‘Who is the best doctor? It is usually, quite simply, the one who listens’
Attention Quebec: The best doctor is the one who has time to listen
In the interest of saving time, rather than sitting around thinking about it, I have just Googled “things you can do in five minutes.” On most websites that exist to help you optimize your work life — to become some kind of human shield against wasted seconds — the suggestions veer toward testing all the pens in your pen mug and discarding those that don’t work, deleting unused apps from your smart phone, or cleaning out your junk drawer. What can you do in five minutes? According to the experts, discard a bit of debris, or as many of these websites put it, “make a dent” in cleaning something up.
Personally, I do not want to be dented by my doctors — I want to be treated by them. So like so many other Quebecers who sometimes require medical attention — or, OK, in my case, require medical attention rather more than we’d like — I have been mulling over what exactly my family doctor could do for me in a slot of five to 10 minutes, which is all he might be able to give if bullish Quebec Health Minister Gaétan Barrette’s proposed health reform, Bill 20, passes. Under the plan, the province could dock a general practitioner’s pay by up to 30% if they don’t meet a quota of between 1,000 and 1,500 patients per year. For many doctors, that means a tripled load.
Under those constraints, what a GP could do for a patient like me — a patient with multiple issues — is, essentially, nothing. He or she would sit down with their file folder open to my multi-part medical saga, read through the flowering garden of issues (including early-onset osteoporosis, arthritis, chronic spinal fluid leaks, Hashimoto’s Thyroiditis, surgery-related nerve damage, uterine fibroids, chronic pain and, at the moment, the last trimester of a somewhat complicated, old-ass pregnancy) and then they’d have to snap the folder shut, because they will have run out of time — or run out of the room screaming.
Now imagine something more typical for such a complicated case, a case where the GP is the vital connector, the sensitive tissue between a dozen specialists who rarely or never speak to each other. Imagine, one health issue more or less, that I was not a 42-yearold woman, but an 85-year-old woman: a woman who could not undress herself too quickly, or explain her issues succinctly or perhaps even clearly. Imagine that the only way a doctor could figure out why I was in was to talk with me, at length, questioning until the doctor began figuring out what tests or referrals or drugs or steps might be needed. Then the doctor would need to get on the phone and call some of my specialists and speak to them.
That single step — the talking — takes so much longer than writing prescriptions, or sending patients off elsewhere, or falling back on statistics. But ask any experienced doctor, or any experienced patient, what the single most important factor in the oneon-one medical relationship is, and you will hear one word over and over again: communication.
Who is the best doctor? It is usually, quite simply, the doctor who listens — who has the time and the patience to listen to the patient. And Bill 20 will eviscerate this kind of communication, which will lead to error, which will not help anyone in Quebec save any money or any time.
I recently heard a wonderful, albeit harrowing lecture by the Harvard surgeon and awardwinning writer Atul Gawande, whose most recent book, The Checklist Manifesto: How to Get Things Right, I would love to see underlined from front to back on Gaétan Barrette’s night table.
In the talk, Gawande, who was chosen as last year’s BBC Reith lecturer (this was from the third lecture in the 2014 Reith series), explains how he was approached by the World Health Organization to study what could be done to reduce preventable complications during surgery. Gawande’s study found that in using simple techniques that upped the levels of communication between those in the operating scenario, the surgical complications rate was reduced by an average of 35%. Surgery-related fatalities fell by an average of 47%.
What Gawande’s team uncovered was that sometimes the most basic information was somehow not imparted or shared: what side of the body to perform surgery on; what the names and roles of all the people on the surgical team were; whether the patient being operated on was in fact the right patient.
These are not errors of individual ignorance or incompetence (say, that the surgeon didn’t know how to do the surgery), but errors that stem from problems in the system in which the doctors work. In the case of surgeons in a typical first-world hospital, the most routine tasks have become so labyrinthine and complicated that it’s become nearly impossible not to miss a step, leading to the most basic mistakes.
A family doctor’s office is not an operating room, but it is still a ground zero — where an unfolding medical narrative often begins. And so it’s no surprise that the Quebec Federation of General Practitioners has gone so far as to call the proposed reform a “toxic treatment,” and “a prescription that presents serious risks.” They have not minced their words, but if Bill 20 passes, they will, god help the sick in this province, necessarily have to.
It’s no surprise Bill 20 has been labelled a ‘toxic treatment’