Poverty, the medical rulers, and their rules
Part V of "Complaint against "Dr Alpha and Dr Beta"
One of the background conditions of my situation is poverty. It affects every relationship I have with the medical system and my feelings on any given day. I've tried to embrace this reality of my existence, as I live a life mostly of solitude and aloneness, with or without a sense of Divine Presence – I'm vowed to poverty, celibacy, and stability in the anchorite way tawt by Thomas Merton and Cistercians but devoid of spiritual heroics (such as what I imagine prevailed in the German Cistercian monastery that joined Luther's Reformation in Germany and survived 70 years afterward).
In our day, “One important difference between groups in the USA is that some groups accept non-Catholics in their membership, others don't. The two options seem to me legitimate. Just as there are a few Lutheran Cistercian communities in the large Cistercian family, and just as there are a few or our Cistercian monastic communities who have or have had one or another non-Catholic in their midst, there might be something positive in our time of ecumenism in having non-Catholics belong to a lay Cistercian community. But that, of course, should not become a norm. That example shows that this is not the time to establish common rules; it is the time to establish communion between communities that respect each other differences.” Unfortunately, the document doesn't even mention anchorites or neo-monastic hermit monks in isolation. http://users.skynet.be/bs775533/Armand/wri/cist_laity-eng.html
But even this form of faith is not a good fit for me; I'm too Presbyterian and Reformed for the Lutheran form; and I'm too committed to living (surviving) in poverty, celibacy, and stability, alone and waiting for God (Simone Weil), which Samuel Beckett parodied in Waiting for Godot. But any way, its choreographer / dancer Randy Glynn and dancer / theatre-poet Tom Brouillette who superseded in silence Beckett's original play, in Randy's choreographic work of the same title. Also, the dance-work is open to a spiritual taste that includes Simone. Besides Simone Weil, I go direct to Thomas Merton, Contemplation in a World of Action; and, like him, I'm a poet.
In this situation regarding my health in such a vowed life (with no support from anywhere), I am extremely vulnerable and, in my relationship to the health system, I end up being simply a toy of the medical system, a system which de facto goes against all the demographic evidence regarding its own sustainability. For one approach to these demographics (first presented in Montreal, Canada, years back when the Dalai Lama visited a medical gathering there, cohosted by a Québecois Trappist Cistercian Abbot, a conference that showed that in our society, the number of aged and incapacitated will balloon enormously, requiring more and more people working to see them/us thru the rigours of the régime of the consistent ethic of life and similar secularist codes (Darwinians think it's unnatural to be prepared to die, to be not-driven by natural selection, the struggle for survival, survival of the fittest, and all that – see philosopher Alvin Plantinga's recent critiques of naturalism and materialism). The Dalai Lama / Cistercian Abbot event was reported at the time in Now magazine, Toronto, in English); it elaborated already some time ago the demographics encountered presently also in an analysis of the Irish population today, in a video lecture by "one of Britain’s leading philosophers, Professor John Haldane of St Andrew’s University in Scotland, a leading Catholic scholar speaking to the Iona Institute, Dublin, Ireland, on 'Love, Sex, and Marriage in liberal societies' (https://www.youtube.com/user/theionainstitute?feature=watch)" -- I don't endorse all the reasoning in it, but it aptly draws on earlier work by Canadian philosopher Charles Taylor, regarding the background ideas of urbanization and industrialization, while both neglect the equally important idea of bureaucratization; nevertheless Dr Haldane projects far more engagingly into our oncoming future. I don't know how Catholic Hospitals will find a way forward thru the impending morass (or any other hospitals for that matter), but I do know my own responsible way of my death in Christ will save society much-needed money, will allow me to depart in peace and dignity, while prior to that time I can perhaps have a few years of flourishing despite my illness. In any case, I want to be counted by “my” hospital and “my” doctors as having borne witness for the record (Berrigan). There will be others like me. To count us is to prepare for Catholic Hospital's own institutional survival and ministry according to its own values (which of course includes, for you but not for me, the “consistent ethic of life”).
Since the economic aspect (or optimatic mode, Hendrik Hart, Understanding Our World,1964, 1990) is always present in created reality, I append to my status as a patient that I am also a member of Canadian society and a taxpayer. For instance, my meagre Canadian Pension Plan is taxed; thru taxation, I too pay for the salaries of the Bad Medicine doctors, Alpha and Beta (I hope residents like Beta do get paid, after all they too have a union and deserve remuneration). I pay for the technology at Nameless Clinic that doesn't help me become more accessible to my insulated doctors, who can't fathom what I need in those aspects of their roles that are non-scientific but equally medical. They get their bureaucratic power from the taxes I, too, pay. Dr Alpha goes on his unposted, no-notice-to-patients vacations which my taxes afford him. I get no notification. He abandons his inter-human responsibility to me, on my taxes. He acts as tho he were in private-practice, an entrepreneur. But he's not. He is a state bureacrat scientist who lives off his patients' taxes, and functions with an underdeveloped inter-human sensitivity and skill-set in that regard. But when he's not questioned, he's an affable guy. Nevertheless, I can't see why my taxes shoud be used by a doctor and a clinic that does me harm, worst of all by throwing me out. Doctors have a union and they negotiate their salaries and financial arrangements thru the Ontario Medical Association; another union exists for residents, Professional Association of Interns and Residents. At the moment, I'm interested in the union function as reported in Toronto Sun, July 9, 2012.
The Ontario Medical Association is launching a legal challenge, alleging the threatening and undermining negotiating style of the Dalton McGuinty government violates the doctors’ Charter right to freedom of association.
The doctors are asking the courts to order the McGuinty government to conduct “meaningful” negotiations and to throw out cuts to doctor fees imposed through regulation.
“The government really left us no choice,” OMA President Dr. Doug Weir said Monday. “We’ve tried to get back to the table with them on a number of times. They have consistently refused to meet with a conciliator. We are... still want to get back to the table; there’s nothing in this to stop that from happening tomorrow if the government wants to.” http://www.torontosun.com/2012/07/09/ontario-medical-association-challenges-mcguinty-government-in-court
But I say: For all the talk of patients' rights over the last 20 years, there is no Patients Union to question the use of our tax contributions for Bad Medicine practices that harm us as a matter of due course under the current system. There's no Patients' ombudsperson at Nameless Clinic, no advocate within Nameless to take up our grievances and get the Nameless Management Committee to deal with our varying needs and to hold scientistic doctors to account and to insist on their retraining in inter-human patient/doctor relations, toward a more integral medical practice, retraining such as is patently needed by Dr Alpha. They are not fined for their professional failures; their unteachability and unwillingness to learn new ways toward a non-harmful medical practice is instead protected by government/union negotiations that do not include patients, not even taxpayer-patients. Their blindspots are coddled. All bureaucrats arrogate power to themselves and their organization, and scientistic doctors paid by the state's power of taxation of the patients are bureaucratic employees, not freelance entrepreneurs (which entails its own problems). This arrangement is inherently unfair to patients, especially those of us who are taxpayers-patients or who are our dependents.
There is also the bureaucratic additional union of the College of Physicians and Surgeons in Ontario. I used to think this was an even-handed body that coud effectuate a negotiation, even arbitrate, between an abused patient cawt in the technocratic claws of a Bad Medicine doctor/clinic which doesn't use its expensive technological powers to inform patients in a timely way of when doctors are taking extended vacations, doctors/clinics abandoning special-needs taxpayers-patients when medications are needed, doctors causing dense queues after their belated return to their posts, and thereby permitting patients, especially those with special needs like myself, to better compete with one another for the available slots that fit the individual time requirements of each patient.
When I was abandoned at Christmas-Chanukah to suffer thruout the season without needed medications, I had no recourse. The Nameless Clinic's Management Committee didn't rise up to provide a stop-gap care for me on the day before Christmas (writing my prescriptions takes only 5 minutes, at that). Instead, some authoritative person simply told me, a taxpayer-patient with special needs, to get lost. When I needed accessibility to my doctor after Easter-Passover, having no idea that Dr Alpha had taken another long vacation, had created an intense queue of his competing patients seeking his services, all of us left to compete on a first-come-first-scheduled basis (it's simply not true that all maladies, conditions, and needs are equal). Then when, exasperated, I learned that under conditions he had established for his vacationing, he had closed down a whole day of potential availability at the clinic to his patients, reserving Wednesdays each workweek to abandon his post and his patients. So, using the business card given me at the reception desk (I can't remember precisely when), I phoned Cassandra Maguire of the Management Committee to seek the accessibility and prescriptions I needed and to complain about the Bad Medicine of which I was the object. I wanted Dr Alpha called to account, so his bad behaviour coud be rectified, since I had no leverage and thus coudn't penetrate the mindset of a stultified status-quo Management Committee, which I notified in my phone call to Cassandra Maguire's voicemail that, if I didn't get help from them, I woud take the case of Dr Alpha's abuse to the College of Physicians and Surgeons. I wanted someone in authority on the Management Committee to hear me out and help me negotiate with Alpha. But. sad tp say, the Management Committee at Nameless is a partisan organization devoted to the doctors' interests even under conditions of practicing Bad Medicine.
When I heard back from Maguire on my voice mail, her supercrispness, brevity, intonation and legalistic approach indicated clearly to me that she had already positioned herself to close ranks with Alpha, after all Alpha is alpha, I was marked as the enemy, and she said ever so crisply that I had 7 days to make my complaint in writing to the CP&S0. And that was that. I had earlier had a very different experience with a then-member of the Management Committee, a registered nurse named Margaret. I needed to talk to somebody about my dermatosis, and she took me into her office and spent time with me, looking at my legs and telling me what to expect as it spreads downward into my ankles. Aside from a period when my doctor was Dr James Urbinski (altho his was a stop-gap assignment and soon enuff he was off to greener pastures), on that later occasion the encounter with Magaret of the Management Commitment was the only time, other than with Urbinski, at Nameless Clinic in all these years that I felt understood as a person (Van Kaam). I had been given Maguire's card much more recently, and her technocratic phone call to me without the slightest gesture of concern for me indicated that more than one functionary at Nameless has contracted Alpha's Disease. This signalled that I woud have to go thru a formal procedure with a deadline, and that the whole system was stacked to protect the errant doctors and to prevent taxpayers-patients with special needs from being heard. The system at Nameless Clinic tries to silence us, I now know from personal raw experience.
For some 20 years, Canada's lawmakers, lawyers, and law scholars have been trying to figure out how to provide protections and rights to patients. There's been a quarrel about whether a Patients Bill of Rights shoud be a federal matter, but this seems quite unconstitutional. In an important article in the Law Journal of McGill University Law School, Flood and Epps studied the difference between patients rights in health care and patients rights to health care. They outline how the medical unions (which like to call themselves “professional organizations” to mask the fact that they actually negotiate fee schedules and bureaucrat scientists' remuneration) with government budgeteers, all without a patients union being an equal party to the talks, tho patients also pay taxes). In the Flood and Epps article, one quote that jumps out at the reader regarding the self-regulation of the medical labour unions:
“But self-regulation, as a form of regulation, is increasingly criticized for failing to protect the public from harm. 47 In recent years, there have been increasing reports of a 'dramatic erosion in the public's confidence in professional self-regulation.' 48 Self-regulating professions are more frequently accused of having a conflict of interest and 'an inappropriate unwillingness to report or act upon the incompetent or unethical behavior of colleagues.' 49 Another criticism made of self-regulatory systems is that many patients do not know where to make complaints or about what they are entitled to complain. 50 Even when complaints are made, a recent survey shows that a large percentage of Canadians who had lodged a complaint against a health care provider were not satisfied with the attention it [their complaint/s,] was given. 51 pp. 525-526
Reading this article of some 10 years ago, to get a basic concept in the juridic sciences literature of patient's rights, after having sought out some help in a crisis with a Bad Medicine doctor, seeking help from the Management Committee to negotiate / arbitrate, but having no access on the spot and then a quick dismissal on voicemail, my situation was described already at least 10 years earlier by Flood and Epps.
The thawt occurs to me: why can't they use some of that technology they abound in to set up a keyboard and monitor in the clinic waiting room where a patient can go immediately after an abuse by a doctor and begin her/his complaint then and there, while the experience is still raw, but the self-censoring mechanisms haven't yet kicked-in within the patient's psyche and mind. Many patients are guilt-tripped too easily by their socialization which commands them to kowtow to bureaucrats and scientists; their/our memories of the abusive events fade quickly because it becomes painful all over again to remember. Patients bill of rights? Just put a single-purpose computer in the waiting rooms so patients can act quickly while the memories are fresh. And give the unrepresented patients the technology needed to record immediately their complaint/s, both locally at the Clinic and to the Hospital-wide central Patients Relations office and the Hospital's Risk Management team. That way, recalcitrant doctors can learn directly from their mistakes, and begin re-educating themselves before mandatory retraining becomes necessary. Why shoudn't a Hospital, devoted for the sake of Christ and the whole community, adopt a stance of pro-active facilitation of patients into the dialogue of each of them with their scientists-bureaucrats who contrastingly already have ample institutional support to weigh in their own interest the whole complaint process, weighting it in their own self-interested favour, thus covering their misdeeds.
Flood and Epps go on to note in a way á propos to Nameless's Management Committee:
An important contributing factor is the quality of management within a system. The vital importance of management, in particular, reporting and communications systems has been demonstrated by high-profile tragedies (p. 526). Self-regulation does nothing to ensure the competence of these kinds of decision-makers, and the professional colleges only have the power to investigate the actions of individual members of their professions as opposed to the actions of hospitals, other institutions, or health care funders and/or managers." (p.527).
A number of health care institutions have internal codes or bills of rights articulating the standard of services that patients can expect to receive. For example, the University Health Network in Toronto has a "Patient Bill of Rights and Responsibilities" that includes the right to be treated in a considerate and respectful manner that considers the patient's privacy and right to confidentiality. 64 University Health Network, "Patient Bill of Rights and Responsibilities", online: University Health Network <http://www.uhn.ca/patient/patientrelations/rightsresponsibilities.asp>. (p.529)
But I say: this is all unsatisfactory, not good enuff: how about a right to timely notifications of a doctor's upcoming absence, of the upcoming danger being "banked" to ensure the doctor has a steady (exhausting) flow of appointments with patients after he/she returns from vacation?
Of course, the entrepreneurial doctors have a different wrinkle in that they are directly competing with one another, and in theory they therefore provide a better system of notifications to patients, and better service, albeit more expensive than a doctor in the socialized medicine system in Canada. Back to that socialized system, for which I am deeply grateful, given the anomalies of my life and complex illness.
In short, the self-protecting guild mentality prevails from the local Nameless Management Committee to the provincial union called the Ontario Medical Association, to the College of Physicians and Surgeons and together they seem to constitute a system (despite noise about Patients Bill of Rights) in which the medical system seeks to keep patients silent and doctors are unconscionably protected even when they demonstrably practice Bad Medicine. In the whole picture, as far as I can see, there is no Patients Union in Ontario; in the specific Nameless situation, there is no on-location ombudsperson for patients, the Management Committee is as brass and it coddles practices by at least one doctor which are Bad Medicine, while being deaf to taxpayers-patients who only want reform so that Nameless Clinic and Catholic Hospital can meet their full potential. We need a great Catholic Hospital in Toronto, and patients need to come more into the picture and the Hospital's game-plan, while the Hospital practices its institutional religious freedom to maintain allegiance to the Magisterium and its teaching of the Consistent Ethic of Life — altho I have a different Christian ethos and I want to be recorded and counted as I seek death with dignity, and with that fact simply recorded and counted by the Hospital for the sake also of the statistical trends it watches and the demographics studied which will flood-in upon all hospitals in Toronto. Please take the time to view Catholic philosopher Dr John Haldane's video-lecture mentioned earlier and get thru its initial “love, sex, and marriage” part to consider the demographics he discusses. We doctors and patients in Toronto's Catholic Hospitals need to weigh and reflect upon these insights. We need to call the professional doctors unions and institutions into this vital dialogue.
part V of "Complaint against Dr. Alpha and Dr Beta" — continued in Part VI "Silence of the not-so-sheepish lamb"
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