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?

Thursday, March 23, 2006

More on Trust Worthiness

Since doing the blog the other day on trust I have been troubled. This whole trust thing is actually quite complicated. It occurred to me that the measure of trust seems to be, in some way related to the consequences of being wrong in our judgment to trust. If that be so, the fact that firefighters are number one is quite significant, whereas, farmers being in number three position, is not very significant. After all, if I trust a farmer when he tells me it’s not going to rain tomorrow and it does, I may simply get wet. If I don’t trust a fireman who says my building is on fire and I should jump, I may burn to death. So trust seems to have something to do with “consequences” if you are wrong.
Somewhat related to this is, we will trust something to someone if we have the expectation that the information will be acted on appropriately and action will results in some benefit. In brief, the person you trusted can help you. This will depend on two things: 1) Does the person have the will or motivation to help? 2) Does the person have the power to help?
Perhaps in retrospect I have been too hard on the medical profession in my “Trust” blog. the other day. Although the consequences of medical decisions is right up there with the firemen, there is no question in my mind that we as physicians, are not as empowered to help as we once were. This is particularly true of primary care physicians who basically have to abide by what is available (almost a first-come first-served principle, and our perception of our insignificance in the system). Yes, I know that the political powers say their priority is primary care, and then they say, in the same breath, that they intend to push (and are pushing) Primary Care Networks, nurse practitioners, pharmacists, physiotherapists, and many other healthcare providers as the person of first contact in our Medicare System. Will we as patients give all of them our trust? My experience is normal patients are inclined to develop confidence in primarily one person with regard to their health, and not an establishment. They may develop a “high regard” for the establishment, but it is usually because of one person in the establishment, and secondarily, to other contacts. Without patient’s trust and confidence, I will predict the patients will be high health care consumers in our new “vision” of primary health care.
As a consequence of not having the power to help, many Family Physicians have lost their motivation to help. It is difficult to get over the feeling of ‘What’s the use” and “why do I have to push so hard so often to make the right thing happen”? I recall saying to my patients that it often seemed like pushing a boulder up a hill, and when you stopped pushing, nothing happened or you lost ground. I truly feel that many physicians have taken the “human” path of least resistance in order to just get through the day. And caring can be a serious handicap to survival.
Politician’s decisions can certainly affect our lives, so our trusting them can have serious consequences. They definitely have the power to deal with the issues we bring to them but sadly, I feel they don’t have the motivation. They seem to listen to the loud voices of special interest groups, and do poles on how to get elected. I guess that’s why I and about ninety percent of the population of Quebec don’t trust them.


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