A new social observation is essential: the vocational call is nuanced, attenuated, even diluted in the desire for quality of life and work-family balance, while the shortage of human resources extends into a new dogma. imponderable. Everything to retain staff, break the unnegotiated and expected conventions of the world of work. Is this an evolution or a setback in our development of social interrelations, of our relationship to work?
Thirty years ago, as president of the Federation of Resident Physicians of Quebec, I signed an agreement with the government that recognized that we could not impose a schedule of more than 24 hours in a row. At the time, this stirred the established order in medical training, although the foundation was patient protection and not just the welfare of medical residents.
How the pendulum has swung into another era! Now, we would never think of including such a schedule in an agreement, when we disapprove in the same breath of the compulsory overtime that we tolerate and nevertheless impose, just like call duty on call for more than 24 hours.
However, it should be noted that several professions are increasingly considered as a “ job », and more necessarily as a desire to invest in a career, in renunciation of several attributes of personal life. Nevertheless, civil society expresses a desire to maintain practices of convenience, such as having a regular doctor and knowledge available at all times. We take for granted and expect places of care available 24/7.
An inexorable evolution
How to reconcile all this? Medicine — and all health professions — is inexorably evolving towards a model of specialization, of improvement, so that a doctor cannot be the only one suitable for all patients. Moreover, availability can no longer escape quality of life rules. Imitate the Dr Welby, omnipotent and omnipresent, is no longer a rite to which the new medical generation, and even the oldest, agrees to comply.
Moreover, we will note the more manifest refusal to bind oneself to the painful conditions of practice of the network. Early retirement, private practice orientation. Despite a significant increase in the number of graduates, the absolute number of new doctors in active practice is definitely not progressing in relation to the growing needs dictated by the increase in the number of citizens and the aging of the population, among other factors. The mismatch only intensifies and becomes entrenched, with no immediate exits, it seems.
While the Prime Minister and Minister Dubé are announcing a “stirring” review — some will see another reform of the Act respecting health services and social services, particularly with regard to medical representation —, do they perpetuate a politically profitable myth that many clashes in the health network are attributable to doctors? They seem to disagree with their power of influence, which is however mainly focused on promoting care for the patients they work with and for whom they are responsible.
This same power of influence and this investment, which have allowed a meticulous organization of care in times of COVID in hospitals, have been exercised for decades to oblige health authorities to make increased investments for the development of care in quantity. and in quality, for the approval of innovative treatments, for the development of diagnostic measures and screening programs.
See a system evolve
There will be those who repudiate the medical voice, claiming that it is exercised with the strict aim of remuneration. Let me dispute that. Many doctors strive to help various foundations, to participate voluntarily in the medical education of the public, to develop knowledge without compensation, to propose development plans for the advancement of care and the quality of life of patients, to participate in a number of committees to monitor their practice and advise managers. If it is this power of influence that the government wants to review, it will accentuate, just like the spirit of the times, the idleness of the medical profession and the degradation of the vocational aspect of medicine. Expecting availability, eagerness and dedication cannot be part of a request to renounce a privileged stakeholder status.
There are expansive shortages of personal and collective investment by many groups of health professionals, in response to the neglect of recognition and conditions of practice for decades, and particularly for ten years. However, the government cannot do without the buy in of the medical profession to an overhaul of the network which must, it is my credo, compulsorily extract itself from political influence. This network, which must be appropriated by managers appointed solely for their competence by authorities other than those directly supervised by the Minister, relies on groups of professionals able to exercise their influence locally to improve care and integrate the path of patients.
Henri de Montherlant wrote: “If you exert influence, at least pretend to ignore it. I don’t believe that members of the medical profession try to influence for the purpose of personal or collective recognition, but rather with the objective of seeing the evolution of a healthcare system shaken by its failings rather than by its accomplishments.
Coming back to the questions in the title, I think that doctors expect their profession to ensure that they practice according to established standards on medical and rational bases, to decide with patients on appropriate treatments in a timely manner with a process that evaluates therapeutic options with openness and adaptability. As for what the profession and civil society expect of doctors, I hope that they will be able to understand the prerogatives in connection with personal life, agreeing that the vocation must be exercised within a voluntary framework and not imposed by necessity. or the desire to shift responsibility through guilt that further leads to disinvestment.
Having the prerogatives and skills to influence is a real power, of course. It is only necessary that those who exercise power for power itself become infatuated with people of influence, not seeking to antagonize them.