Western Standard Editorial Contest
Brian Day: Health Care Protestant
Michael A. Platonov
“When will we get a bed upstairs?” This is, universally, the final question posed by newly admitted patients in an Emergency Department. As a response, I have perfected a combination wince/shrug pantomime coupled with some mutterings about housekeeping services readying any available space, if there is one. I leave out the part about expecting to wait up to three days. Four years of medical school plus six years of residency can teach a man a lot of things, but survival skills tend to be first and foremost: double your caloric intake when on call overnight, make the surgeon see their sick patient first, avoid the ER when a new shift starts and so on.
The greatest skill of all, however, was learning to live with oneself while immersed in the religion that is Health Care. Too grandiose a statement? Consider such terms as the five sacred pillars of the Health Care Act, patron saint Tommy Douglas (with his CBC hagiography), and the anathema of alternative delivery methods. As an acolyte in a Heath Care temple, (i.e. a hospital), one has to live with oneself while paying lip-service to the mantra of single payer health. To do otherwise risks being labelled "pro-American" or something similarly damning. But it didn't begin there. Our medical school ethics class made it quite clear that questioning health care delivery would result in a verbal run-in with the professor. Upper classmen warned us that failing to toe the party line would result in lower essay scores. Pragmatism, I am not proud to admit, won the day. As hospital work began, the failings of the system became obvious. Complaints were prevalent. I learned that you could safely complain about the hospital administration in their plush boardrooms. You could find takers for any diatribe against the provincial government in its ivory tower. The pharmaceutical industry was a ready target with their expensive drugs. But God forbid you mention the system. The system was conceptually infallible.
The rebuttals came, typically, in three stages. First, that the system simply needed more money. Every year, more money. Once it was pointed out that we were already on track to have just two government ministries, (Revenue and Health), the fallback position contained rich themes of social justice. Without a government monopoly, the refrain echoed, costs would rise, efficiency would fall and the poor would be abandoned. Finally, when the uncontroversial, efficient European model of provision was cited, it was suggested that the best physicians would migrate to private health and thereby cripple public health forever. This always struck me as an inadvertent condemnation of public health care by those who sought to defend it. Counterproductively, those who defend the system want to work within it, advance through its ranks and ultimately control it. Nothing changes. Those who believe in true health care reform must have strong stomachs to immerse themselves in the bureaucracy they detest in order to foment change.
This is why the election of Dr. Brian Day as president of the Canadian Medical Association was such a remarkable event. In case you missed it, Dr. Day runs a privately funded orthopaedics practice in Vancouver. Dr. Day seems to believe, like Senator Michael Kirby before him, that a thoughtful approach stripped of religious overtones must be applied to the endless crisis that is health care in this country.
The very fact that he might become CMA president led to the application of the "Dr. Profit" moniker, unorthodox requests for repeat elections, and general teeth gnashing. Refreshingly, saner heads prevailed. For the sake of the patients waiting in Emergency as you read this, lets hope that trend continues.