We hear repeatedly about the cost of the health system, always referring to the billions spent. Again and again, governments and unions, negotiation after negotiation, address the problems relating to the said system according to the power of money and especially according to the power over health held by the different actors in the system. Let us have no illusions, this is a fundamentally corporatist power struggle influenced by public opinion, itself subject to an image “war”.
As in all Hollywood fiction, what is the “casting” of a possible “Top Gun health”? For what…for who exactly? Wage war by proxy or make peace at all costs? On what paradigm is the Santé Québec agency based?
In the current paradigm, it is the masters of money and time who are invited in the film Heal me doctor. But, in this reheated film, the union rhetoric is always the same: “Pay us more, we’ll give you more.” » The reality that we refuse to name and which is implacable is that “the more we give you, the less you give”. The reason is simple, but paradoxical, because giving more is to the detriment of your quality of life and your own health: you doctors, nurses and the many others. This is the price to pay for clinging so much to your power over medical procedures!
To get out of this paradox, it is necessary to change the paradigm. Who has the most effective power over “health”? Paradoxically, it is those who act on healthy lifestyle habits who have more power over “health”. But they have little power over money. For example, I listened to the president of the Quebec sports federations deplore the seven million allocated to the Los Angeles Kings for a weekend of practice, while all 68 sports federations receive the same amount, but per year! What about the financing of other actors who act in prevention: psychologists, nutritionists, music therapists, infrastructure managers, etc.? ?
Furthermore, since the “biggest” problem in the health system is access to primary care, is the current “emergency-hospital-doctor-nurse” paradigm appropriate? Once again, during the last negotiations, this old management-union couple made us watch this old “money for time” film again. Do you think it will work? Of course not !
Now let’s talk about real power during a real emergency. It’s 2 a.m., you feel a terrible tightness in your chest, you’re sweaty… you call 911. Seventeen minutes later, paramedics take charge of your case. They take your vital signs, do an EKG, measure your blood oxygenation and decide what to do next. The same goes for your child in respiratory distress.
Who has the real power at this moment? These are the paramedics we pay $26 to $34 per hour. Just like police officers and firefighters, 24/7 hours are part of their “job”. Why then not change our paradigm and create a first line of home visits based on paramedics? Don’t they already have the competence for major emergencies? Why not extend their skills to minor emergencies? And why not, if necessary, put them in line with a pharmacist or doctor and prescribe the antibiotic or medication capable of relieving minor problems such as ear infections or fever?
At the time, the doctor came to your home. Why, always the hospital, the clinic? Why then not relieve doctors and nurses of these hours and congestion that they cannot cope with and adequately pay the workers of a mobile first line? Why not reserve the hospital emergency department for real emergencies and the GMF for family medicine?
So, telemedicine teamed with a field paramedic technician would have so many benefits, particularly for the aging population and for access to the front line for emergencies, whether minor or major. The 811 dispatcher will then determine if an ambulance or a drive-by paramedic is required.
Whether we like it or not, to get out of a paradox, we have to change the paradigm.
The one I am proposing is perhaps not the right one, but please “let go” for the good of the orphans of a family doctor, like me, and the good of all those who are waiting for surgery, of a deficient child waiting for a professional, and of all those who suffer, abused by a sclerotic system. Looking forward to a health summit to discuss PPP: Powers, paradoxes and paradigms!