What's Wrong with Healthcare?

Thinking inside and outside of the healthcare box. After 41 years of family practice, what's happened to Canada's healthcare system?

Wednesday, February 15, 2006

Normal Living Creatures Move to Comfort

It never ceases to amaze me how people who work 35 to 40 hours a week can pass judgment on physicians that work 60 or more hours a week. I had the occasion to sit on some committees that had as members, representatives from the Alberta College of Physicians and Surgeons during my “administrative” years. The committee that particularly stands out in my mind was one that was to look at and outline the health region’s responsibility to the physicians in the region, and the physician’s responsibility to the health region. The position of the college was that “ethical” physicians must provide the region with sufficient “on call” time in all areas, to serve the needs of the public that depended on the region.
So I proposed to this college representative a scenario in which a remote town in Alberta had five family physicians that provided on call services 24/7. One of these physicians dies. Shortly after this, another physician develops a disabling disease and has to retire. This now leaves three physicians looking after the same population that previously was being looked after by five physicians. Subsequently, one of the remaining physicians has a mental breakdown. Should the remaining two physicians still provide the services and care that five had previously? Are they unethical for drawing limits for themselves so that they can perform well? Is the college condoning physicians who are providing services at a time when they are totally exhausted? Are they serving the needs of the patients or the system?
I recall assisting an obstetrician with a caesarean section one morning. He was an excellent surgeon who enjoyed woodworking as a hobby. When he made his incision through the skin of the patient, there was an immediate ooze of blood (usual scenario) which obscured his vision. Before I was able to swab this away, he bent over the incision and attempted to blow it away (with a mask in place on his face) the way a carpenter blows sawdust away from his “marked cut lines”. The nursing staff had not noticed but he knew I had. Fortunately, everything went well with mom and the baby. After the procedure he told me that he had done several surgeries, delivered several babies, and seen an office full of patients in the preceding thirty six hours and was heading home to bed.
What is the college doing to prevent physicians from working when they are exhausted? I would think that the least they should do is support physicians when they restrict themselves to the activities they feel competent doing, and work hours that would maintain their competence.
I recall being at a “Medicare” rally with my seventeen year old daughter many years ago. The guest government speaker spoke out strongly in favor of our system and pointed out that our monopoly system should be credited with many things including doctor’s surgical fees being 1/3 of those in the United States. My 17 year old daughter whispered in my ear: “Yes, but they are missing a great opportunity; they could conscript you and pay even less, or get your services for free by making you slaves”. I was amazed at the insight of one so young when our elected wise “men and woman” (our provincial and federal MLA’s and MP’s), and a room of 100+ adults, didn’t see where things were headed. It was shortly after this event that Canada started to see the migration of our family physicians to the U.S. This migration subsequently cost Canada thousands of doctors and nurses. It wasn’t about the money, either, as many socialists maintain. It was about valuing our freedom and the U.S. valuing us. It was about not being “owned”. Remember, all normal living creatures move to comfort, and most normal living creatures feel more comfortable with freedom.

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