Un commentaire int�ressant que je vous "forwarde".Emane d'un coll�gue de Shawville (dans le Pontiac) � qui je demandais son opinion et qui est d'accord pour que je vous la fasse partager.Pas tr�s dans le ton de ce qu'on dit actuellement,mais pas moins int�ressant.
Important de savoir en partant que le Pontiac est extr�mement bien organis�.Environ 20 000 de population.Equipe de m�decins de famille polyvalents(tous font de l'hospit et de l'urgence sans exception)-anesth�sie et excellente �quipe de consultants itin�rants.CT-SCAN.T�l�radiologie.Et en plus,� environ une heure de Gatineau/Ottawa.Probl�mes de nurses comme ailleurs...coupures diverses qui font mal.Mais excellent esprit d'�quipe et facon tr�s "anglaise" de g�rer les conflits...Le jupon d�passe rarement.Bref,un vrai mod�le d'organisation des soins de sant� en milieu rural. Bref,voil� pour le contexte.Qui vous permettra de situer la r�ponse. Catherine, We live in interesting times, and I will try not to react from an ideological perspective. I have been hearing alot of that, example: "an attack on our autonomy", "coercion", etc, and it is not a very logical place to begin to understand what is going on. Taxes are coercive, but in the end they are an exercise in equity, and we accept them. In fact, I am trying to understand the current events as problems in equity. It is obvious that equilibrium is possible in many different ways, at least historically. When I first arrived in the Pontiac the whole job was done by 4-5 GPs. Obviously they did alot more of some things ( especially ER) than current staff does, but it was equitable, therefore tolerable, even to the extreme. Looked at this way we have worked hard in the Pontiac to develop a system whereby the hard work is divided equitably. Not easy to do, but we have been moderately successful. Of course we have fewer penalties associated with our system, since we don't really have the power to impose any - certainly not financial ones. The current proposal has taken our model one step further, and given it teeth. Is this a good thing? Yes and no. Any system which seeks to more equitably divide the hard work seems to me to be a good thing. However, this division is very complex, and there is a risk if the engineers are outside the system. A purely bureaucratic management will be unable to manage the complexity, and the weightings required. Another negative is that it completely lets off the hook some major culprits, particularly the training institutions who have consistently hidden their heads in the sand about the real needs of the population. One good thing I see in the discussion document is a discussion about priorities which resembles the real world. When I was at Health Canada it was hard to find anyone who was interested in investing in health care. Everyone was keen on improving health, but there was a sense that disease was simply the failure of prevention. There was a total disconnect with the reality of illness and care that was astonishing. This document at least seems to acknowledge that healthcare is important, and needs to be organized around certain priorities, and I find I agree with most of the priorities outlined. Absent from the discussion is an analysis of the impact of these changes on physicians. When Dr. Potvin gave up his private practice to come to the hospital exclusively as a surgeon on "remuneration mixte" he had great anxiety about loss of autonomy, but it was mostly an illusion - the obligation is flexible, and he is actually better off. I suspect that when they finally get around to organizing the GMFs this will also be the case, and it is why I am so interested in designing a rural GMF which is consistent with our reality, not some transplanted urban model. Be a little careful about praising the Barrer Stoddart Report - it is widely perceived as being the analysis that convinced the governments to cut back medical school enrollment 10 years ago. To be fair to B-S, that is the only recommendation they acted on, and it caused a mess. Some of the current recommendations may have been inspired by portions of that report which were not implemented at the time. BTW, thanks for keeping me informed. I think I get more breaking news from you than I do from the R�gie, or the MSSS, or the FMOQ put together! En tout cas... the summer is ending, but the temperature is rising. A suivre John PS: I don't know of any catamarans for sale ( you really like speed eh!) - you know they flip over... if I hear of one... [EMAIL PROTECTED] (Catherine Bich) le 2002-09-03 13:11:06 Pour : "John Wootton\(DSP\)" <[EMAIL PROTECTED]> cc : Objet : ton avis Bonjour John, Quand tu auras le temps,laisse-moi savoir ce que tu penses du petit texte que j'ai �crit et diffus� sur URG-L concernant la loi prise 2 . J'ai toujours int�r�t � lire ce que tu penses... Crois-le ou non,mais je pense parfois que cette inscription obligatoire des MD dans les �tablissements a quelques bons c�t�s.C'est certainement pr�f�rable comme je le dis � des petites lois cibl�es distribu�es ici et l�.Une grosse loi qui touche tout le monde aura au moins l'effet positif de provoquer un d�bat. Tu peux me r�pondre en anglais. C.
