Is medicine “just plumbing with more expensive tools?”

“Picard, you’re a hard man to ignore. But it’s well worth the effort.”

This pithy critique, delivered by an unnamed Canadian politician to André Picard, is now his unofficial bio, boasts The Globe and Mail’s veteran public health journalist and author. When Picard was honoured as the winner of the 2011 Hyman Solomon Journalism Award by the Public Policy Forum last year, he delivered a short but brilliant thank you speech that he called “The Five Mantras of Health Care Reform.”  Here’s the text of his important message:

“Mantra” is a Sanskrit word meaning “instrument for thinking.” Mantras are short phrases designed to focus the mind – and we could certainly use some focusing of the mind in the health field.

Mantra #1. Medicine is the easy part of health care

It’s just plumbing with more expensive tools. We need to invest in things that will make the population healthy – education, housing, the environment, community building, meaningful work.

And when people are sick or wounded or demented or disabled, we need to get our priorities straight in caring for them. We need to hold their hands, listen to them, comfort them, help them navigate the care journey, and help them remain members of their community.

And, of course, we need to continue to do good plumbing.

Mantra #2. The law is an ass

We must stop hiding behind the Constitution in such a cowardly fashion. Health is not a provincial responsibility, nor a federal responsibility; it should be a universal goal and a fundamental right.

In the provision of health care, we need to be guided by values, not shackled by anachronistic laws fashioned in – and for – another time.

Mantra #3. To quote the legendary economist John Kenneth Galbraith: “If you don’t count it, it doesn’t count.”

We need concrete health goals, to be guided by evidence, to measure results, and to reward success.

To do so, we need to invest in technology; we need to make a culture of safety a priority; we need to embrace innovation, and we must make patient-centered care a mission, not merely a public relations catchphrase.

Mantra #4. You can’t deliver 21st century care with a 1950s system.

Our health system was designed for the delivery of episodic acute care by physicians, principally in hospitals. Canada gave the world medicare, but that was the 1950s and ’60s. Let’s get over it – and move on. The reality today is that most patients have multiple chronic conditions, and they can be treated in the community.

We need to fundamentally re-shape the system to reflect their needs. That means an emphasis on primary care, on team-based care delivery and on creating a continuum of care.

Our ultimate goal: A good life and a good death.

Mantra #5. Stop whining. Start doing.

The poet Shelley said of his mother-in-law:

“She has lost the power of communication but, sadly, not the power of speech.”

Those words describe well my feelings about far too many of our elected officials, and our business titans, and our community leaders – and my frustration with their seeming inability to articulate a vision for health care.

The lobbing of rhetorical hand grenades like “unsustainable,” “out-of-control spending,” and “an aging population that will bankrupt us” is tiresome and counter-productive – not to mention that these Chicken-Little-like warnings are fallacious.

Leadership is about finding solutions, not embracing failure. Make the system work, don’t assume it is unworkable.

Have we lost sight of the raison d’être for medicare? We brought in medicare because it’s just, it’s fair, it’s efficient, and it’s cost-effective.

We can have these social and economic advantages and be financially responsible. It’s not either-or.

Leadership means not only articulating these values, but giving them life.

No, medicare cannot be all things to all people. For me, the starting point is defining what medicare should cover – and not cover – in the 21st century.

To be deserving of the title “leader”, you have stop whining and start acting.

In conclusion, I want to thank you again for bestowing this great honour, the Hy Solomon Award. It falls in the category of lifetime achievement award, but I want to serve notice tonight that I’m not dead yet. I plan to be around a lot longer.

I also plan to become increasingly cantankerous and obnoxious on behalf of the Canadian public, which is demanding that our leaders embrace and implement health care reform.

As Martin Luther King Jr. said:

“Our lives begin to end the day we remain silent about things that matter.”

Health care matters. We owe it to ourselves to get it right.

©  2011 André Picard

3 thoughts on “Is medicine “just plumbing with more expensive tools?”

  1. Interesting piece. I agree with all except number 3. Much of what matters (quality of life issues) can not be counted and much of what can be measured and counted does not count or matters very little (eg whether cholesterol is up point something).

    • Hello Dr. Joe – I suspect Picard would agree with you especially in the day to day provision of health care in a medical practice. I took #3 to mean more systemic issues (like funding unnecessary screening tests, for example).

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