One, that stands out to me, is the loss of courageous thinking. Not simply repeating what has been concluded by others or committee but truly independent thinking. Fresh eyes and a fresh mind.

After all isn't that what doctors learned as students?

That we have afforded ourselves an education into the depths of biology, physics, chemistry, biochemistry, physiology, anatomy, pathology, mental health, society, ethics, and the list goes on, through which we can engage with patients and families to hear and examine their concerns and advise them.

Or have we learned to become procedure oriented? Best practices, procedures and protocols with champions, managers, forms and apps.

Is our daily practice one of courageous thinking with each patient, and beyond that with each matter, or is it one of rote, repeating the same things over and over?

Have we seen the demise of courageous thinking in clinical practice?

Just listen to how some providers give reassurance to patients asking for details and asking questions, "Don't worry, we are giving you the best care, we are following best practices and protocols", rather than acknowledging the questions and attempting to provide answers.

Have we seen the demise of courageous thinking at the Boards of the Canadian and Provincial medical associations, colleges and health authorities?

What is the status? How has it come to pass? What can be done?

How do we measure it?

Here are three suggestions:

First, we look for openness and transparency.

Is the person who is advising me sharing with me the facts and possible different views so helping me to arrive at decisions, or is this a paternalistic recommendation from the person possibly emanating from others; staff, consultants, and committees?

Second, we look for quality.

What is the quality of the information shared?

Is it overwhelming, copious amounts, with no hope of finding time to review and examine it, leaving no alternative but blind faith in the recommendations and executive summary?

Rather than being self rejoicing, does it fuel a sense of dependency and reluctance to engage?

Year after year of recommendations to accept, "it's the best", and sometimes laden with sweet signing bonuses.

Is it ignoring our education and training and failing to distill complex matters and simplify plans?

Are we selling our souls?

This brings me to the third suggestion.

Third, we look for commitment.

Yes, the person advising us may be getting paid, but where does their commitment lie?

Is the commitment of the doctor or provider to the patient? Or is the commitment of the doctor or provider to the Health Authority or the Provincial Medical Services Plan, to collect and submit information, sometimes including complete reviews for extra payments with only a cursory need for the patient to be present.

Is the commitment of the doctor, as director, on boards of associations to the members or is it to themselves?

Are they committed to the structure of the association and the individuals comprising it's staff, consultants and committees; to speak with one voice, where consensus rules and alternate views are rare or non-existent?

Has it changed?

It's all there in the history of the "Code of Conduct" for Board members of the BC Medical Association (Doctors of BC).

Are there heroes and villains? Without a doubt, but are the real heroes and villains the values and ideals we uphold or not?

What will the future be?

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