As future health professionals, we at the Quebec Health Professional Students' Roundtable (FRESQue) have made several attempts to communicate to Minister Barrette our view that public consultation is a necessary part of reforming our health system. Unfortunately, our attempts at engagement have been met with something almost worse than silence: contempt, condescension, and intransigence. We do not doubt that the Minister has a plan for Quebec healthcare. Our issue is that he refuses to share these plans and engage the population that pays for and is served by the system. His attitude has led to antipathy and mistrust regarding his reforms, which is sure to hamper their effectiveness.
The Minister has shown disdain for public discourse, telling us that it is too often filled with misinformation; however when we ask him to release information to inform debate- such as his plans for public health funding- he told us that the plans were secret. In this way he creates a self-fulfilling prophecy, hamstringing the public discourse he then goes on to discredit.
He also changes his stated motives constantly: when he first launched bill 20, he said that family doctors needed to work harder. When asked about the role of interdisciplinarity at our recent summit, he said that doctors would soon see that there was no way they could shoulder the increased patient burden, and would be ‘forced’ to work with other health professionals. It is clear that the ‘lazy doctor’ rhetoric was nothing but political bluster intended to bully family doctors into an agreement. What we do not see is the planning, support structures, and adequate funding in place to support this essential interdisciplinary solution. The Minister’s focus on doctors being ‘forced’ to rely on other professionals misses the point of interdisciplinarity- it’s not about using other professionals to increase physician productivity, but about creating cohesive care teams that can improve effectiveness and accessibility of care.
He has a cynical view of future health professionals, telling us at the summit that our idealism would melt away as we entered the ‘1%’ and became focused on self-interest This was not appreciated by a room full of non-physicians who will not necessarily be in the ‘1%’ but who have a commitment to the health of our patients and our system- a commitment shared by the future physicians in the room. He has a similarly cynical view of policy, taking pride in calling himself a “bulldozer” and treating reform as a fight where he takes territory first, then chooses whether or not he will negotiate.
He has said repeatedly that public consultation is impossible because it would take 20-30 years. With limited resources, we did it in six months. We received 33 memoranda from all quarters, which informed an engaging two day summit. The summit agreed on a set of general recommendations which the Minister derided as being idealistic and not rooted in budgetary reality. Notwithstanding the fact that budgets are political decisions, we invite the Minister and the public to visit our website, where cost-benefit evidence can be found for a number of our recommendations- such as the call for more psychologists in primary care.
We are tired of the contempt, condescension, and bullying attitude of this Minister. We call for involving the public early during the drafting of reform, when the voices of patients and the people who make the system work can have a real impact. We know that when the patient is not the focus of the healthcare system or its evolution, it takes a heavy toll on both our patients and us.
For the Minister, to do otherwise than to engage the population would be to discredit his party, harm our healthcare system, and insult the population he is accountable to. We have proven that public consultation is possible and that it can be done quickly and effectively. While we wait to see if the Minister will rise to the occasion, the FRESQue will continue our consultations in an effort ensure Quebecers have a voice in the future of their healthcare system.
David Benrimoh is a 4th year medical student and co-founder of the FRESQue, signing on behalf of the FRESQue.
The FRESQue is comprised of 27 university level health professional student associations and is committed to engaging the public and presenting the student vision of a more just, effective, and accessible healthcare system. You can reach us at firstname.lastname@example.org or visit our website, lefresque.com, where you can find all the recommendations and supporting memoranda from the summit as well as a recording of the Sunday, including the Minister’s speech.