36 thoughts on “Medicare Provocateurs”

1. I don’t see a lack of voices out there laying criticism. Everyone and their brother critiques the way Canadian health care is run, up and down the professional food chain. The problem, rather, is that nobody in any position of authority seems to listen or care, except when the “voice” in question toes the government or bureaucracy line. How many smart people – on either end of our fictitious political spectrum – have built their careers on research and policy critiques that went unheeded?

   (The Don Drummonds of the world don’t count…they’re politically connected consultant-mercenaries, hired to give a government an “arms-length analysis” that fits whatever policy direction it hopes to take.)

   There’s credibility to be gained by being more open to criticism – anyone who thinks doctors don’t shoulder *any* blame for the mess we’re in is being dishonest. But even then, there’s no guarantee anybody will listen. The only thing a doctor or nurse can do is his or her job. Speak your mind by all means, but do your job. The patients know who to believe.

   1. Great comments, Frank. Thanks for making them!

      I agree that many people criticize performance. However, I think very few criticize ideas or ideology. It’s easy to talk about people dying on wait lists. It’s hard to talk about why giving everyone the exact same meal on every dinner table every day of the week leads to tyranny and suffering.

      Your call to caring for patients as the best way to hold the moral high ground is well taken. I agree. I worry that too many have kept to their last while the shop crumbles around them. In the end, we will be (and are being) blamed for system underperformance.

      Thanks again for taking time to share a comment!!

      Cheers

2. I have been just as frustrated as you, Frank. The duly elected representatives of the patients created this health care system. Doctors are not responsible for it but have just being doing the best we can.

   If we are trying to move forward, whether doctors “shoulder *any* blame for the mess we’re in” does not matter. Which is more important: being right or being happy? Blaming someone or fixing things? Governments have been blaming doctors for failures in the health care system for years. Blame has been a tool to keep politicians in power.

   It’s time for us to move forward on fixing our health care system. Governments care about being elected and, as Shawn said, the healthcare system was a tool to get them elected. We can use the failures of the health care system as a tool to make politicians suffer the consequences of their over-promising and under-delivering healthcare.

   1. Thanks Gerry!

      Great comments, as usual

3. Hi Dr. Whatley,

   I enjoy your articles. Please keep writing!

   Question for you: say doctors were to be in charge of health care as per your suggestion. How would doctors be compensated?

   As a taxpayer, I would have significant concerns of physician self-interest getting in the way of accessible and quality health care.

   1. Hey Billy,

      Thanks so much for posting a comment!

      I think PATIENTS need to be “in charge” so to speak. They need to be integral partners in deciding what happens to their information and which direction care goes. Of course, if you are bleeding on the side of a road, you want someone else to take over and just take care of you. But most of healthcare is not that way. Patients want to be involved with everything else. So I think we need to have patients empowered to say what they want out of their healthcare system.

      And I agree, we should not concentrate decision-making or power in any one person/body….including doctors.

      Thanks again for taking time to post!

      shawn

4. Gerry, perhaps blame isn’t quite the word I was going for, so much as admitting and taking responsibility. We can’t “fix” anything in health care until we take a serious look at how we got to where we are: how decisions were made, who made them, whether “mistakes” arose from lack of foresight, blind ideology, willful ignorance, or whether said mistakes were really just bad luck.

   Take the opioid problem. There are hundreds of causes of it, not least of which was criminal dishonesty on the part of Purdue. But Purdue alone could not have caused over-prescription. The company needed: a cadre of doctors to write the guidelines and push a culture change; medical journals to not pay closer attention to conflict-of-interest disclosure; academics to not scrutinize the evidence base, and under-train the management of pain; governments (like in Ontario) to not put in place monitoring systems; and many, many puzzle pieces to fall into place.

   But instead of looking at all of the missteps along the way, we see government basically using the College as an enforcer, targeting doctors that might be out of line, but might also be acting in good faith and what they feel is in the best interests of the patient.

   The problems in health care are many, but they can’t be solved until everything is put out in the open and scrutinized.

   1. Take the word “blame” out then we are basically in agreement.

5. We need a two-tier system, like every other civilized country on the planet (including the UK). This system is beyond bankrupt and all we are actually offering to patients is a place on a waiting list. Let’s just admit that two-tier already exists…… because it does….. and let’s move those dollars from Buffalo, NY, to Ontario!

   1. Good comment about 2-tier already existing, Jodie. Patients with means can make the trip. The poorest have to stand in line here. We can do better.

6. Hi Shawn,
   Yes it is me again…You write so eloquently and I agree with your blogs that is why I simply cannot understand your hypocrisy. You seem to criticise the system that you now support, You step over and then obliterate our lines in the sand (refusing to work with the LHINS for example). You congratulate yet another MOH in some hope that they are going to listen to you, to the oma to the doctors of Ontario, they will not. I am not sure if you are just trying to make it to the end of your tenure as president, or afraid to bite the hand that feeds you. Some of us doctors have been screaming into a void for 4 yrs, we have solutions but NO ONE will listen to us including the one organization we look to for support. We have been in a fight for our lives as physicians, advocates and even patients ourselves and have been patted on the head told to play nice and go back to your jobs. Vilified by the government and the public, reinforced by our OMA who have concentrated more on silencing us than getting us a contract.

   1. Yes, Sam Lamont, certain irony there to write about wanting to promote people who speak their mind without fear of ridicule, while at the same time OMA conjures up a “code of conduct” policy to enforce the sinister and mysterious concept of “OMA values”….. irony indeed!

   2. I understand your frustration over current affairs in the Ontario health care system and especially with how physicians have been treated. I believe that explains why you are lashing out at Shawn here. I also know that there are lots of others who are angry about the LHIN issue. This does not mean that Shawn supports the current system; in fact, I think this article, as well as other things Shawn has said and done, show the opposite.

      As frustrating as it is, outcomes take time. I am confident that there are changes happening at the OMA behind the scenes. If you have not read the articles in the January/February 2018 Ontario Medical Review, you should. I found the Message From The President and the explanation of Binding Arbitration very informative.

      I can feel your upset and I wish there was more to do quickly other than to suggest that you read these articles. Hang in there, Sam.

      1. Gerald I Goldlist, actions speak louder than words…

         1. That was my point, Sam: there is action going on, but you can’t don’t see the end results of it yet. I suspect you won’t accept that for now, but it’s the best I can offer.

            1. Thank you Sam and Gerry! Great string of comments.

               Sam,

               Clearly, you care deeply about these issues! That is fantastic. The opposite of love is not hate; it is apathy. You are certainly not apathetic! This is excellent and we need to sign you up, with all your passion, to help drive change.

               Your note was probably more appropriate for a personal email. I always appreciate your honesty, but Yikes! You said some pretty hurtful and untrue things. Because this is a public forum, I must try to respond; readers will want to know.

               So here goes:

               You said, “…I simply cannot understand your hypocrisy.” I appreciate you saying this in public. If you post it here, you probably say it widely to others, so I appreciate the chance to defend myself. It hurts. I disagree with you saying it. But I support your right to say it.

               You said,”You seem to criticise the system that you now support…” I’ve done around 200 interviews over the past 10 months and every single one has pointed out the need for change. Same thing with my Twitter feed. If anything, I’ve criticized too much.

               You said, “…You step over and then obliterate our lines in the sand (refusing to work with the LHINS for example).” The Board advised docs to not work with the LHINs in Nov 2016. At that time Bill 41 was just a bill. We had no Binding Arbitration. We were not negotiating. Now Bill 41 is LAW, and we are in BA within negotiations. Furthermore, 32,000 members were being harmed in negotiations due to the ‘no participation’ stance, HR work especially for northern communities was impossible to fix, and hospital MDs were finding it impossible to abide by ‘no participation’ and the need to get hospital funding. We had to move on and develop NEW tactics. Finally, the “Line in the Sand” was a motion by the SGFP (family docs) stating non-participation until we got a ratified physician services agreement (PSA). Now that we are in BA, we will never get a ratified PSA…at least not during the 4 years that the current PSA cycle covers. BA delivers rulings handed down by the Board of Arbitration, not ratified contracts that members have voted on.

               You said, “…You congratulate yet another MOH in some hope that they are going to listen to you…” The new Minister of Health has not done anything wrong, yet. It is always wise to be civil. We should hope for the best with a new person on the job. But even in my congratulations, I said that we have work to do. Hating every MOH just because they took the job will not get us anywhere.

               You said, “I am not sure if you are just trying to make it to the end of your tenure as president, or afraid to bite the hand that feeds you.” We are in Binding Arbitration. We do not have to beg with the government anymore. This comment is just hurtful hyperbole. I only comment because I want readers to know it is untrue.

               You said, “Some of us doctors have been screaming into a void for 4 yrs, we have solutions but NO ONE will listen to us including the one organization we look to for support.” I appreciate that you have been speaking up! Excellent. We all need to do more of it. I hope you have run for election and will help out. The “organization” is simply a group of us. The more we have people like you working in the ‘organization’ the more the organization will reflect you and your voice. We continue to beg docs to help out….and many do!

               You said, “We have been in a fight for our lives as physicians, advocates and even patients ourselves and have been patted on the head told to play nice and go back to your jobs.” I agree that we have been in a fight. And we have been fighting hard! I do not see anyone, in the last 10 months, getting a ‘pat on the head’ from the OMA. This is simply untrue. Certainly, I go out of my way to find and engage with passionate, angry, frustrated docs. I love them!

               You said, “…Vilified by the government and the public, reinforced by our OMA who have concentrated more on silencing us than getting us a contract.” Again, we’ve poured millions into getting a solid contract. And we are making progress through the painful journey of BA. It’s painful, but 100% better than before. No one is silencing you, Sam. I assume you refer to the Principles document being developed that outlines best practices for physician interaction. Most docs agree that we should try to treat each other with respect, especially in a public form. Respect, in this case, means trying to use basic, civil language (I don’t need to repeat some of the things that were said in 2016). Most docs agree with this. And most docs value vigorous debate, too.

               Again, thanks so much for your note. I understand your frustration. Your passion shows that you deeply care – this is EXCELLENT! I hope you can find fruitful ways to funnel your passion to drive change. There’s nothing more frustrating than being frustrated and not seeing any change for the consternation.

               Although it’s painful, I appreciate you giving me the chance to respond. Please send me an email to continue this conversation…you have it and use it regularly.

               Best regards and sincerely,

               Shawn

               1. I see a great career in politics in your future…
                  ‘nuf said’ Shawn 😉

7. The preservation of the sacredness of the concept of Canadian equality purports to ensure that all Canadians suffer equally.

   It is no good for a high-functioning overman to get his hip replaced any quicker than any other man. This would be a contemptible breach of the unassailable right to equality, the overman must suffer equally.

   But does not the overman’s suffering prolong all mans suffering?

   By allowing the overman to expedite his medical care, would that not strengthen mankind?

   Will it not happen anyway? An overman here, an overman there, a back scratch scratched back, the overmen grow, and laugh, and play together.

   The rights of the overman to expedite his care should be the same for all overmen. Money talks.

   The government only has so much to give…can we continue to draw blood from a log and not expect to be at loggerheads?

   When are we going to demand the ability to freely earn our living and rid ourselves of this soul-sucking government dependency?

   1. Thanks Nick!

      European universal care systems do not have the wait times we see in Canada. The public and the private arms both offer great access. That’s the whole point. We want better access for everyone.

      Our current approach creates poor access for everyone, expect those with enough money to fly south. Why don’t we look for ways to improve access for everyone by using the blended approaches we see in Europe?

      Thanks again!

      1. Hi Shawn,

         I agree.

         I did medical school in Australia, followed by part of an internship, and returned to complete 6 month locum just recently.

         I’m by no means an expert on their system but I can say they universal care, both public and private sectors, with patients paying into private health insurance plans for private care.

         The system is blended in the sense that a patient can get a referral to a private specialist by seeing a publicly funded or ‘bulk billing’ GP and there are intercommunications between both sectors.

         In fact where I did med school in a major Australian city, the public and private hospitals were right next to each other and connected by a bridge, a stone’s throw from the medical school.

         The private hospital was modern, clean, private spacious single patient rooms, prioritized access, state of the art technology, patients treated like valued customers, the kind of place I’d imagine if I had to hospitalized, and treated the way I would want to be treated.

         The public hospital, where we spent most of our time, was not so modern, rather more drab, but still capable, well-staffed, and never refusing access to care, never beyond capacity.

         Issues were more surrounding ensuring there was enough incentive for docs to work in the public system. to avoid the temptation of only private sector service for money, a natural inclination I suppose, my impression was wait times in the public system were similar to what we have here.

         This I can see being a challenge but not insurmountable, if common sense rules/regulations are put into place and the common-mans rights honoured and respected.

         The other thing I valued was competition insofar as it made care better.

         If as a GP your patients liked you and were willing to wait to see you, there was nothing wrong with charging a premium , say an extra $20-30 per visit ion top of what was ‘bulk billed’ to the government. In this way quality was rewarded, innovation incentivized.

         Similarly, much can be gleaned from blended Euro systems, and I think it would be great if you could direct me some literature in that regard, Shawn. This is a long overdue issue we really need to push, of course to provide better care for our patients, but also to sustain our livelihood.
         Thank you once again.
         Nick

         1. Thanks again, Nick. The anti-change crowd really hates the Australian system. Thanks for sharing your experience in it!

8. The answer, my friend, lies in simple solutions just barely out of our reach because they are not in our line of vision.
   Please follow my Health Twitter Talks….

   1. Thanks for all your work on your Health Twitter Talks, Joy! Excellent. Feel free to post a link to one of them here.

9. Is there a medical association or patient association that does not accept the premise of socialized medicine? The philosophy of “health for all” through universal health care systems is destroying the practice of medicine. The doctor/patient relationship with individualized care is now dominated by population-based health care. Principles and medical professionalism are being redefined to serve this purpose. Access to care is based on the government’s ability to pay and the whims of politicians and bureaucrats. The independent practice of medicine will not survive if it continues to give credence to the philosophy of Medicare.

   Medicare is an immoral and unjust government social program. Patients and doctors must fight for freedom not funding!

   1. Great comments, Heather!

      We can win the war of change by focussing on performance. Having said that, you make a great point. Even if there was a way to inject billions and create short wait times and better service, medicine would still wither. The foundation of medicine is the doctor-patient relationship. Everything in the state system seems bent on undermining that relationship. The relationship is the source of MD influence in the system. Whether it’s making docs run faster and faster or forcing them to spend more time with EMRs than with patients, it all makes medicine wither.

      Thanks again!

   2. We will never see dentists giving in to being “funded” by the government. Doctors sacrifice autonomy and professionalism for the security of getting paid most of the time, that pathetic A007. Seems like we are the dogs hanging around the trough where crumbs are dropped…… and now we have chains on our necks!

10. It is rather puzzling to see that the Evidence Based crowd is so silent on where our health care system itself is concerned ,which is not evidence based in the least….with even more non evidence based, but ideologically correct, initiatives being piled on…the “first do no harm” principles that should guide us all being thrown to the wind.

    There is evidence out there, good solid evidence from health care systems around the world of what works and what doesn’t… from systems that work and deliver to the satisfaction of all, that put our deteriorating and dysfunctional Canadian health care system to shame.

    The “blue pills” washed down by the ideological SJW koolaid who are driving our health care system over the cliff is powerful stuff.

    1. Interesting observation, Andris. It seems like only certain evidence is exciting enough to get discussed in some circles!

       1. “The smart way to keep people passive and obedient is to strictly limit the spectrum of acceptable opinion, but allow very lively debate within that spectrum….” – Noam Chomsky

          1. That should hang on the office wall of every federal and provincial health bureaucrat in Canada.

          2. I hate it when someone makes me agree with Chomsky 🙂

             1. Ha! Me too. Great quote, Gerry

11. Something is drastically wrong silence and/or fear of being shuned at the ‘Granite Club’?

    Since September 2011 untold ten’s of thousands layperson taught coma; cheyne-stokes respirations; cyanotic; miosis. Give chest compression’s only, they are doing this eagerly to anyone under orders.

    Professor Rube Goldberg is trying to reinvent the Glasgow Coma Scale patient should become hyper aware chest compressions.

    Pulse oximetry off the scale extinguish all sources of spark, patient is pure O2.

    Dean of Medicine ‘Trump University’ quote “Humans have evolved into house plants there fore hypercapnia is a very good thing.”

    Brain dead genius

    MOHLTC protocol compression’s only https://www.ontario.ca/page/get-naloxone-kits-free

    My letter ‘Flaws in Toronto’s Opioid Overdose Prevention Program’ EMN 2015; 37(12):31 With hyperlinks to Public Health Ontario’s training literature
    http://journals.lww.com/em-news/Fulltext/2015/12000/Letter__Flaws_in_Toronto_s_Opioid_Overdose.14.aspx

    Common quotes Pharmacists; EMS; MDs and RNs while crying “Gary I know they are killing any respiratory emergency patient with chest compressions and/or oxygen deprivation”

12. One thing that I think that every doctor in every situation that involves any discussion of pay or the cost of health care should be armed with is the full cost of delivering health care including all intraovernmental costs which are hidden or omitted from government discussions of the subject.
    Every such statement should be met with the actual costs including those of the Ministries including the present value of the lifetime earnings of the most junior and senior MOH employee at every meeting.
    I am pretty certain that the supposed percentage of health care dollars consumed by physicians would immediately drop by at least half if you look at it this way. I also think that people would be shocked to learn just how much those burocrats actually cost us when you count things like unfunded portions of indexed civil service pensions which, I believe, in Ontario is in the neighborhood of $500 million a year. I believe that the average starting clerk at the ministry ends up with a present cost of about $125000 dollars a year for a entry level job that it is essentially impossible to get fired from. We should never let any statement be put forth by the government without adding their cost back into the equation and publishing corrected figures. Also have the MOH advisors at arbitration declared the cost of them and their 1970s pension as a potential conflict of interest I’m fairly sure everyone else with that much money on the line has?

    I think if we make it clear and just how much money never leaves the government, and what it pays for, the public will very quickly decide where money needs to be cut from. I think we can assume that they would prefer it be cut from paying the unfunded portion of the 30 years of indexed pension that the person who changes addresses on OHIP cards receives than from the salary of the physician who can’t afford to practice in their community anymore.

    1. Brilliant comments, John. We have no idea where the money goes.

13. Well I know 500 million a year of it goes to pay for the unfunded portion of the indexed pensions of retired Ontario civil servants. I suspect that the general public might prefer that this be cut to waiting for surgery since all of them lost any similar pensions at least a decade ago. Guaranteed pensions were what bankrupted the big three car makers and would have bankrupted most industry if the government hadn’t helped them shed them. Perhaps it is time that the government did what everyone else did to avoid bankruptcy. I think that it would have very strong public support. Don’t you think that it is just a little suspicious that the people who receive these pensions keep pushing things that make it look like your cost is just the cash that you get every year.

    I think that they know that they have to lose the unfunded portion of their pensions and are making policy almost solely to distract the public from this. The recent policies only make sense if you look at it this way.
    The head of their union said that they would do “whatever it took” to keep them and I suspect that the economists in the ministry are very involved with the union. The OMA also has good pensions so I wonder if either side is really getting unbiased advice.

    Perhaps the OMA should executives and the minister and premier should spend a weekend together without their advisors and just agree to make pensions guaranteed contributions and use the extra money to pay for health care and the same for us.

    Servants should not be better paid than those who pay them. Honestly if they went on strike they could likely be replaced by just a few temporary workers and things would be even better.
    There is simply no need for anything but a federal ministry of health so why do we permit unnecessary people to take most of the money

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