One year later: reflections on the future of health care

College of Physicians and Surgeons of Alberta CPSA, Latest News, Medical Matters, Messenger 4 Comments

It’s difficult to call myself the new guy now that I’ve officially been the CPSA Registrar for one year. But while I am still learning and growing into this position, I continue to be impressed with the quality of physicians we have here in Alberta.

When considering what to write for this edition of Medical Matters and thinking about the past 12 months, I felt it appropriate to discuss some of my thoughts about the future of health care in Alberta. I’m certainly not claiming to have any special knowledge or capacity to see into the future, but I’m fortunate to have spent my career involved in many different areas of health care provincially, nationally and internationally, which gives me a unique perspective that I’d like to share.

Looking ahead, I think some inevitable changes are coming and the medical profession will need to embrace them if we want to remain relevant. I hope the following five opinions will induce some thought and discussion:

  1. Autonomy of practice is a fallacy. No one is fully autonomous in any workplace; this is not unique to physicians. That‘s not to say someone is looking over your shoulder at every decision you make; however, all physicians need to understand every decision has an impact on the greater healthcare system. Decisions drive the quality of care people receive and the costs of health care, and create the environment care is provided in and received. We must embrace the reality that we are all part of a greater system that requires an understanding of how each and every one of us contributes.
  2. We are all accountable for quality. I’m not sure where I first heard this, but I think it’s very applicable: a government contractor cannot be paid without some degree of accountability for an outcome, yet that is exactly what happens when a physician is paid for providing care. As we become better at collecting data and translating that into knowledge, we can better understand the quality of care Albertans receive and the safety of the healthcare system in general. People will soon expect to know how their doctor rates among peers and will expect more for their tax dollars. I can see this happening in the next five to 10 years.
  3. We need physician leaders. If more physicians don’t take on leadership roles and learn how to be good leaders, I believe our patients will suffer. We, as a profession, need to stop looking down on those who choose this path. A friend of mine, a highly-respected physician, recently decided to take on more of a leadership role and cut back his clinical care by 50 per cent. As a result, he’s been referred to as a “part-time doctor”. This is an example of how physicians generally don’t appreciate the impact leaders can have on the healthcare system and by extension, the care patients receive. Leadership is not easy and those who take it on will tell you the work can be far harder than providing direct patient care. Healthcare leaders are not avoiding patient care or “going to the dark side”; they are stepping up to try and make a difference. These physicians need to be thanked, not chastised.
  4. Health care is going digital. We’re living in a digital age. Most people are very comfortable now doing their banking, shopping and vacation bookings online, and the expectation is that a great deal of health care should be accessible online too. Our classic approach to seeing patients in an office or hospital is changing and we need to evolve with this change, and to consider how we can truly embrace patient-partnered care. There are risks associated with this approach, but there are also significant benefits. We can’t ignore the potential benefits for fear of the unknown.
  5. Teams are stronger than individuals. The practice of medicine is becoming more difficult every year. Knowledge is expanding faster than we can keep up, patient expectations are higher and accountability for quality is a reality. It is impossible for any physician to do everything on their own and we must embrace the healthcare team that we’re part of, along with the reality that others may be better at doing some things than we are. We’re all in this together, and by working in teams we can support each other. Patients should always be a part of the team as well, as partners in their own care. True team-based care will lead to a much better environment for all of us, and better care for patients.

These are just my opinions and not really based on any formal research or evidence, but I’ve spent the last 28 years thinking about these sorts of things. I’ve worked in many countries and with some incredible people. Through it all, I’ve seen common themes in successful healthcare systems and structures:

  • The best health care is provided by high-functioning teams. Physicians accept their roles as both members of those teams and, at times, leaders of those teams.
  • The best results come when decisions are based on what is best for patients, and patients are partners in their own care.
  • Patient outcomes improve when clinical data is translated into knowledge that physicians can use to change practice behaviours.
  • People are recognized as the foundation of success; they are supported by leadership and they are supportive of each other.
  • Care is not seen as a transactional event that takes place at one point in time, but rather as a continuum that engages many parts of the system.

As always, I look forward to hearing your thoughts.

Scott

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Maarten Coetzee

I agree, very well put. I also appreciate the encouragement given to physician leaders. Thank you for this article.

Scott McLeod

Thanks Maarten. I’m happy to hear you enjoyed the article. Scott

Lee A. Green, MD MPH

Scott, you modestly state that “These are just my opinions and not really based on any formal research or evidence…”, but as a health services researcher of over 30 years’ experience, I can say you’ve pretty well encapsulated the research and evidence. Well put.

Scott McLeod

Good morning Lee. Thanks for reading the Messenger and thanks for the feedback. Take care. Scott