I read something a few days ago that I assumed came from the military. I served in the Canadian Armed Forces 31 years ago and the language was similar to what I had seen before. At that time, the goal was to help me transition from a civilian to a soldier, a military professional required to carry out my mission and tasks without regard to personal danger or loss of life.
Among other things the document said: “A primary care provider’s personal circumstances, including their personal health status and responsibilities outside the workplace (e.g., childcare, pet caregiving, etc.), are not relevant factors in discharging a duty of care. Such personal circumstances should be addressed through accessing labour and employments benefits and/or any related labour and employment agreements…”
When I looked more closely, I knew it must be a mistake. Family physicians are independent medical professionals that provide medical services, and we bill the government for the delivery of these services to patients. We are not employees of the government, and we do not receive any benefits. Family physicians are solely responsible for our clinics, our staff, as well as our personal and professional welfare.
The military had used this exact language when I was told that I might not be able to attend my own wedding because I was being tasked out. Needless to say, as much as I love my country, I completed my contract and high tailed it out of there. The Canadian Forces themselves identify the unique position that members of the military profession are in: “In no other profession in Canada, including the police and fire services, can a member be legally ordered into harm’s way.”
Why then are the Ministry of Health and BC Centre for Disease Control telling me about my duty of care? Why are they telling me that my personal health and responsibilities do not matter? Why are they telling me how to behave?
Family doctors are not soldiers. We are not superheroes. We are health care providers and human beings.
Our personal circumstances matter, as they matter for all people. Sometimes these circumstances make it difficult or impossible for us to do our jobs. They are absolutely relevant factors in discharging a duty of care because they are relevant to the human beings doing this work.
Such circumstances cannot be addressed by family physicians through accessing labour and employments benefits or agreements because we have no labour and employment benefits or agreements. We are delivering healthcare to British Columbians in the midst of a global pandemic without funded sick time, health benefits, or the security of employment agreements. At the same time, we are responsible for the healthcare of our patients, the employment and wellbeing of our staff, and the costs associated with running the province’s primary care clinics.
Family physicians have adapted time and again to the changing pandemic conditions over the last 18 months. We have managed wave after wave of COVID-19 along with resultant changes to infection prevention and control measures. Family physicians and other healthcare workers have played a critical role and have been disproportionately impacted by the pandemic. We have been caring for the citizens of BC while also living through it with our loved ones.
Stressors on physicians increased massively during COVID-19, including increased workload, anxiety related to the supply of personal protective equipment, and uncertainty about patient care and health services. We are now seeing the results. A published survey of physicians working in Vancouver found that the prevalence of burnout was 68% among all respondents, with 21% reporting that they were considering quitting the profession or had quit a position.
The issue is more than exhaustion; it’s about moral distress. We face unprecedented and challenging working conditions in a stressful environment, with expectations and demands that cannot be met. We are losing hope about our ability to deliver quality care in a broken system.
Coming out of the pandemic, we need to support healthcare workers, not berate them. We need to focus on the health and working conditions of doctors, nurses, and other healthcare workers. Rather than only celebrating “healthcare heroes,” it’s time to support healthcare humans.
Dr. Toye Oyelese
BC Family Doctors