. Hi Shawn,
    as usual, your insight into these matters never ceases to amaze me! I too, have read recent news articles and editorials (occasionally, some even from colleagues) and wonder what planet some of them are coming from. Have they forgotten the cause and effect of the cuts in the 1990’s? I came to Ontario to set up practice in 1999, at the height of the doctor shortage, naive to the political environment of the time. Looking back, it was damn awful! Mature family practices were closing left and right as docs were either retiring, or going into other streams of work. It seemed to be totally lost on government that their actions were gradually gutting full service family practice. The cost and intensity of running a practice was outpacing the woefully outdated fee schedule.

    So what did the public end up with? …more closed offices, a huge swell in orphaned patients, and more docs moving into higher volume, lower complexity single problem clinics.

    So when government, editorialists, and other commentators try to say that fee cuts or stagnant wages don’t hurt patients, they not only have forgotten history, but are not thinking things through to their logical conclusion…

    Keep up the great work!

    1. Great points, David.

      I bet you never expected to see something worse than the late 1990s? On the bright side, we don’t have the same MD shortages. This system gives government all the power to cut fees and legislate grand changes to how we practice, and it gives us all the responsibility of paying for our clinics in an uncertain environment.

      I’ve never seen so many doctors interested in getting into different kinds of work!

      Thanks so much for taking time to read, comment and share some encouragement!

      Cheers

      Shawn

      1. Excellent article again, Shawn. In a reply you said that we don’t have the doctor shortages as we did in the 90’s. Is that really true? Even if is, almost 1,000,000 Ontarians without a family doctor is still a large shortage.

        1. Hey Gerry,

          We had close to 3 million unattached patients – patients without an FP – 10 years ago. Graduation and immigration have added around 1000 doctors per year for the last 15 years. Plotted against population growth, we are in a very different situation now. Ask Boris for some slides on this…or look through his twitter feed. He’s done extensive research on it and presented it to council.

          Great to hear from you!

          Warm regards,

          Shawn

  4. It is so difficult to keep going in this environment. I was a nurse for 14 yrs. then I went to med school in my 40’s. It was a miracle! Now I am being told that my training and experience and constant upgrading of education is worth less and less (30%less as of the last fee cut) and can be done by an NP…maybe I should write my RN exams and upgrade to NP, better salary, no overhead, luxurious benefit package with actual sick time, a pension, oh my! It took me 25yrs to find my purpose and I love being a doctor and that is why it hurts so much to be disrespected by our government. If they cut anymore, I will not be able to pay my hydro bill and keep the lights on at my clinic! (Did ya catch that little dig at the hydro issue…lol)😎

    1. Oh Sam,

      What a terrible story! For what it’s worth, you can find joy in medicine somewhere, if that’s where your heart is leading you. Working in another province or up north will offer more freedom and greater respect and autonomy. If you have to stay in Southern Ontario for other reasons, then I don’t blame you for considering your NP exams! I’m sure you saw my post about Nurse Practitioners Paid Twice as Much as Doctors?

      Thanks for taking time to read and share a comment!!

      Cheers

      Shawn

  5. Machiavelli stated that there are only two causes for hatred— fear and envy.

    Sometimes one, sometimes the other, sometimes both.

    2. Andris,
      Yes, I think both fear and envy are underlying causes of “Doctor Derangement Syndrome” Likewise I think your comment in the Medical Post on 3rd February “It is a Kantian value” describes our current status as physicians in Canada.
      I think narrowing in on the pathology is helpful but communicating it to people successfully is eluding us. Politicians /Media are not interested in Truth only in whatever truth suits their purpose. Also our Truth is not easy to hear -telling the Doctors Haters that the reason they hate us is that they both envy and fear us is not likely to win them over.
      I think humor and parables such as Shawn’s wonderful blogs are helpful. Linking the welfare of Health Care providers to the Health of patients as Nadia and many,many others have been pushing seems to be getting some traction. However I’m not sure how much difference these strategies will make in the end despite the heroic efforts that people are making to advance them.
      What will work? Leadership? Professional Advocacy ?(certainly our OMA fees should be able to buy the best out there) Has anything worked in other Countries?
      Sorry Shawn and Andris this as not a very cheery comment but Damn it ! I’m not a Philosopher/Journalist/Politician/ Spin Doctor/ Writer/Professional Advocate/Systems Engineer. I’m a Physician.

      P.S Sam. Knowing the autonomy that RNs have up North I did apply to be an RN at low point in my various battles with Licensing Authorities (the Shame of being a Foreign Medical Graduate never really leaves you) Short answer -Not Qualified/Over Qualified and Not Accepted 🙂 But as a previous RN NP you would likely fair much better. I do wish you well.

      1. Well said, Helen!

        Media cares most about selling papers, less about truth. After all, What is truth?, in a relativistic age.

        Thanks for sharing you comment about RNs up North, too. I’ve heard this from other MDs who’ve tried that route. Not cool.

        Warm regards,

        Shawn

      2. lol, Helen. As easy as it sounds to switch to nursing, we as doctors are not that well equipped to be nurses. Having done both, I have a unique position. I did not understand the difference until I had trained for both. The short answer is this, we work on the same tree but completely different branches. Each profession has it’s focus and education and it is surprisingly different. That is where MOH is making a huge mistake, they cannot and importantly, SHOULD NOT, think they can simply replace doctors with NPs. We are not interchangeable. So I think at this point, I will stick with my MD and fight like hell for my profession and my patients. 😉

        1. Sam, Really good to hear from you. I would like to think that the MOH is listening to unique people like you who have experience as an RN,NP and MD. Since you obviously can speak with authority on all 3 professions. However it seems that to date the MOH has been short on listening skills.
          I wish you continued joy in working as a physician. Something I hope all of us can retain in these very difficult times.
          Regards,
          Helen

  6. Shawn,

    Another point you raised regarding the relative shortage of physicians now as compared to 1999… I agree that relatively speaking, there is a much greater supply of physicians now than in the late 90’s. This too, I feel, has placed us in a difficult spot. We may not operate in a free market (medical services speaking); however, relative supply and demand have a direct bearing on our ability to bargain effectively with the province. I dont think we will see another “2004” again any time soon!

    This is another aspect in which I feel the association has miscalculated, and let us down. They kept arguing for more doctors, and crying doctor shortage for a number of years after things had settled. I think they took it way too far, and this has contributed to our current circumstances.

    1. Well said. Also, the federal health transfers made the province feel rich in 2004. And doctors were so mad in 2004 that they rejected Furious George’s first contract.

  7. With regard to “selfish-doctor syndrome”, some Ontario specialists continue to assist OHIP, as experts at the Health Services Appeal and Review Board, in disputes against residents of Ontario regarding out-of-country (OOC) health services. Do these Ontario specialists not understand that there colleagues are in a dispute with OHIP or do they have “selfish-doctor syndrome”?

    1. Thanks for sharing this, Perry. I don’t know enough about the review board. I need to do more reading! 😉

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