A prominent doctor at the MUHC says the institution's attitude towards its patients desperately needs to change - and the impending opening of the new superhospital building would be a good time to start.
Dr. Sherif Emil, the head of Pediatric General and Thoracic Surgery at the Montreal Children's Hospital, tells CJAD's Tommy Schmurmacher a new outlook is needed toward the people using its facilities.
"The environment is one where the patient is taken for granted," Dr. Emile says. "The patient is sort of lucky to be there, lucky to get an appointment, rather than seen as the reason for our existence as an institution."
He says it's a symptom of a larger problem in health institutions across Quebec, and he points to several instances where he's needed to receive health care at other institutions.
"The care itself, the medical act, was fine. There was no malpractice involved. But the attitude, the [foul] language, the lack of introductions, the lack of treating the patients like human beings standing in front of you. People who act like that — I'm just curious how they would feel if it was their brother of sister or wife or child right there in front of them.
'It shouldn't be a big philosophical or academic issue. It's simply treating people the way you'd want to be treated when you're most vulnerable. That's lacking on a daily basis in the environment of many hospitals affiliated with McGill, and I'm sure many of the other hospitals."
Part of why there is such surliness among staff, Dr. Emil says, is that no one will get them in trouble, and the unions often protect them regardless of what they do - or don't do.
Opinion: Will a new MUHC be a renewed MUHC?
Sherif Emil, Special to Montreal Gazette
The MUHC (McGill University Health Centre) super hospital in Montreal,
Vincenzo D'Alto / Montreal Gazette
I recently took my first stroll through the new McGill University Health Centre, which will become my new professional home in a few weeks. As chief of pediatric general and thoracic surgery at the Montreal Children's, I will be moving into what can be best described as closet space with no windows. I am allowed to bring very little of my current office contents with me, and I will have to adapt to a generic space void of any personal effects.
I will do just that, because the building is truly marvellous for patients and families. Rooms are large and private. Facilities are state of the art. Families will be able to stay comfortably with their children during their most vulnerable days. Play areas will allow children a respite from disease, and all that is used to cure it.
However, as I walked through the beautiful building, a question echoed in my mind. Will the new MUHC be a renewed MUHC?
I am a proud McGill graduate who received the best gift anyone can hope for from the university and its affiliated hospitals: the ability to serve as a children's surgeon. Seventeen years after graduation, I returned to the Montreal Children's from my native California to lead pediatric surgery. My return was largely driven by a bond to McGill that never broke. This institution taught me not just the science, but also the art of medicine.
However, since my return, I have been increasingly disappointed by what has happened to the MUHC and McGill's other affiliated teaching hospitals. Although superb medical care is delivered every day by hundreds of skilled and selfless professionals, an unfortunate culture of indifference has crept into the hospital environment. The patient is often seen as a burden, rather than the organization's raison d'être. This is manifested hundreds of times daily - in the technician who uses foul language, in the clinic clerk who speaks rudely to patients, in the nurse whose every move is saturated with frustration, in the physician who belittles the patient's concerns or never returns their messages, in the administrator who fails to listen to those in the trenches. We have been relatively immune from this at the Children's, but we are about to become citizens of the superhospital, and it worries me.
I have repeatedly experienced this malaise when I have sought care as a patient, a patient's relative or a patient's friend.
I waited eight hours in a Jewish General clinic to see a physician. When I expressed my horror, the response was: "Welcome back to Canada." The next day, I contacted the director of professional services, only to be told that is not within his purview.
During a visit to the Royal Vic ER for a very distressing emergency, my wife and I were never addressed by name or treated with any degree of professionalism. None of our caretakers - nurses, residents, doctors - bothered to introduce themselves or clarify their roles. Simple introductions have become a luxury. When we took the time to submit a detailed report regarding another episode of blatantly substandard care that compromised our outcomes, we received a letter full of denials and excuses many months later.
When my wife confronted a clinic secretary at the General who was engaged in a profane telephone conversation within hearing distance of several patients, she was told to mind her own business.
During an outpatient operation at St. Mary's, the orderly taking me to the OR said, "I guess someone %*#@'d up," after I told him that the wrong procedure had been written in my chart. An hour later, I was in a recovery room listening to a torrent of four-letter words coming from an orderly who could not be seen in the ER for a needle stick. This was in a Catholic hospital that was an example of compassion and humanity during my medical school years.
These are not isolated incidents. Hundreds of patients have shared similar stories with me over the last six years. If physicians who work within the system experience this, what does the general public experience?
Since the Arthur Porter disaster, the institution's leaders have invested most of their energy on trying to contain the damage, and accommodate governmental regulations that may decrease our ability to care optimally for the whole patient. I don't envy them. They have extremely difficult tasks to perform in a highly dictatorial health-care environment - a sometimes intimidating environment, where voicing concerns can result in threats of reprisals.
Healing, in every sense of the word, is where medicine starts and where it ends. Our culture of healing is suffering. And no amount of brick or mortar, not even $1.3 billion worth, can induce a culture change. For that, our leaders first have to admit that we need a change of culture.
When I've raised these concerns in town hall meetings or with MUHC leaders, the answers often were "join a committee," "we will get back to you" or "you're too harsh on us." Even now, I can imagine a defensive response to this article. For those who will be angry at me, I have only this to say. I care just as deeply, or even more, about this institution as you do. I owe my success to its existence. And so, let me provide a practical suggestion that costs little or nothing. The leaders of McGill's hospitals can introduce a patients' bill of rights coincident with the move to the new hospital.
Here is a draft:
Every patient receiving care at the MUHC has the right to:
Be addressed by their name in a courteous manner.
Receive care in a healing environment free from inappropriate language or actions.
Receive patient and family-centred care that addresses the biological, social and psychological aspects of their disease.
Privacy at all times.
Know the names and roles of all those involved in their care, especially the team-leader or physician in charge.
Be able to reach their physicians and receive responses to their messages.
Receive continuity of care and follow-up on pertinent health issues within a reasonable time frame.
Receive all necessary information regarding benefits, risks and alternatives of treatments.
Have their concerns addressed in a prompt and transparent manner.
Receive feedback on their concerns in an accountable manner within a reasonable time frame.
Let this bill of rights hang in large bilingual posters throughout the hospitals, so that all of us, patients and staff, know what is expected. This does not have to be seen as a burden. This can be a cause for all to rally around: to set out to be an example of cultural transformation in medicine for Quebec and Canada.
McGill medicine is a world leader in whole-person care and medical professionalism, but let us be true to these principles within our own teaching hospitals first.
There is no better time than now for the new MUHC to become a renewed MUHC.
Sherif Emil is director of the division of Pediatric General and Thoracic Surgery at the Montreal Children's Hospital of the McGill University Health Centre.