Medicine and Professionalism. Justice for all.

   I have often wondered why so many physicians who have become 'administridiots' seem to become unreasonably critical of their erstwhile colleagues. Instead of showing more understanding for their fellows in the trenches, they seem to become resentful of them. Perhaps that is to justify their own abandonment of clinical practice. Ontario has treated its physicians in a disgraceful way, one in which most segments of society would not put up with.   The reasons for physicians inability to deal with such political situations is exclusively due to their sense of responsibility and obligation to their patients.  However, no relationship can be entirely one-way and unfortunately, for the most part, that is what it has become.  Administridiots are constantly writing codes in that direction but rarely regarding patient behaviour.and on occasion, abuse.  Physician administrators show no more insight than those with no medical background.
   A Dean of Medicine I once knew and admired said to me: "I'm sure that most of the department heads (a position with a significant administrative role) around here would never see another patient again if they could avoid it." I think he was right. Most of the department heads I have known, and I have known many, have continued seeing patients a half day a week mainly because it was necessary to maintain their credibility. Department heads are the leaders in medical education and attitudes. So medical administrators with an M.D, degree, are less likely to make recommendations that benefit the health care system and both health care professionals and patients.
   Now here is an outrageous Canadian Medical Association post on March 15th 2016 by Dr. Louis Francescutti,a former CMA President:

 
"Now here is a rather radical idea!
If implemented properly and with conviction, this idea will not only immediately improve physicians’ morale and increase their sense of engagement, it will also measurably reduce patient error, virtually eliminate waits, improve access to specialist care and save governments millions of dollars. This elusive dream is a reality if we want it.
The solution, as unappealing as it sounds, is rather simple.
We, as physicians, need to stand up and accept responsibility for what is going on in our dysfunctional health care systems across Canada. If we won’t fix the problems, who will?
At the individual level, we need to hold each other to account for our actions and inactions. The easiest way for this to happen is for all physicians to be in salaried positions on one-year contracts that can be renewed if they continue to meet performance standards.
The peer-review processes that are used to evaluate an individual’s performance from the time they apply to medical school to the time they finish their residency training unfortunately tend to end once they enter practice. Most of our professional practices are not reviewed by our peers, and this needs to change. Peers should review each other quarterly and the results should be made public. We need to measure the quantity and quality of physicians’ work, the outcomes of their work and their adherence to standards of care. As part of the evaluation process, we need to ask patients whether their physician is available when they need him or her and whether their physician treats them compassionately.
When someone realizes that they are now expected to meet a meaningful accountability standard, they will change how they do things for the better. If they are unable or unwilling to meet the standard, a difficult discussion will need to take place when the one-year contract comes up for renewal.
At a broader level, physicians need to take responsibility for designing a health care system in which patient-centred care is not just a slogan but a reality. Injuries do not happen only between 9 a.m. and 5 p.m. on weekdays, and diseases do not respect the clock. This redesign needs to be supported by a new data analytical infrastructure that rivals that of financial institutions or Federal Express. We need to start measuring and managing change, and we need to impose consequences for wasteful practices.
Increasing the accountability of physicians sounds simple and logical. Now here is why it so difficult to do. For starters, why would any provincial medical association support the notion of greater accountability for their members? They say all the right things (“The patient comes first”; “Our members are accountable”) but a quick reality check tells us otherwise.
In his 1890 painting The Doctor, Sir Luke Fildes portrayed a Victorian GP pensively watching over a dying child on a makeshift bed of two mismatched chairs in the middle of the night while his parents watched from the shadows. The doctor’s compassion for his patient is clear. But is medicine still a compassionate profession today? A 2013 Ipsos Reid survey found that only 35% of Canadians thought their physician was compassionate, a 30% drop from 2003. Really! Where is the profession heading? According to the same survey, the public also thought we were less hardworking, less well-educated, less dedicated, less trustworthy, and less up to date on recent developments in medicine than in the past.
A recent Commonwealth Fund report was equally damning: Canada’s health care system was ranked at the bottom of the countries examined.
So what exactly are we getting in return for the $225 billion we spend annually on health care in Canada? Your guess is as good as mine. Accredited facilities are harming our patients at alarming rates, so much so that we need new patient safety institutes. Everyone is jumping on board the safety train, with good reason. Recent estimates in the United States peg the death toll from medical errors and misdeeds at over 200,000 patients per year. In comparison, 33,000 people die annually on American roadways. What are the numbers for Canada?
The Institute of Medicine reported that almost 35 cents of every dollar spent on health care in the United States is totally wasted as a result of unnecessary services, inefficient delivery of care, excessive administrative costs, inflated prices, prevention failures and fraud, to the tune of $750 billion per year.
We develop cleverly crafted campaigns with slogans like “Choosing Wisely.” What on earth have we been doing up to now?
Our health care system is in urgent need of change. If we continue to leave the responsibility of improving the health care system to others, we will wait a very long time for effective, sustainable change to happen because there are so many vested interests involved. You want to improve the care systems we work in? Start holding the real power brokers, your fellow physicians, accountable and watch things change. As Dr. Aidan Halligan, a brilliant physician and dear friend who passed away too early, said repeatedly, “What you permit you promote!”
Let’s stop being satisfied with the status quo and start promoting a greater sense of calling to do the right thing.
As the Governor General of Canada told the profession at the October 2012 Convocation of the Royal College of Physicians and Surgeons of Canada, society is fed up with our profession looking after our best interests and is about to rewrite their social contract with us. Let’s get to work and restore Canadians’ faith in us."

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   I think this clearly puts Dr. Francescutti in the 'administridiot' category.
   The CMA should be ashamed of itself for failing to comment on this disgraceful biased Orwellian op-ed until after the event.  Unfortunately, they do not understand what 'professionalism' is.