Training on professionalism for medical students
On February 16, the QMA’s Students Committee held its second professionalism training course on the topic of future issues facing Québec’s healthcare system.
Antonia Maioni, political science professor at McGill University’s Department of Political Science and Institute for Health and Social Policy, gave a synopsis of the history of Québec’s healthcare system. The healthcare system in predominantly Francophone and Catholic Québec was long run as a self-contained entity by the church and charitable organizations; however, along with the education sector, the province’s healthcare system fell under the purview of the state in the 1970s.
Since then, the provincial government has had the difficult task of negotiating with Québec’s physicians. Case in point, when Claude Castonguay implemented the Health Insurance Act, not all doctors were on board with the move. What the government was hoping for, however, was support from physicians in bringing about social change. According to Ms. Maioni, while family physicians grasped the important task being set for them, specialists were another story. Afraid of being short-changed, they called a strike in October 1970. Many specialists also moved out of Québec at the time.
Mr. Castonguay’s vision for the healthcare system was quite modern for the time. As Ms. Maioni pointed out, he was one of the first to understand the importance of social determinants on health, and Québec was the first province to create a system that combined health and social services. The other notable feature of the system was the decentralization of primary care services.
We would be remiss if we didn’t mention another legacy of our healthcare system. When the system was first set up, the federal government committed to covering half the costs under the Medical Care Act. But the rules of the game changed in the 1980s, when Québec started receiving less money from Ottawa for healthcare.
With costs constantly on the rise, the debate that’s been swirling around healthcare for decades has unfortunately become somewhat of a broken record. We question how much money the system costs to operate, but rarely how the money is actually spent. “Yet, money should be seen as a tool or a lever for getting things done. That should be what it’s all about,” points out Ms. Maioni, who also feels the efficiency of the healthcare system should be judged based on population health rather than performance indicators. “However, Québec has made remarkable strides in this area since 1960, when the population really wasn’t all that healthy,” said Ms. Maioni.
For his part, Dr. Hugo Viens, President of the Québec Medical Association, gave a presentation on physician engagement.
He started by reiterating a few basic principles of professionalism, namely that it’s more than just a competency, it’s a pledge to society.
“The reason students give most often for wanting to become doctors is so they can help patients,” he stressed. “The problem is, once they’re actually practising, doctors tend to focus on their individual relationships with patients and forget that they belong to a profession that has a responsibility to society.”
Dr. Viens went on to list several areas that physicians can concentrate on in their daily practice to increase their level of professionalism:
- the appropriateness of the care and procedures they administer;
- educating patients to create a better public perception of healthcare needs (we know expectations are high!);
- multidisciplinary work with other caregivers;
- the organization of patient care;
- shared decision-making; and
Dr. Viens also explained that the next generation is aware that the social determinants of health play a bigger role than the healthcare systems themselves in guaranteeing good population health, and that they can leverage this knowledge to transform the healthcare system. In fact, that’s why it’s crucial that we improve care trajectories and make them less costly, as well as implement more integrative practices. This is within reach for doctors, who need to step up and be leaders in overhauling the healthcare system, being best positioned as they are to implement a multidisciplinary approach, a review of compensation methods, a reorganization of healthcare systems and, above all, the teamwork model.
In conclusion, Dr. Viens stressed that in this era of “doctor bashing,” physicians as a whole may be seen in a negative light, but individually they still have sway, and they need to have the courage to have the big conversations: “Our voice still carries weight, so let’s use it to defend our patients.”