Are doctors knights, knaves or pawns? Are they altruistic agents devoted to public service? Selfish conniving opportunists? Or hapless dupes, lacking agency or judgment? Are they conflicted villains?
Societal opinion dictates whether government policies are permissive, punitive or prescriptive (see JAMA article – 1st page only “Societal Perceptions of Physicians – Knights, Knaves, or Pawns?”). Opinion polls place doctors as valued members of society. But opinions change faster than fashion.
The British Economist, Julian Le Grand, discussed this in his book Motivation, Agency, and Public Policy: Of Knights and Knaves, Pawns and Queens
The JAMA authors write:
“Le Grand’s work on post-World War II British social policy found that perceptions of human motivations gradually transformed, with the prevailing view of the typical British citizen morphing from knight to knave as the costs of maintaining an expensive welfare state increased.” (JAMA)
Knight – one on whom the dignity of knighthood is conferred because of personal merit or exemplary service to country
Knave – rogue, scumbag, lowlife
Pawn – a person manipulated or used to some end. A puppet, tool or dupe
As money runs out, perceptions change.
Do doctors have a vision for healthcare? Do they know how to improve things for patients? Does anyone have a vision?
Healthcare uses up almost ½ of Ontario’s budget. Still people cry out for even more coverage (e.g., drugs). The system will fail without significant change.
Options:
- More public monopoly (more accurately, monopsony )? More taxes? User fees?
- Insurance driven (expensive) employee benefit plans? Like USA?
- Out-sourced public offerings? More private management of the government monopoly?
- European approaches? Everyone, except North Korea, allows citizens choice. Is it un-Canadian?
- Public system with wait-time guarantee (i.e., government pays for care out of state if state can’t provide service)?
Doctors need to develop opinions about options. They need to speak with patients and local decision makers.
Le Grand’s comments aside, what doctors say and do drives societal opinion of them. As we run out of money (Ontario Will Eventually Have to Pay the Piper, Globe and Mail), what will physicians do? What do doctors envision will improve the system?
If you work in healthcare, what’s your vision? If you’re a patient, what do you think needs to change?
Physicians have a choice. Come up with a positive vision to benefit patients or get bulldozed by policies based on societal perception of you as a pawn or knave. What will it be?
Do doctors have a vision for healthcare? Do they know how to improve things for patients? Does anyone have a vision?
Shawn…..important questions. I believe physicians should have greater leadership in hospital policies and leadership. Hospital admin. and doctors seem to work from vastly different agendas. The much touted hybrid health system appears to be years away as we see zero momentum from politicians for such a system. U.S hospitals suffer similar disparities…arrogant/overpaid hospital executives with docs having far too little impact. Hence specialists opening 20-40 bed specialist hospitals.
Canadian patients will suffer more as govt reduces services to reduce costs. Doctors will have more difficulty during their
negotiations going forward…sharing the pain. So if you don’t make your voices heard ….nothing changes for you or patients.
I only wish everyone were as informed and interested as you, Don.
I agree; it will get worse for patients and providers if government insists on more of the same.
I struggle a bit with ‘hybrid’. What exactly does it mean? We have a blended system now with Workers’ Compensation (WSIB) paying cash for MRIs sooner than Medicare patients. MPs, prisoners, RCMP, military and others all live outside of Medicare. Finally, those who might otherwise be exercised about changing the system usually have the means to purchase care outside the country; they don’t get excited about Canadian Medicare.
Maybe it will go like this. Medicare will get worse and worse until it’s clearly only catastrophic insurance because everyone will be purchasing their MRIs and elective surgery in the USA. The challenge is that chronic care still has only one realistic option: Medicare. I suspect as more Boomers get into the chronic care cohort we will see them demand options besides the government queue.
Thanks again for taking the time to read and comment!
Cheers
Shawn
Hello Shawn,
I follow your installments regularly. I think they are absolutely amazing, and agree wholeheartedly with the direction you are taking.
I wanted to suggest an alternative view to the timeframe for doing an “annual physical” that you quoted in your most recent blog.
Please don’t get me wrong, I don’t want to underplay what we do, but I don’t want others to pick apart the comment, suggesting that it is falsely inflated to support our argument. Having spent over a decade on the Section on General & Family Practice, and at least two years as chair of the Section’s tariff committee, I would suggest that stating an annual physical is taking a full hour may well be open to criticism. I’ve discussed this with a number of members in the past and have received answers for time frame ranging from 20 min. to 30 min. to 45 min. I don’t recall in recent time hearing of anyone quoting one hour for a physical and have rarely heard the figure of 45 min. quoted for a physical.
I might respectfully suggest re-adjusting the comment to state that a typical periodic health exam usually takes (on average) between 30 to 45 min. (and even that I think be a generous number.) Please take this for what it is worth, it is just an observation.
Keep up the great work. These blogs are absolutely great!!!
David
David B Bridgeo, MD
Family Doc, Windsor, ON
Thank you SO much, David! Excellent comment.
I will update the post forthwith.
I sure appreciate you reading and writing!
Highest regards,
Shawn