At the start of the parliamentary session, the government announced its intention to decentralize the health system. The Regroupement québécois de médecins pour une decentralization du system de santé (RQMDSS) expects it to formulate clear orientations and a promising vision for the future of the Quebec health network. What we are currently experiencing is unprecedented in the history of our health system: access to care is crumbling, staff shortages are worsening, emergencies and obstetrics services are closing, clinics are moving away. patients, and regional health services are becoming poorer.
In such a context, we suggest that the government be at the bedside of the system and its actors to listen to them.
Caregivers have long suffered from the hyper-centralized decision-making structure far from the field. If we do not address it quickly as a society, the situation will only get worse, and the social contract between the government, the caregivers and the people cannot be honored.
Hyper-centralization is the lose-lose concept for the patient and the caregiver:
1. Centralization transforms the patient into an accounting object of care which becomes a statistic defining the health policy of tomorrow. This dehumanization distances the caregiver from his therapeutic ideal for his patient and makes him suffer (see The suffering of caregivers, by Jean-Pierre Béland). The patient, for his part, has the impression of being a number and does not live his experience of care.
2. If the caregiver feels alienated at work and is subject to accountability that does not take any account of the human aspect which links him to his patient and which nevertheless contributes to the improvement of the overall health of the latter, he disengages.
3. The disengagement of caregivers from their public system threatens the sustainability and quality of care, in particular for vulnerable populations. This is very clear today when we look at the consequences of sick leave, leaks to the private sector of caregivers and lengthening of the delays for surgeries, examinations and appointments in specialty.
When we know that the careers of caregivers are largely based on a human vocation, this systemic dehumanization makes no sense. We must revalue this vocation for the future of our professions and to protect patients.
From this perspective, we cannot support centralizing initiatives, such as Bill 11, which would encourage family physicians to go faster and faster with their patients, to meet quantitative criteria without considering the complexity of the human bond. If the bill is accepted as is, the very essence of their practice would then be called into question; for example, doctors will no longer be able to take care of all the members of the same family since the government will decide which patient should be seen here or there.
If the government wishes to improve access to health services in Quebec, it should not be through ancillary control measures and a strengthening of the centralization of management in the health network. On the contrary, we encourage it to bring back a local governance in each hospital, and to deploy, in consultation with the actors in the field, a decentralized first line and on a human scale.
The RQMDSS is fully prepared to actively participate in the search for positive solutions to rehumanize the Quebec health system.
We believe that decentralization is the essential path we must take to take care of patients and their caregivers, and to bring people back to the heart of the care process.
* Other signatories: Marie-Claude Blouin, Ruth Vander Stelt, Félix Le-Phat-Ho, Michel Desjardins, Daniel Kaud, Sylvain Genest.