Accountability is the cure for what ails Canada’s health system, but only if physicians are willing to “step up and quit pointing the blame at everyone else,” says outgoing Canadian Medical Association (CMA) President Dr. Louis Hugo Francescutti.
“Never, at least in the 30 years I’ve been practising medicine, have I felt there is a greater need for the profession to really stand up and look like the profession we have the potential to be,” Francescutti told delegates at the CMA’s annual meeting in Ottawa during his valedictory speech on Aug. 19.
Physicians have been given a “monopoly” over medicine in the expectation they will do right by their patients, he said, but there’s increasing evidence they’re not living up to that bargain.
Exhibit A: Canada’s declining performance in international comparisons of health systems. For example, in a recent Commonwealth Fund ranking of peer nations, “the US ranks last only because they spend more money; take that out … we would be absolute last,” said Francescutti.
He also cited changes in how patients perceive the profession; there’s been a precipitous drop in the percentage of patients who describe physicians in the same glowing terms the profession uses to describe itself. “If you look at these different attributes over the last 10 years … the one that’s dropped the most is compassion.”
It’s no wonder that medicolegal fees are on the rise, said Francescutti. “The reason they’re going up is because patients aren’t quite as happy with their doctors as they used to be.”
“If we were to view our health care system as a patient, based on what we’re hearing, I think that patient is traumatized and what we have to do is step up and figure out a way to make our patient better,” he said.
That starts with “meaningful accountability,” urged Francescutti, citing international examples of systems that evaluate their physicians annually on the basis of “availability of care, compassion of care, quality of care and quantity of care.” He acknowledged that such radical change is “impossible for our current health system,” but can serve as an example of what accountability really means.
“You can do it personally,” Francescutti said. “I’ve tried over the last year to give myself a personal evaluation on all of these measures to make sure I’m getting better and better.”
Accountability also means taking a hard look at waste in the health system. Studies of US health care have revealed some $750 billion wasted annually because of unnecessary services, inefficient delivery of care, excessive administrative costs, inflated prices, prevention failures and fraud, said Francescutti. “Even if we’re 50% better than the States, and I can’t make that argument because the data [do not] support it, in theory there should be $30 to $50 billion in our system that’s not being used efficiently.”
Arriving at this kind of transparency will likely take time, he added. “Just as it took us a year to have the discussion on end-of-life care, it’s probably going to take us a little while to feel comfortable having the discussion about a new way to evaluate ourselves.”
Francescutti hasn’t shied away from controversial topics during his term as CMA president. He urged frank dialogue about death during the organization’s cross-country consultation on end-of-life care, and is among the most vocal opponents of Health Canada’s new medical marijuana regime.
Over the last three decades, Francescutti has championed public safety and injury prevention. Among numerous awards, he received the Queen Elizabeth II Diamond Jubilee Medal in 2012, and is decorated as one of Alberta’s Top 100 Physicians of the Century.
Francescutti currently works as an emergency physician at the Royal Alexandra Hospital and Northeast Community Health Centre in Edmonton. A professor at the University of Alberta, he also teaches courses in injury control and public health.