For 6 days, captors held employees hostage in a bank vault in Stockholm, Sweden, August 1973. Police finally rescued the victims and caught the criminals, but some employees defended their captors for days afterwards.
The Stockholm Syndrome describes the positive feelings that victims sometimes develop toward captors by mistaking a lack of obvious abuse for kindness.
Even after long waits, survivors of major illness are glad to be alive and thankful for their care in Canada.
Fear mongering about financial ruin and system change makes patients cling to a system that holds them captive to long waits with no easy options.
Debate centers on whether our system harms patients. It does. But, issues get dismissed as isolated, or labeled as ‘solved’ with wait-time strategies and benchmarking.
Patient harm is the wrong debate.
Holding Patients Hostage
We need to focus on what patients aren’t getting. The public doesn’t really know what they are missing. It’s up to providers to say so. When patients finally get an MRI, they’re impressed. Who wouldn’t be…for ‘free’!
People need to know we have an economy-car version of healthcare at a mid-sized price. For the same or less money, better systems can:
- Treat patients like valued customers
- Give patients choice about who they see and when
- Provide home or office visits
- Provide same/next day imaging AND results
- Offer specialist consultation within days
- Arrange elective surgery within the week with biopsy results in days
- Offer electronic access to records
- And much more…
Increased Utilization
At this point, quants (quantitative analysts) say, “But that would just drive up utilization.” Utilization equals the number of services provided. More service means more money: always bad in a publically funded system.
But, increased utilization is good if more patients get necessary care.
Quants see spikes in utilization as unnecessary care (even in the face of population growth). They assume providers offer unnecessary care when allowed, fingering providers as liars and thieves. They assume the same of patients; ergo, patients don’t deserve more care.
But, we know patients need more care; they die on wait lists currently. We also know patients would like better service; they want more value for money and prompt care options at home, not abroad.
Food Industry Analogy
Just imagine if we socialized the food industry. Groceries cost thousands per year, and many citizens are malnourished and poor. Socialized food would help. We could set prices and offer only essential items, without junk food, for free in government stores. We could make it illegal to purchase food elsewhere.
Others have tried this: state-run food industry results in no choice, long line-ups, and terrible customer service. Sound familiar?
We Need Change
Medicare was built to prevent financial ruin from acute, major health needs, before modern treatment options existed. Now, most care issues are chronic, multiple, and create arguments over the definition of ‘need’. Medicare began like collision and theft automobile insurance, but it now covers all mechanical issues: a warranty, not insurance.
We are held hostage, unable to change. We defend our captor mistaking lack of obvious abuse as kindness. We must debate whether people should be free to choose more than the bare minimum of care.
(photo credit: tripadvisor.com)
Brilliant post, Shawn!
Thanks, Marko! I appreciate you taking time to read it!
Shawn…in one of the California HMO”s many of the systems you write about are currently in practice. We can debate the cost to the patient/insurance but the vision of what the Canadian system can be exists now. The key discussion is focusing on patient and doing that at an affordable public cost. It pisses off me and most others to no end when we are made to feel grateful that big brother is taking care of us. What we forget is that they exist at our pleasure not the other way around. There are jokes about the apologetic Canadian. Why, because we complain among ourselves but not to those we employ…..govt burocrates.
Conversation yesterday was discussion of longevity and what that might cost and the burden on the young. We canadians spend billions helping other countries for a variety of reasons. The narrative needs to focus on providing canadians with the best care possible. Comes down to priorities of where we spend our dollars. I got the impression yesterday that many physicians believe that us seniors have a “best by date” on our foreheads. If we go past that date the economy will fall apart.
My job is to stay alive in a healthy state as long as possible….not check out to save the economy or make it easy for the youth that follow. I can only do that in partnership with govt, physicians and a mindset that has a common goal….as they say on the Enterprise ….live long and prosper.
Physicians are the best positioned to provide solutions to govt and patients alike. You may feel hard pressed now but I believe you and your associates are best positioned to facilitate change with the publics support and commitment.
Keep up the good work
Don
Wow, great comments, Don. Thanks so much for taking time to write!
“…we are made to feel grateful that big brother is taking care of us. What we forget is that they exist at our pleasure not the other way around.” You nailed a key concept here. We need to put patients – voters – back at the centre. Even with 100% public funding, we could redesign it so that funding follows patients making providers/institutions see patients as customers to be helped instead of cost centres to be controlled.
I cringe at your comments about health costs making retirees/elderly feel guilty. I thought Medicare was precisely to care for those who need it, but can’t cover costs themselves? This seems perverse: drive up deficits then make the ‘best generation’ feel guilty for using Medicare.
Thanks again for your comments! We need to have adult conversations about healthcare in Canada. Two issues stop discussion: 1) Medicare = Canadian Identity, and 2) No one considers healthcare beyond the USA (other non-American countries have great ideas that work well).
Looking forward to hearing more from you in the future.
Best
Shawn
Great Post Shawn! I agree with the Stockholm syndrome felt by Canadians. With the Government as our captors we will be forever thankful for the crumbs they throw us. This is not the system that will take us through the 21st Century. The challenge is to show the hostages there is more out there and the option is not to scrap universal care but to improve care for all. The catch is that care will not be improved equally for all – it is not equal today anyhow. Are we held hostage to the misconception of equal care for all? How can the benefits for all of unequal hybrid growth be embraced?
Thanks so much for commenting, David!
I agree: “The challenge is to show the hostages there is more out there and the option is not to scrap universal care but to improve care for all.”
You comments on equality bring up a huge topic: what do we mean when we say equality in healthcare? Do we have it now? Why do we think it’s so important? What will we sacrifice to get it (if we even decide what it is…)?
Thanks for taking the time to read and comment; I really appreciate it!
Cheers
Shawn
Hi Shawn, I for one would be fine with user fees. I know that because so much of what we get for free is free, I (and I think we) take it for granted. I wouldn’t mind paying $20.00 for a visit to my gp, or $50 to go to emergency. I would also agree that those lower down in terms of income should have fees waived. I think we need to get real about what is going on in healthcare.
One idea I had was to solicit “sponsorship” money towards a hospital’s linen fees–that is, instead of asking for donations, ask for a certain amount toward a concrete purpose. And giving toward something like linen fees, when we all have those expenses in our own homes, makes it an identifiable expense: we all have to buy sheets and do laundry. So those type of goals help when it comes to giving. It’s just that so often the money we contribute to charities seems to go into an ill-defined black hole and that actually makes giving hard.
I make monthly payments to Doctors Without Borders and the Humane Society because I can envision a practical goal. Running sponsorship drives for certain hospital expenses, and having a centralized, provincial online site for doing so, might be a more efficient use of fundraising efforts and money. Having one site for an entire province would cut down on expenses — and many people are now familiar with e-transfers, so this would help too.
Despite the complaints I write about, I know also that our system is suffering and I have quite a bit of empathy for the whirlwind that is a hospital environment. I can see that we, as users of the system, need to extend our empathy and creativity towards helping everyone receive better care. We really are all in this together.
Irene Ogrizek
Thanks so much for writing such a thoughtful comment, Irene!
Many rules govern how hospitals raise money. Hospital foundations can raise for ‘capital expenses’ but not operational or human resource expenses. I won’t even touch the imbroglio over how foundation money gets allocated…very contentious! Regardless, your comment about laundry holds promise.
I do not think the system needs more money until we change how money gets spent. Too many regulations, and leaders too scared to change for fear of losing their jobs, makes the whole operation painfully inefficient. I could tell you stories privately; the issue is immanent in our system. Check out my post How to Fix Healthcare: Let Leaders Lead.
I believe underlying assumptions need exposing. We need people to ask why the system is so provider focussed, why we can’t attract physicians into leadership positions, and why we don’t let people doing the work – nurses, doctors, and allied health – partner with patients to come up with solutions.
Thanks again for your comments. I enjoy your blog; you write so well!
Best Regards,
Shawn
Now I’ll have to look up a cure for Stockholm Syndrome, since my patients are probably suffering from it 😉 Now how’s that gonna make me feel next time someone seems glad to see me?
Very appropriate consideration of “warranty” vs “insurance”?
How do my patients who don’t want to get too well in case they lose their “disability” fit into this? -philw-
Too funny…very brilliant observations.
I am certain patients want to see you and aren’t just glad they survived a visit! 🙂
I never thought about disability causing perverse incentives…wow. There used to be a distinction between the hard-working poor (e.g., farmers whose crops failed) and the poor who were poor because they didn’t like to work. This distinction draws cries of prejudice these days, but I couldn’t help thinking about it in relation to your comments about patients not wanting to lose their ‘disability’ benefits by getting well.
Thanks so much for taking time to write!
Shawn