- © 2007 Canadian Medical Association or its licensors
I agree with much that my old friend Michael Bliss put forward about “socialized medicine and Canada's decline,”1 but I would submit that the responsibility for our inadequate health care system rests more with our medical educators — the clinicians and the professors — than with our politicians. True, in the pre-medicare days, we did maintain high standards of medical education and we produced competent doctors. However, in 1968, our profession handed over responsibility for policy, planning and human resource development holus-bolus to the politicians, the health economists and the bureaucrats. We did so with scarcely a whimper and subsequently let our new masters in Ottawa confine us in a legislative straitjacket called the Canada Health Act, with its 5 criteria or pillars: accessibility, universality, comprehensiveness, portability and public administration.
In their zeal to exercise this kind of control, the architects of the Canada Health Act are guilty of an incredible oversight. Nowhere in this statute is there a word about the responsibility for the training and distribution of health care professionals. Furthermore, there is nothing to indicate which level of government — federal or provincial — should pay for it, and today this involves many billions of dollars.
So we medical school professors relinquished control without putting up much of a fight. Then we hunkered down in our academic trenches and began to produce a vast array of urban-based super-specialists, while almost completely ignoring the now disastrously depleted state of rural health manpower.
This new order of medical education seems to have replaced the skill of history-taking and facility for the classic Oslerian methods of physical diagnosis (observation, palpation, percussion and auscultation) with almost complete dependence on increasingly sophisticated laboratory testing and diagnostic machinery. Now randomized clinical trials and evidence-based medicine have taken over the helm. Add to this the sorry fact that the medical school curriculum has ignored the teaching of communication skills for too long — and it shows.
All this might be dismissed as the rant of an old retired dinosaur, but our profession has somehow lost its way and it is nobody's fault but our own.
Footnotes
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Competing interests: None declared.
REFERENCE
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