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College of Physicians and Surgeons of Alberta CPSA, Latest News, Medical Matters, Messenger 11 Comments


A great deal has happened in Alberta since my last Medical Matters and I would like to share a few thoughts with everyone. I recognize these are very difficult times for physicians, as they are for many Albertans. I admit I’m no longer on the front lines of clinical practice and therefore can’t directly relate to the stress people are feeling right now, but that doesn’t mean I’ve forgotten what it’s like to care for patients and work in a health system. I also have a relatively unique perspective because of my background and I would like to share some of my thoughts with you.

We have a Council Position Statement and our standards of practice to help guide you. What I’m about to share is not an official CPSA position, nor is it direction to physicians on how they must act in the months to come. These are thoughts shared from someone who has lived and worked in several different provinces and countries, and practised medicine in different jurisdictions during times of peace and times of conflict.

No easy solutions to complex problems

During my time with the Canadian Armed Forces (CAF), I was very fortunate to have a year of strategic leadership training. One of the key components of that training was understanding how to manage complex problems. During that time, we heard from many brilliant leaders but one statement has really stuck with me. The CAF Chief of Defence Staff, Gen. Jonathan Vance, reminded us that in today’s world conflicts, there are no winners, because complex problems don’t have simple solutions and what is a “win” to one person is a “loss” to another. Changes applied to one part of the problem just create problems in other parts of the problem. All you can hope for is continuous gradual improvements over time. I would like everyone to consider that in Alberta’s current context.

None of us have easy answers to the problems that exist today, especially in health care. My experience from working in several other health systems is there is no one perfect system—each one has good and bad within it. I’ve also learned there are many ways to provide care and a “standard of care” is a very relative thing. I’ve heard that some doctors are thinking about leaving Alberta and for those who are considering this, I would recommend you take some time before making that decision. I can assure you the grass is not always greener.

Whenever I see success in a health care system, no matter how well funded it is, I see people working together for a common purpose, with good leadership in place. In fact, some of the best care I’ve ever seen has come from people working in some of the most adverse condition imaginable. That is because medicine is founded on people caring for others, which also means caring for each other. This is a time to look after your personal health and the health of your colleagues.

Remembering our values

I recognize there’s a great deal of anger in our profession right now, at a time when many physicians were already burning out. It’s times like this when bad decisions are made that have long-term impacts. Emotions are valuable in making decisions, but we must recognize how those emotions are influencing our decisions and not let them take us down the wrong road. This is especially true at a time where comments made on social media will be there forever. From my experience, complex problems become worse when anger is the emotion that drives decision-making and actions.


"Despite how you may feel at the moment,

you are respected and valued."

Those who rely on their values and ethics to guide them will more often than not do better in the long run. We run into problems when we start justifying reasons to deviate from those values and ethics because of anger. I can assure you that never works out for the best, especially for patients. It’s actually very fortunate that CMA recently renewed their Code of Ethics & Professionalism. I believe it can be the foundation for physicians to fall back on at times like this and I encourage everyone to take a look at this document and use it as a guide moving forward—look after not just the best interests of your patients and the profession, but also your own personal health. 

Putting our patients first

In any conflict I’ve seen, there are always innocent bystanders that end up becoming trapped in the middle. In health care, those are the patients. We, as a profession, cannot put our patients in the middle. We must recognize they are struggling with their own concerns and they’re coming to physicians for help with their problems. They don’t need to worry about the medical profession’s problems on top of their own. Clinical encounters need to focus on the patient, not the profession.

I understand most of the anger today is about feeling respected as a core member of the health care team. I would argue that the most important respect needs to come from ourselves, family, patients and colleagues. That is, and always will be, essential to the long-term success of the medical profession.  As physicians, we can’t lose sight of that. 

I know these are challenging times, but let me leave you with just a couple thoughts: There are no easy solutions to complex problems. Do your best to not make decisions driven by anger. Use values and ethics to guide you through challenging times. And last but certainly not least, look after your own personal health and wellness, in addition to the health and wellness of those around you.

Despite how you may feel at the moment, you are respected and valued.

As always, I appreciate your thoughts.

Scott

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Leslie Kasza

Hello Dr. McLeod: Unfortunately I have a chronic autoimmune neurologic condition and on immunosuppressive medication. I have had to self isolate at home for the last 10 days. I am doing what I can, following up with patients that I know and doing their follow ups over the telephone, as well as taking any calls from patients, colleagues and pharmacies. The documentation is being done in my medical record. I have decided not to take new consults while at home, but certainly will take phone calls from colleagues and give them direction as well as help. My secretary is largely… Read more »

Theo Kemp

I personally would only feel part of the team if I have the same privelages and given same respect as the Physicians that govern me. That is to be recognized as part of the team and a Government employees given the same benifits as my College Physicians in office. The General at war has it’s role in office, but when the soldier on the battelfield gets his face shot off and he needs sickbay for a month then his wife and children has no worries because the end of the week they will get the paycheck to pay bills .… Read more »

Lizette Elumir

Thanks for your thoughts. I think it’s important to fully understand all perspectives. The assumption is that physicians are leaving Alberta because they think the “grass is greener”. Maybe they are considering leaving because of their core values. I want to have faith that leadership will listen to experts. I want to have faith that leadership will not terminate contracts. I want to live in trust that leadership will not refuse to negotiate. If leadership stops doing that, what else will they stop doing? How many more contracts will be terminated? When will a refusal to negotiate turn into authoritarian-like… Read more »

Scott McLeod

Good morning Dr. Elumir,

Thanks for taking the time to write in with your very valid points. The comment I made about the “grass is greener” applies to everything you just mentioned and not pay. Every physician will need to make decisions that are right for them and uniquely them. Perhaps the emotion for some is fear and that’s completely understandable. It’s just important to understand what emotions are driving the decision making.

Scott

Greta Senekal

Thanks, Lizette Elumir & Liam Martin, for painting the “bigger picture”.

Liam Martin

I have no doubt that physicians who practice in this province subscribe to the sentiments expressed in this commentary. No physician will deliberately put a patient in harms way. You argue that the respect that is important is the respect we have for ourselves and the respect that comes from our families, colleagues and patients. However you have forgotten the other element of respect and that is the respect that comes from the system, in this case the government. The lack of respect shown by our current government to the profession cannot be ignored. Who can respect a group who… Read more »

Scott McLeod

Hello Dr. Martin, Thanks for the comments and perspective. I agree it’s important for the system to respect physicians. The respect of the people doing the work every day is essential to the success of any organization. What I’m saying is that it’s not the only respect to consider. It’s important to see all the respect that is there and not just what may be lacking. There may be greener pastures out there, but all I wanted to share is that sometimes you may be trading one issue for another and it’s important to know that before making the decision.… Read more »

Dr. Don Korzenowski

Hi Dr. Scott, Totally agree, with Your article. CPSA evolved over 40 years and have worked very well with “practising physicians” with “some” empathy! Less, You are “Guilty” until proven, otherwise. More understanding. However, You have not discussed a simple and blaring fact. The Erosion of socialized medical care since Tommy Douglas! Governments since then have failed to manage the costs of socialized health care, secondary to market inflation and technology. They have avoided political suicide by losing their electorate. This was accomplished by battling the medical providers. They have continued to provide the illusion of US Mayo Clinic Health… Read more »

Scott McLeod

Hello Dr. Korzenowski,

Thanks for reading the Messenger and taking time to provide your thoughts. There is just not sufficient time or space here to provide you with a robust response. I would however be willing to chat with you. I can reach out by email. For that conversation it would be good to know what you mean by “patient accountability” and 3rd world price goals. Scott

John O’Connor

Really, really appreciate your candour and well-measured words, Scott! It goes without saying-though I’ll say it here-that along with due prudence and forethought, freedom of expression must be protected and in fact encouraged. When conscience and social responsibility dictates, one must not be afraid to speak out on issues that truly impact patient and community health. It is especially tough in these challenging times. While having razor-sharp focus on our ethical standards, and commitments to our patients, we must be aware of our roles and duties as advocates. As physicians, we are incredibly privileged, and, more than we realize, are… Read more »

Scott McLeod

Hello Dr. O’Connor,

Thank you for your comments.

Scott