Most rulers love popular advice, not honest criticism. Popular advice mixes two parts flattery plus one part suspicion plus 3 parts repeat-what-the-ruler-already-said using your own words. Great rulers despise it.
Medicare almost never has great rulers. Most politicians like to hear experts that congratulate accomplishments (flattery), question doctors’ motives (suspicion) and decorate party platforms with voice-overs from academics.
Doctors must learn to kowtow or get ignored by government. When clinics struggle to pay office staff, doctors must hold their nose, bite their tongues and offer popular advice. Doctors must kowtow to politicians to be included or face being left out of healthcare with left-overs.
Doctors Kowtow
Politicians and bureaucrats enjoy life when they don’t have to waste time engaging doctors. Whether it’s Health Links or Primary Care reform, government has a long resume of coming up with grand solutions, excluding doctors by design.
“You’d better be on the agenda or you’ll be on the menu!” Experts advise.
Do physicians compromise to get on the agenda? Do they avoid speaking out against inefficiency, waste or injustice?
Too often, doctors keep quiet to get included in a process. They reason it’s better to keep quiet about injustice than risk being thrown out of the inner circle.
Workers vs. Stakeholders
In successful businesses, workers speak up to improve operations. Employees risk their jobs if they keep quiet about waste or inefficiency. Companies must innovate or lose out to competitors who do.
In nationalized monopolies, workers speak up as citizens to improve their own lot and the interests of the stakeholders they represent. Stakeholders risk their lunch invitations to Queen’s Park if they speak out about waste or inefficiency. A nationalized monopoly does not need to innovate. It cannot lose.
Whine vs. Challenge?
At every level, Canadian healthcare encourages kowtowing and whining instead of rigorous challenge. Everyone tends to support the party line for fear of being left out of the political process. Ultra-sensitive to voter opinion, politicians would rather hear popular advice and keep their public image untarnished than hear rigorous challenge and risk re-election.
Now, more than ever before, Medicare needs doctors to be recklessly honest. Yes, reckless. Ontario’s doctors have nothing to lose right now, and patients have everything to gain. As things get worse for patients from Wynne’s cuts and underfunding, voters will lash out at government and doctors. They will demand to know why doctors didn’t speak up about mismanagement. They will despise doctors’ attempts to placate politicians.
If political rulers truly care about Medicare, they will welcome critique from outside groups. They will detest popular advice and flattery. They will refuse to listen when doctors kowtow, and doctors will refuse to try.
photo credit: economist.com
Wow, Shawn, yer really churning them out!!
Government does not see patients. Doctors do.
Government knows that if patients have frustrations with the system and how it serves them, they will (at worst) blame physicians or (at best) physicians will have to deal with their emotions. Doctors and staff will have to work harder to try to achieve ‘better’ access for their patients in a system that serves to ration access. Physicians know that the shortcomings of the system are not their fault and feel resentment about being seen as responsible for the barriers and obstacles erected in their patient’s path to get needed care. It leads to burnout and ‘circling of the drain’ as both physician and patient dissatisfaction increases. After 4.5 years of family practice, I had enough and flamed out.
The problem, historically, with the OMA in the past 30 years is that it has always wanted to be ‘at the table’…to be a partner with government. Government has used this to their advantage over and over again, partnering with the OMA when it feels like it. If things did not go as planned, government was happy to blame physicians by saying that the OMA and Ontario doctors ‘signed off’ on it.
What has been sacrificed for this arrangement are fees paid to physicians. Physicians have been able to ‘keep up’ by working harder and harder, often at the detriment of their own physical and mental health. Indeed, Ontario family physicians carry more patients and see more patients than doctors in any other part of the country.
It is time to step away from the table and let the government alone own this mess. This has never been the fault of the individual physician. It is time for the OMA and all Ontario physicians to look after ourselves and each other. Only then will we effectively be able to look after the patients of Ontario.
Thanks for your very thoughtful comments, Paul!
When times are good, we need people who can build relationships quickly, work cooperatively and speak the truth in such a way that relationship gets maintained.
When times are bad, we need all of that plus a willingness to get into a tussle. Although it goes against ever fiber in most of us, there comes a time when we have to be willing to get into a dust-up for a good cause. Welcoming back abusive friends isn’t always safe and does not help the friend.
Looking forward to visiting with you in May!
Best
Shawn
I would like to share a conversation with an ophthalmologist that sounds burned out too. He was desperately trying to get a surgeon in another part of the province to do surgeries on a 45-year-old woman with extremely bad cataracts. They were so bad that I would call them Third World cataracts not Modern World cataracts.
One of us asked him why he had not bumped another cataract patient to do this case instead. His reply went something like this:
“I’m not sure which patient who has been waiting a year for their surgery already to cancel. If I cancel someone next week they will have to be rebooked into late September… Every month my waiting list has been growing longer. We have several hundred patients who are desperate for earlier surgery already on our cancellation list.
She came to the ER because she could no longer function. I ended up squeezing her in today to an already overbooked retina clinic because I was on call. I did not have a free technician with time to do an A-scan.
Today I worked from 7:30 am in the OR until 7:30 pm in the office. There is a limit to how many patients I can look after. I’M AT THE LIMIT!”
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It really hurts when the media and politicians blame us for the failings of the Health Care System and even blame us for seeing too many patients.
The duly elected representatives of the patients created this health care system. Physicians are not responsible for it, but just doing the best we can.
I agree with Paul that: “It is time to … let the government alone own this mess.”
What a powerful story, Gerry. Thanks for sharing it!
The Toronto Star would publish 10 articles about how much you bill before printing one story about how hard you work.
At the other end, doctors work harder and longer than they want to maintain incomes. This steals time from patients. Even while running like hamsters, most doctors do not make as much as senior managers in hospitals. Simply working less is not an option for many doctors (dependents, alimony, etc.).
Regardless of the reason, patients do not get as great service from exhausted physicians. But of course, politicians love to replace MDs with NPs, and RNs with RPNs to ‘ease the workload’ on providers when they’re really just saving money by offering diluted care.
I expect big changes soon!
Thanks for taking time to read and comment.
Best regards,
Shawn