Medical Professionalism Matters to Me
 

 

 

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.