The election for President of the Doctors of BC is underway and voting closes on May 15. But who cares about medical association politics?
When doctors lift their weary heads from patient charts, they can feel heavy discouragement about increasingly complex patient needs and the acute-care-built health system that increasingly struggles to meet them.
Many of us also feel a fervent energy for change: our health system is ripe for transformation and we feel the urgency and the motivation to speak up for better patient care. There is promise in team-based care; shared care between specialists, family doctors, and other health care providers; caring for patients at home rather than in hospital; universal pharmacare, and comprehensive mental health services – the list goes on. Harper’s government gave us little opportunity, but momentum has shifted and we will gain more as provincial parties make election promises in 2017.
We have shared frustrations, and a diversity of values and opinions about how to fix them. Debate and conflict is a symptom of diversity; if we listen to the diversity we can pull together rather than push apart.
But polarities are sticky, represented again as opposing voices in the Doctors of BC election this year. Canada’s champion for expanding private-pay, for-profit health care delivery, Dr. Brian Day, is up against another equity champion, rural GP Dr. Trina Larsen-Soles, who practices obstetrics, ER, oncology, hospital care and teaches in the public system.
“Fighting” for privately-funded, for-profit health care offers hope for some. If we are feeling fed up, it validates our anger. It is easier to set up camp in a solution that offers hope than it is to pause in the frustration long enough to learn from it. In this idealized camp of the clear-cut solution, we save ourselves the frustration and anger that brought us here. We are comfortable believing simplistic arguments that for-profit clinics can take the pressure off public wait lists and we ignore evidence that indicates the opposite.
Fighting also backs us into the corner of our polarity. Dr. Day’s lawsuit against the BC government will go to court this September, as he seeks the right to bill patients for care they already pay for through taxes – a great business opportunity with great momentum. How can he effectively work with government to shorten waitlists when he is embroiled in a lawsuit with them?
The inevitable polarity of a lawsuit precludes engagement in reform of public health care services. Rejecting these much needed reforms is at the heart of his lawsuit, and yet there are lessons from all of our practices – Dr. Day’s included – that could inform meaningful, and more equitable, publicly delivered service improvement. But Dr. Day threatens to discredit doctors who advocate for public health care reform, accusing them of “attacking the rights of patients”.
People unite through anger and opposition, although rigidity and conflict are the opposite of innovation and collaboration.
A basic principle of conflict resolution is that common ground often exists underneath the conflict. Conflict will perpetuate until we look under the surface at what underlies it. To do this, we must get out of our corners, step onto common ground, and know the problem with depth and scope before proposing solutions.
In this old “public-private” health care debate, both sides agree that the delivery of health care services in BC is flawed and needs repair.
Both sides are devastated when patients fall through the cracks. Both sides know that health spending has not kept up with population growth and inflation, and gaps and flaws in the public system persist. Both sides know that the poor and disadvantaged will not benefit from the diversion of scarce public health care resources to for-profit health care facilities. Both sides know that private payment for health care services is profitable for doctors (and insurance companies). Both sides know that autonomy and independence are motivating.
The tormenting itch felt by both sides is the desire for innovation.
We don’t need to argue that the health care system has flaws and that we need improvement and reform; we agree on this, and need not create conflict where there is none. In their election platforms, Dr. Larsen-Soles and Dr. Day both describe with equal fervor a health care system that will not survive in its current form. However, their solutions differ, as we vote again for equity vs. private-pay.
But more importantly, let us vote in this election (and every election) for collaboration, not conflict. We need to find space in the system for the creativity of doctors and patients, and consider solutions from our common ground, rather than from islands of polarity, and from the ground up, not only from the top down. Divisiveness and fear-mongering – familiar remnants of past regimes – do not serve us. At the heart of collaboration and innovation is speaking honestly and abandoning fear.
We need leadership for overdue health reform that will enhance conversation, not conflict. We must remain in conversation, speak and listen, and honestly declare what informs our point of view, so that we can learn from all of it. If it is profit, then it is profit; that doesn’t mean there isn’t also motivation for innovation there too. But we cannot learn or collaborate when we are hiding, either from our truth or in the comfortable camp of our polarity.
Finally, let us learn from what has worked and what hasn’t in health care reform, and look at, not turn away from, the evidence. It is our professional responsibility as doctors to do so.
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