In rich countries in general and in Quebec in particular, the health network is like a barrel of the Danaides. No matter how much we fatten it up, finance it and extend it, it loses everywhere and is never enough for the task. Everyone wants to go to heaven, but no one wants to die, they said yesterday. Today, when we almost no longer believe in heaven, we want to die even less and we count on doctors, who are increasingly inaccessible, to save us. We therefore have fragile physical and mental health.
Does this problem have a solution? The various political parties compete with proposals in this area. The Coalition avenir Québec is counting on the idea of front-line access counters to make care, rather than doctors, accessible. The idea is good, but remains to be implemented. The Quebec Liberal Party has been making the same promise for twenty years: a family doctor for every Quebecer. Who still believes it?
The Parti Québécois and Québec solidaire (QS) are proposing to make CLSCs the gateway to the system and to reduce the private sector – clinics and health care agencies – to better coordinate the entire network. Excellent ideas, just like the one from QS to found Pharma-Québec and establish an entirely public prescription drug insurance plan, but we can already hear the resistance rising, fueled by the proposals of the Conservative Party of Quebec, a supporter of more private health.
I don’t know which of these proposals will prevail in the coming years, but one thing seems certain to me: they will necessarily create dissatisfaction since, in this area, in essence, demand will always exceed supply.
This fatalistic observation should not, however, lead to resignation. It remains possible, despite everything, to do better than what we are doing now. It is in this spirit, lucid but voluntary, that the emergency physician Alain Vadeboncoeur subscribes by publishing To take care (Lux, 2022, 148 pages), a short essay which, in order to breathe new life into the Quebec health care system, sets itself the task of “proposing orientations without falling into utopia”.
The proliferation of major administrative reforms over the past fifty years has not worked miracles and has above all caused confusion. Let’s act, says Vadeboncoeur, but with caution, by making modifications and changes in mentality likely to improve things.
First observation to remember: the network suffers from a “human deficit”; it lacks doctors, of course, but also nurses, orderlies and staff in all categories. Filling this gap will be expensive. Courageous, Vadeboncoeur does not hesitate to write that, to achieve this, it will be necessary not only to put an end to the irritants of compulsory overtime — which drives staff away — and the use of personnel from healthcare agencies — a solution which claims to solve the problem it causes — but also pay doctors less to get more.
In this regard, we must deplore the race for tax cuts that characterizes the current election campaign. “For a province that is crying out for health funding from Ottawa, let’s say that the message is equivocal”, rightly noted columnist Emmanuelle Latraverse in The newspaper from Montreal from August 30th.
There is another urgent need: getting the right care from the right caregivers. Is it normal that I need to see an ENT to have earwax removed from my ears? That healthy children be called to the pediatrician for a simple follow-up? That doctors in private practice are still wasting time with annual health check-ups offered to healthy people?
As citizens, we also have our share of responsibility. Our panic fear of serious illness often pushes us to consult unnecessarily at the slightest minor discomfort and to demand tests and blood tests whose medical effectiveness has not been proven in a preventive logic.
Our obsession with screening, fueled for decades by fearmongering medical discourse, clogs the system with no health benefits except in people with risk factors or real symptoms. Those who doubt it should read, to convince themselves, Overdiagnosis (PUL, 2012) and The last of the healthy (PUL, 2008), solid essays on the question respectively signed by the American doctors H. Gilbert Welch and Nortin M. Hadler and brilliantly relayed, in Quebec, by the late doctor Fernand Turcotte.
Vadeboncoeur, with good reason, fears the great promises of health system reform, which are too good to be true. His proposals, many more numerous than those presented here, may seem too modest, but they have, in addition to courage, the merit of feasibility.