“External ambition is conditioned by a kind of despair or abandonment of inner ambition. This quote from Paul Valéry has always been in my head, not really knowing what interpretation to give it. It does, however, have meaning when viewed through the lens of the health system, to which the ambition is attributed to offer the best care to all. This has never been so far from reality, in my opinion.
In particular, this is explained by the different, even divergent, interests that modulate the activity of the health system. Domestic ambitions, those of interest groups, seek to favor their needs. Oncology, cardiology, pediatrics, mental health, union representation, and so on. In fact, each group considers that it does not derive enough benefits from the public offer. While ambition should equate to offering the best, it is increasingly restricted to negotiating and sharing the availability of the offer according to resources, without regard to merit, according to what one decides to invest. and to consent from our taxes and duties in search of the physical and psychic well-being of society.
This range of individual ambitions is truly on display in the progression of private care, allowing some to obtain the necessary or desired care, and others to offer it in a context free from bureaucracy and state denigration. Collective or external ambition takes its toll, neglected both by those who can or must finance and support it, and by those who provide the required care on a daily basis, 24/7.
The mismatch between collective ambition, which is increasingly portrayed as wishful thinking, and individual expectations widens, particularly when one thinks of the majority’s quest for quality of life wanting to reduce working hours by restricting them to the day shift from Monday to Thursday, which is incompatible with maintaining a competent network at all times.
And to be honest, within the network, the individual effort is also very variable, while many in the same groups of professionals never contribute to on-call duty, evening or night work and heavier tasks. and ungrateful.
There is a crossroads ahead of us. On the one hand, giving free rein to the provision of care according to the needs expressed by the population and wanting to pay to meet them, which necessarily leads to an increasingly private model. On the other hand, the significant and coherent reinvestment in a public network, worthy in its places, in the working and exercise conditions, capable of adapting continuously without the constant intervention of politics.
Isn’t it unfortunate indeed to see the multiplication of aesthetic clinics or more or less relevant private care, leaving them to cannibalize medical resources and other professionals? But in the same breath, how can you blame them individually for wanting to get out of the slump in the public network on which successive governments have wanted to imbue excessive control, both financial and in the management of human resources, imposing an administrative hegemony that causes confusion as much for users than for caregivers?
In recent weeks, the pitfalls of end-of-life care, at home or elsewhere, have sparked debate and reactions. We recalled the fact that a law codifies the rights of Quebecers in this regard. However, this comes up against a management of the network that no longer has the fallen ambition of being present for everyone in a timely manner.
I am not talking here only about doctors and other professionals who must act and practice in an increasingly stifling straitjacket, where opinion is often considered a political blunder, where ambition for oneself and for patients must conjugate in the very imperfect conditional, where the search for the best in care almost invariably results in a further deterioration in the conditions of caregivers and paraclinical staff.
I will also note in passing the unfortunate initiatives to computerize the network which, for many, result in a surplus of work rather than help with the task. Health professionals increasingly suffer from IT overload, having to fill out form after form at the leisure of managers looking for data to justify their good or bad performance, to confirm processes rather than demonstrate the value of human intervention. with patients.
At the dawn of the formation of Santé Québec, there is reason to wonder what resources it will benefit from, the ambition it will communicate to citizens and all the professionals who make up the network, the independence this organization to present the real costs necessary for the offer of services that must evolve, new features that must be integrated, computer tools that must be acquired, technologies that must be acquired and participate in developing, research and development of knowledge that must be assimilated at all levels to ensure staff interest and competence.
Quite a mandate when, unfortunately, the daily management of crises, accentuated by excessive media coverage of the network’s imperfections, makes us short-sighted in the face of everything that would allow us to act with more assurance, confidence and pride.
“It is better to be disappointed than to hope in the vagueness”, said Boris Vian. In terms of health, let us dare to ask ourselves if we have the maturity and the ambition to accept such an observation.