Monday, August 29, 2016

So You're Saying We Need A New Approach?

The wrong answers to the wrong problems continue to be brought forward.

It's been two weeks since Ontario's doctors sent a pretty clear message that they had no interest in playing nice-nice with the Wynne Liberals. In fact, the doctors just aren't into the Liberals anymore - if they ever were - and are looking to hook up with Patrick Brown's Conservatives (though Brown's recent unforced error on sex-ed might prove a deal-breaker for some).

There's still a lot of sniping going on, particularly on Twitter, and the post-mortems are still rolling in. There's been significant upheaval in the OMA leadership, albeit a predictable one, given the crisis in confidence expressed by the vote against the fee deal. And a renewed interest in the age-old question of whether family doctors and specialists - the "have-nots" and "haves", respectively - should get a divorce and negotiate for themselves.

Naturally, we're also getting some good-old-fashioned Policy Punditry, in particular this piece from the Toronto Star making the social media rounds:

It's worth taking the time to read, largely because for all its OECD-referenced insights, the problems the authors look to solve have almost nothing to do with government-doctor relations. 

"How many of us have been stuck in badly managed waiting rooms, being made to feel that the attending doctor is doing us a huge favour? Or have eyeballed patient records stuffed on a shelf behind a receptionist? Or dealt with a surly scheduler, trying to get a same-day appointment with a sick child in tow or to find out if a specialist referral has been submitted?"

Breaking down the list of complaints laid out by the authors, we find the following:

1. ER overcrowding: as I've argued elsewhere, and others have done for twenty-odd years, this is an issue of under-investment in long-term care (or, I suppose, inpatients not dying quickly enough, but that's a little too morbid a thought for the end of summer).

2. Cranky doctors: a cranky attending physician is not cranky because of his or her pay. It's because of burnout, the doctor's own personality (that might very well be mismatched to medicine), unsupportive administrators, and the stress of managing patients that need admission to beds...that are already filled. (see #1)

3. Paper charts: the move to full electronic records has been abysmally slow, but as anyone that works with them can tell you, electronic records create as many headaches as they supposedly fix. We're far enough along that it's senseless to go back to paper, but any promise of efficiency arising from electronic records is clearly a false one. 

4. Cranky receptionists/clerks: have the authors of the article ever worked in a medical clinic or hospital? The clerical staff catch crap left and right, up and down, hour after hour. It's like working the counter at McDonald's with the added responsibilities of a call centre operator rolled into one. It's frankly a miracle there isn't an epidemic of medical clerk suicide.   

The policy direction offered - rethinking how doctors are paid - is surely worthy of debate, but there's little reason to believe that a new pay structure for MDs would improve upon any of these problems. Shifting doctors to salary, like the UK's NHS? The same NHS that has just as many problems as Canada's health care system, including worsening budget constraints, and labour unrest from doctors? That's the answer?!? 

Next time: How to think about health care reform

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