Voici un �ditorial qui explique bien les pr�occupations des nouveaux m�decins
http://www.cmaj.ca/cgi/content/full/166/7/879 C,est simple on suit les conseils qu'on donne... c'est juste une job, faut pas se tuer � l'ouvrage, la famille passe en premier, les administrateurs vont toujours pointer le doigt accusateur vers nous. Pierre B. Catherine Bich wrote: > 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.
