I read this op-ed by Dr. Louis Francescutti on Tuesday evening after a long day. Perhaps it was because I had spent the day trying to convince adolescents’ parents that scolding never works, perhaps this tone still grates on me since I was an adolescent, but whatever the reason, Dr. Francescutti’s nagging that my work was not good enough and I wasn’t accountable set me off.

I spend my days trying to convince youth that my suggestions are not meant to ruin their lives, but rather to treat their auditory hallucinations or their anxiety or their depression. I cajole, beg, coax, reason, flatter, give articles, demonstrate apps – in short, I’ll do anything to get my young patients to do what they must to be better. When they are most despondent, I say, “We’ll never give up. We’re going to keep going until you feel better.” Persistence is my best and worst quality.

There is one thing, however, that I never do. I never scold people, never lecture. I learned when I was 23 years old and just starting my residency in Psychiatry that scolding doesn’t work to change anyone. The above rant is my way of commenting that the tone of Dr. Francescutti’s opinion article on medical professionalism did not open my mind to his overall message that greater accountability is needed in the medical profession.

Sometimes a writer will seek to make a point by being provocative. The kindest readers believed this to be true of Dr. Francescutti. Again, my experience has taught me to strive to be persuasive and to find the points of consensus among people who might otherwise disagree. The research in my discipline, psychiatry, shows that this model works best in circumstances where there is conflict or tension and where the goal is to help one person see another point of view, often a hurtful point of view.

In many parts of Canada today, provincial governments are scolding doctors in much the same manner as Dr. Francescutti scolded us. Some commentators suggested that doctors are overly sensitive but mostly, I believe, we feel hurt. The partner we want to have in transforming the healthcare system, the government, has rejected all of our suggestions and, since it can, has decided it is just going to set up the system as they think is best. I can certainly attest that, in travelling around Ontario talking to doctors in every specialty, of every age, after I hear how angry doctors are, I do hear how hurt they are that their work is so underappreciated and undervalued.

When the atmosphere within medicine is tense, filled with mistrust and hurt, tone is even more important and I believe that Dr. Francescutti overlooked this in his comments. In times like these, people need their leaders to say,

“Remember who you are and what you do for your patients.”

“Yes, we need to do more, but don’t you always do more?”

When you’re encouraged, no matter how bad things are, you can say, “I didn’t quite get that, Dr. Francescutti. Could you say it again, maybe a bit differently? I think you’re making some good points.”

Health care transformation should be a dialogue: What do you think we need to do?

2 thoughts on “Medical Professionalism II

  1. Pamela Velos says:

    Majority of MDs have no input and certainly no control re healthcare system operation, performance and much needed changes. MDs have been subjected to useless, financially expensive and wasteful ideas that have been tried for years and only make things worse.
    Only those who grab the bull horn as Francescutti has done, and promote themselves as consultants who have the answer, loudly denigrating their colleagues, saying what governments like to hear, have any influence on what happens next. Very demoralizing. The last thing we need is one of our colleagues telling us very publicly that we’re the problem.
    Thank goodness for social media, because in the past we wouldn’t know who was selling us out, nor would we have a way to counter their opinions.

  2. Andrew Fenus says:

    Possibly too subtle for a person whose natural proclivities seem to be bullying and scolding! Good work, nonetheless, Dr. Beck.

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