Insider’s fictional look at medical politics

Insider’s fictional look at medical politics

BY SHEILA PRATT, EDMONTONJOURNAL.COM JUNE 25, 2011

After 30-plus years in hospital wards and boardrooms, including Edmonton’s Capital Health Authority, Dr. Bob Bear has plenty to say about the troubled health care system.

In an unusual move, the kidney specialist chose to write fiction, rather than another stilted management report, to convey his message.

Sorrow’s Reward is a quiet gem, a novel written in an unconventional form — a series of tight vignettes, poignant conversations, a mix of poetry and prose, that takes the reader inside a kidney dialysis clinic in an unnamed Canadian city.

Bear draws on the 30 years he ran a dialysis clinic in Toronto, his work as a consultant in more than 100 hospitals, and his experience as a senior executive in Alberta.

Between slices of anguish, good intentions and commitment from health-care workers, Bear offers an unsettling critique of a troubled system.

“I wanted to contribute, albeit indirectly, to the ongoing discussions our system and how to make it better,” said Bear.

“I also wanted to cast some light on lives of individuals with chronic disease, how much courage we see in them.”

There will be much interest in the novel in Edmonton, given the health-care controversies raised by MLA Raj Sherman in the past year, and Bear’s role as second-in-command to CEO Sheila Weatherill in Capital Health from 1997-2001.

(More than 80 people from the medical establishment showed for the book launch earlier this month at Audrey’s.)

Bear says he has followed “with bemusement both the political posturing and media coverage” of those controversies, including the recent allegations of queue-jumping by prominent Albertans from former CEO Stephen Duckett.

“All of these surfacings are nothing but symptoms. The attention and the media should be on the underlying disease,” says Bear. More on that later.

Through his complex cast of characters, Bear pokes under the surface of modern medicine — the courage and quiet anger of patients, doctors’ variable compassion, the limits of technology for healing and the mostly unacknowledged presence of death in the unit

He fears doctors are losing their special healing touch, their compassion, as they mistakenly assume that “technology is the practice of medicine.”

“There’s a risk the profession will lose that capacity. Someone else, some other profession, will fill that role,” he predicts.

But the underlying disease in the health care system is its “highly politicized” culture, he says. The dominant ethic is “keep the noise down.”

“That’s the disease and nothing much will change until that disease is treated.”

The fictional Compassion Health System runs the dialysis clinic with the loftiest of principles. But there are many agendas at play in this room while patients lie hooked up to the machines three times a week.

Board chair Wallace Brown wants to run “the best health-care system on the continent.” But he has trouble getting good information on quality of care from his CEO, Adrien Brooks, who sees his job as “keeping the noise down.”

Brooks visits the unit one day, oblivious to the “quiet anguish” all around him. “I see him focus on the politicians and business types, objects of opportunity,” observes one patient.

Then there is the young, entrepreneurial staff physician, Dr. Leo Tam, who sees opportunities.

“There is an epidemic of kidney failure,” thinks Tam to himself, noting the complete lack of preventive medicine.

“However, all of that is a different matter.

“What counts is there is a large market for dialysis and it will continue to grow.”

The drug company sales rep is a smooth, dubious presence, recruiting doctors (with cash incentives) to find patients for a drug trial. “ … this type of clinical trial is really a sophisticated marketing tool, notes the sales rep Lynette Ainsley. “The company may or may not publish the results.’’

What matters is that Tam has agreed to speak favourably about the unit.

Meanwhile, nursing director Eva Heckles knows the “secret truth” about the unit, that unstated operating principles, “manage and protect.” “I am a muffler” she says, a “fire warden.”

All this is, of course, fictional. But Albertans have seen plenty of politics at play in the controversies over cases of physician intimidation, allegations of deaths on lung cancer wait lists and evidence of people dying in emergency wards.

The province has asked the Health Quality Council to look into these issues in a closed door inquiry and rejected calls for a public inquiry.

Bear says he wasn’t too surprised to see the health-care controversies hit headlines last fall though the media coverage is often “wide of the mark.”

As a member of Weatherill’s senior management team, Bear was on the inside when some of these events happened.

Bear, for instance, is named in the 2001 lawsuit launched by lung surgeon Ciaran McNamee, the first case of physician intimidation to surface last fall.

McNamee claims he was told to stop advocating for patients, lost his job at Capital Health and was forced to leave the province. Allegations were never proven as the case was settled out of court.

After four years at the top, Bear decided to leave Capital Health and took a position in the medical school at the University of Alberta until 2005.

There is talk of ‘patient-focused care’ all across the country, but it is mostly “bromide,” he says.

Patients are not the top priority and that will only change if people demand a better system, he says.

“Patients don’t understand how important their role is. They don’t take full control and neither does the population demand it.”

“People are not so different anywhere, but in Alberta the population is very accepting.”

It’s deeds not words that will change the culture of the system, says Bear.

Don’t look to the Canada Health Act. It contains lofty principles but they are “routinely violated.” And the act doesn’t address current issues such as preventive care, quality of care and accountability, he says.

But how about Alberta’s brand new patient charter of rights, comforting principles about the need for a patient-centred care, a culture of trust and respect, focus on wellness? Might that change the culture?

Only if the deeds of health-care providers match the lofty words, he says.

spratt@edmontonjournal.com

http://www.edmontonjournal.com/health/Insider+fictional+look+medical+politics/5006867/story.html