Bill 11: the quality of care rather than the flow, pleads a doctor

“It’s sad. ” The D^D Marie-Hélène Marchand is worried about her patients at the end of their life. She fears the effects of Bill 11 on her vulnerable clientele. “If I am forced to work more to offer time slots to populations in order to see them quickly in 36 hours, it is less medical aids to die that I am going to do, less home care, less care. palliative in hospital less. “

The conciliatory tone adopted by the Minister of Health, Christian Dubé, Thursday did not reassure her. The government’s rhetoric, she said, has remained the same since Bill 20, which sought to impose financial penalties on physicians who fail to meet productivity targets. “We ask family doctors to work more, assuming that it is because they do not work enough that we have a problem of access to the front line, denounces the D^D Trader. It is insulting. “

At the time of the interview, the D^D Marchand had 30 patients enrolled. The reason is simple: the patients she follows die quickly. She accompanies them towards death. “I do not register them each time at the RAMQ [Régie de l’assurance maladie du Québec], she says. If I arrive and the person is dying, I will not ask them to sign because there is a paper to be signed. “

If she is forced to take on more patients, she fears that vulnerable patients will be left on their own and end up in the emergency room to take their last breath. This is already happening, she laments. People with advanced cancer, who were discharged from hospital, see their condition deteriorate suddenly. “The patient cannot go to a clinic because he is too weak. He comes to the emergency room, and there he comes to die in the emergency room. Sometimes we don’t have time to find them a room [privée] for it to be human. “

Risky quotas

The D^D Marchand considers the target of 1,000 patients per doctor mentioned by the Legault government to be a “form of interference”. “According to our code of ethics, we, our only boss, it’s the patient, she said. It’s not the flow [qui importe]is the quality of care we offer. “

According to her, imposing treatment quotas on new doctors threatens the expertise developed by family doctors – in end-of-life care, drug addiction and sports medicine, for example.

“We have residents who do an extra year in palliative care to gain advanced skills. They too are subject to MPAs [activités médicales particulières, c’est-à-dire des tâches imposées par le gouvernement]. They find themselves dividing their practice between palliative care and something else. Sometimes, they even have a hard time finding positions in palliative care ”, deplores the D^D Trader.

However, about fifty Quebec doctors have an exclusive practice in palliative care, she estimates. “We are so few that we have a hard time placing our students on an internship,” she said. We must keep in mind that we must ensure a succession. “

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