Physician-centred health care

Diane_photoDiane Kelsall is Deputy Editor, clinical, at CMAJ, and Editor of CMAJ Open

 

As clinicians, we are taught about patient-centred care, where the needs and desires of the patient are foremost. For those of us who work as medical teachers, we are told to focus on the goals of our students in a learner-centred curriculum. We work in multi-disciplinary teams in hospitals and clinics, where it seems, at the very least, paternalistic for the leader to be a physician.

Some of our traditional roles have been taken over by other health professionals—and we are often told that they provide the same or better service at a lower cost. Administrators and other health professionals run the hospitals and clinics we work in. Few doctors are in leadership at the government level, even for decision-making related to health care.

We are frequently blamed for rising health costs, and some of us are not welcome at the bargaining table where our own remuneration is discussed. People may view us as greedy or, increasingly, as lazy and not willing to sacrifice for the greater good.

Somehow over the years, things changed from the physician as “god” to the physician as No Good.

Why did this change happen? Could it have been a reaction to our casual assumption of money, control and entitlement? Or maybe our failure to play well with others? Did we destroy the mystique around our profession when we abandoned our white coats in favour of casual clothes? Perhaps it was when women entered the profession in large numbers? Or was it simply that health costs began to spiral out of control and a scapegoat was needed?

Few of us would wish to go back to the times when a patient may have been kept ignorant of a cancer diagnosis for “his good”, a nurse had to step back to allow a doctor to go ahead through a door, or throwing surgical instruments across the operating room was condoned.

But surely there must be room for us—a physician-centred place—in the health care system.

There is such a place. That place is Medicine. And we are the experts, the only experts, in this millennia-old discipline. From its early days in ancient Egypt to the heady promise of gene and molecular therapy, the medical profession has advanced—and society has benefited.

Because of the life’s work of physicians over the centuries, we have a greater understanding of the human body and mind; what can go wrong and how to fix it. We now know that that cancer or diabetes or an infection does not have to be a death sentence. Indeed, the blind may see and the lame walk; some may even be raised from the dead.

To be able to do this work, we study for years (in some specialties for more than a decade)—and then we keep on studying to maintain our skills in the discipline where we are the experts, the only experts. There is no one else.

Because when patients are sick - really sick - they need a doctor. Yes, the doctor needs to be part of a health care team that works together. And yes, the doctor needs to respect the contributions of others and recognize the importance of involving the patient in his or her own health care. But a health care team without a doctor is missing expertise, expertise that can literally mean the difference between life and death, between illness and health.

But even when patients are not at death’s door, we bring our expertise to bear in addressing their current health concerns—major and minor—and work with them, in conjunction with our colleagues, towards a healthier future. We can listen, we can examine, we can diagnose, we can treat—and perhaps even heal.

Sure, we have made mistakes (big ones, on occasion) but, for the most part, we have tried to make the lives of our many, many patients better. People live better for longer, and are healthier.

And as such, we have earned the right to be key players in our health care system. At all levels.

We need to be included at decision-making tables—to participate as essential contributors. From the individual clinic to the hospital to government. Locally, provincially and nationally.

If health is the issue, we have the right to be there. To speak, to share our expertise—and to have our contribution respected. We need to be heard, along with the voices of our patients, our fellow health professionals and others.

To improve the health care of all Canadians, we, as doctors, need to be in our rightful place.

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