Canada DOESN’T have a race problem… grading on a curve

I make a lot of hay on this blog by pointing out negative things in Canada, the country I love. As a blog about race and racism (with some gay shit sprinkled in there for flavour), I go out of my way to find, illustrate and criticize things that happen here that are to the detriment of minority groups. Reading my writings here, some may walk away with the impression that I think that Canada is a particularly bad place to be a person of colour (PoC), a gay person, a woman, or member of another disadvantaged group. This is simply not true.

Part of the reason I am so passionate about Canada and the issues facing Canadians is because I recognize that our country has the overwhelming potential to model positive values to the entire world. Perhaps uniquely, Canada is making the experiment of multiculturalism work and has found a way to maintain a level of civility and understanding that transcends any kind of formal legal protection, but that has simply become a feature of our national identity. How could I approach such an important issue with anything less than my full attention and fervor?

However, all the doom and gloom that I cast around may serve to distract from the fact that Canada is a really amazing country:

Canadians are hard-working, great readers, the most tolerant people in the developed world, and enjoy more “positive experiences” than everyone but Icelanders, according to a new analysis of social trends released here Tuesday. “At 84 per cent on average, Canadians report the highest community tolerance of minority groups — ethnic minorities, migrants, and gays and lesbians — in the OECD, where the average is 61 per cent,” the report said. Residents of the U.S., Australia, New Zealand and the Nordic countries were among the most tolerant, while those in southern and eastern Europe, as well as Japan and Korea, were less tolerant.

This is something to celebrate – among countries in the developed world, Canada still stands out as a place where minority groups are, by and large, respected and tolerated. The kinds of racial strife and discord that seem to run rampant in many developing countries (particularly those in the Middle East and Africa) are completely foreign to us, and aren’t likely to degenerate to Rwanda or Bosnia levels ever. We should be happy about this.

However, and I cannot stress this enough, we should not be satisfied. It’s wonderful that we’re at the top of the OECD, but racial and cultural tolerance are not a competition. We are not trying to win the “world’s nicest people” award, at least we shouldn’t be. And while accolades are nice, it is dangerous to judge our successes by the failures of others – downward comparisons are a bitch.

While we are doing very well, we can still do better. By highlighting and discussing the issues that I do, I am trying my best to keep these conversations from getting swept under the rug of complacency. There are many areas to improve, and by doing so we can show the rest of the world how they can make the same improvements.

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Conservative Party shows its “true colours”

Nobody likes being called racist. The word carries with it so much baggage and negative connotation that even to be painted with the appellation does some serious psychological damage. Nobody reacts more strongly to the label than do those who identify as conservative. The two words, conservative and racist, have been paired so often as to become synonymous. While conservatives, bristling under the accusation, tend to blame this conflation on liberal bias against the long-suffering conservative minority, those of us that actually pay attention to these kinds of things tend to notice stuff like this:

An email sent out by a Conservative campaign staffer in a Toronto riding seeking people in “national folklore costumes” to appear at a photo-op is an insulting use of so-called ethnic voters as props, critics say. Canadian Arab Federation president Khaled Mouamar received an email late Tuesday from a Conservative campaign staffer for the Etobicoke Centre riding asking “representation from the Arab community” for a Thursday visit from Stephen Harper. “Do you have any cultural groups that would like to participate by having someone at the event in an ethnic costume? We are seeking one or two people from your community,” the email signed by Zeljko ‘Zed’ Zidaric said.

This is simply run-of-the-mill political pandering, to be sure. Every party targets minority voters, as they are a growing demographic with increasing political power. There is nothing wrong with looking for ways to increase one’s visibility in minority communities, and the above quotation speaks to the Conservative Party’s strategy to do just that. However, there is a great deal to be learned here about how members of the party view members of these communities. As far as Mr. Zidaric is concerned, members of minority communities are props to be posed in front of cameras, and then promptly forgotten about:

The Conservative government cut off more than $1 million in funding to the Canadian Arab Federation after the president expressed “hateful sentiments” toward Israel and Jews, according to then immigration minister Jason Kenney. “So suddenly now we exist as props for a photo op?” said Canadian Arab Federation president Khaled Mouamar. “This is hypocrisy.”

The way that political representation is supposed to work is that members of special interest groups are courted for their support during campaigns. The price that politicians pay for the support is to move political influence to the benefit of those groups. For better or for worse, this is how groups of people get action from their political representatives beyond the list of campaign promises. However, if you don’t value the people whose endorsement you’re courting beyond what they can do for you in terms of votes, then you’re going to use them like props.

And so, to those of us that have watched the pattern of disrespect toward minority groups from conservative politicians over the years, statements like the above yield a total lack of surprise. Or, statements like this:

Donald Trump once again made headlines Friday over comments he made about President Barack Obama. This time, Trump steered away from the president’s citizenship, suggesting that votes Obama received in the 2008 election were race-based. “I have a great relationship with the blacks,” Donald Trump said on an Albany, N.Y. radio station Thursday morning. “I’ve always had a very great relationship with the blacks. But unfortunately, it seems the numbers that you cite are very, very frightening numbers.”

To a guy like Trump, they aren’t black people, they’re “the blacks”. They’re (we’re) a monolithic group that can be meaningfully defined by the colour of their skin. He doesn’t have to have a relationship with black people, as long as he has a good relationship with “the blacks”. The Conservative Party, at least the ones running the campaign in Etobicoke Centre, are not concerned with forming political partnerships with minority groups – they want photo ops with “the ethnics”. Having Jason Kenney spearhead outreach to communities with large immigrant populations is kind of like having Fred Phelps lead the Pride parade.

So it was a poor choice of words, but it reveals the underlying attitude, and something far worse. Political theatre aside, statements like Mr. Zidaric’s show that despite growing political clout, members of minority communities are considered second-class citizens. Many of the groups that spoke to the media articulated this position:

Shalini Konanur, a member of the Colour of Poverty campaign that released the video, said while the Tories have overtly pursued the ethnic vote, all major campaigns have been guilty of it. “That term, the ethnic vote, is quite a divisive term,” said Shalini Konanur. “We’ve always had the view that we’re all Canadians. We have Canadian issues. And those issues are larger than the “ethnic communities” or the racialized communities that we come from.”

It’s an all-too-real and disappointing fact that many people of colour (PoCs) in Canada are constantly made to feel as though they are guests in someone else’s home rather than members of the family. Having dark skin in Canada invariably means fielding an incessant stream of unsolicited questions about “where are you from?”, as though being white in Canada is the default and any deviations must be investigated. Most of us (if I may speak in such generalities) are capable of treating such interrogation as harmless and well-intentioned despite being tiresome, but to have our major political parties treat us this way is disheartening to say the least.

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“Liberation Therapy” saga continues

A while back, near the beginning of this blog, I brought to your attention a new potential treatment for Multiple Sclerosis – a severe degenerative disease. The treatment, pioneered by an Italian doctor by the name of Zamboni (I couldn’t make this stuff up – I’m not that creative), is referred to as ‘liberation therapy’, and involves using venous angioplasty (balloons) to clear blockages.

I expressed my skepticism about this procedure at the time, saying that I generally doubted the claim, simply because there’s little connection between the circulatory and nervous systems. It seemed improbable to me, but I was happy (and encouraged others) to wait and see what the evidence says – what happens when we observe patients under controlled circumstances with adequate followup?

Well, it seems that this happens:

People with multiple sclerosis may show blocked neck veins as a result of the disease rather than as a cause, a large study published Wednesday suggests. The findings cast doubt on the theory that blocked or narrowed veins are a main cause of MS, study author Dr. Robert Zivadinov of the University of Buffalo said. The findings published in the journal Neurology were consistent with thinking that the condition — also known as chronic cerebrospinal venous insufficiency, or CCSVI — is more common in patients with multiple sclerosis but not to the degree first reported by Italian doctor Paolo Zamboni.

Please don’t mistake me – I get little pleasure from being right in this case. People close to my family have lived with MS, and I would much rather be wrong if it meant that people could undergo a simple medical procedure and achieve relief from their symptoms. However, the facts are the facts. In this case, the facts do not support the claim that blocked veins contribute to MS, and there is consequently no reason to suspect that alleviating the blockages will have any effect on MS patients.

This study is, perhaps, not the definitive ‘smoking gun’ that liberation therapy is not effective, but it certainly does cast doubt on the original hypothesis of its efficacy. One of the chief components of the scientific method’s accuracy is the ability to reproduce results in a variety of locations. If some event only occurred once, and cannot be observed by others performing the same procedures as elicited the original event, then serious doubt is cast on the original observation. It is far more likely, in a case like this, that there was some flaw in the original observation. This is a good thing – it prevents us from making decisions based on bad information.

However, sometimes we are hell-bent on making those decisions no matter what the evidence says:

The New Brunswick government says it will still help multiple sclerosis patients gain access to therapy to open narrowed neck veins, even though a new report on the procedure is raising concerns. New Brunswick Health Minister Madeleine Dube said that could be debated in the medical community for some time. “But while this is being researched and debated, those people still need support and we are committed to that,” she said Thursday.

There is nothing strictly incorrect about Minister Dube’s statement; however, she and I do seem to have a disagreement over what the word ‘support’ means. Under my definition, it means giving sick people the best care possible, guided by scientific evidence and good practice. Under her definition, it means giving patients whatever they ask for to make them feel better. While I am all for making people feel better, I do not subscribe to the philosophy that cutting people open to elicit the placebo effect constitutes responsible medical care.

For all intents and purposes, there is no reason to suspect that liberation therapy elicits anything stronger than a placebo effect. For every anecdote that states an improvement in symptoms, there is one that talks about how the symptom relief has faded over time. And among those anecdotes, there’s more from people who keep chasing the bad medicine like an addict fiending for a fix:

The monitoring is for Canadians such as Caroline McNeill of Langley, B.C., who travelled to California to have her neck veins reopened using balloon angioplasty. She has had the procedure twice before, and noted lingering benefits such as feeling less tired. “The numbness on my fingers has started to come back again, and I have really bad dizziness and vertigo,” McNeill told her doctor. She plans to return to Newport Beach in Southern California for a stent later this month.

It doesn’t surprise or confound me in the slightest that people who experience a temporary benefit would go back to the well, so to speak, and give the therapy another try. When the current regimen of therapies are only partially effective and carry a whole host of adverse effects, it’s completely reasonable to leap at any alternative. This is why these ‘alternative therapies’ (which is a really stupid name) are so dangerous – they make wild promises that offer benefits that have no scientific backing whatsoever. The people to whom these promises are made are often desperate for any relief, and will try just about anything no matter how dangerous it is.

This is why people who advocate “health freedom” make me so angry – there is no way you can expect people to be dispassionate and conscientious consumers, weighing the plusses and minuses of different options, when the stakes are so high. People’s lives and day-to-day well-being hang in the balance, and they’ll jump at any chance to feel better. This is why our policy should be based on scientific evidence, not the whims of politicians and the desperation of sick people.

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Special feature: The Hate Speech Debate

Many of you know that I am a volunteer with the Vancouver branch of the Centre for Inquiry. One of the regular events that CFI Vancouver hosts is called Cafe Inquiry, which is a moderated group discussion on a variety of topics. This past weekend, I was honoured to be asked to moderate a discussion on a topic of my choosing. Given that I’ve previously given a presentation on the subject of racism and skepticism, I thought I would try and tackle one of the other tent-poles of this blog: free speech.

The issue I chose to present for discussion was Canada’s hate speech laws, and whether or not they are a good thing. This is a topic for which there are strong arguments to be made on both sides, and I thought it was particularly well-suited to a group discussion rather than a didactic presentation. I brought this question to the group, as well as a number of other questions that were of particular interest to secularists and atheists.

My purpose at this event was to moderate a discussion rather than to present my own personal opinion. While I do have a position on this issue, it was not my place to defend that position to the group, although I was prepared to be the only one in the room to advocate it. Luckily, there were an abundance of opinions on both sides of the issue, allowing me to fulfill my role as facilitator rather than partisan. I gave a brief presentation outlining the parameters of the debate, and then tried to step back and let the discussion take its course.

I’ve posted the video of the discussion, which took place over 2 hours. The battery on our camera died before the end, but I will summarize the group consensus. You can see the slides here. (Please note: Having problems with Youtube, and have to re-up all my videos. Process is taking longer than I would have liked – hopefully it will be resolved by the end of the day, but my apologies for the fact that this isn’t ready on time).

Overall, I was very happy with how the discussion turned out. I was disappointed that the group didn’t spend more time talking about the effect that hateful speech can have in terms of discrimination, but other than that I think we hit all of the high points. We took an informal poll at the beginning, asking people whether they supported laws against hate speech. As I suspected, the number explicitly supporting them dropped from 6 to 4 (out of about 20 people) – many people maintained that they were “fence sitters”, which is really the only logical position to have in a discussion that has such depth and difference of opinion. The argument that seemed to hold the most sway was the open question of whether or not hate speech laws actually reduce hate speech, or if they are redundant with the social pressures that do a pretty good job of accomplishing that already.

While I am a proponent of unrestricted free speech, even hateful speech, I am cognizant of the fact that there are a number of reasons why it is desirable to reduce the amount of hate speech in society. Primarily, we have to be concerned with the safety of others, and hateful speech can and does lead to hateful actions against people. Secondarily, hate speech leads to systemic discrimination, which violates the idea of the rule of law. Finally, hate speech is morally wrong, and those who violate moral precepts should be punished.

My problem with outlawing unpopular speech is that it often doesn’t work – by setting up “dog whistle” phrases for certain prejudiced attitudes that don’t qualify as “hate speech” but communicate the same ideas, we drive attitudes underground where they can fester. Putting bigotry out in the open allows us to deal with it, and gives us opportunities to learn from it. Secondarily, I am concerned by the arbitrary way in which we select which groups are protected by these laws. I can see the same arguments about “hateful speech” used to censor legitimate criticism of religion, or criticism of any majority group just as easily as a minority group. The ‘victim card’ that majority groups like to play to cast themselves as on the receiving end, rather than behind the wheel, of discrimination will surely see them deputize hate speech laws in this way. I am not comfortable with legitimate criticism being cast as hate in any circumstance, and I am concerned that these laws will be used to accomplish this.

Anyway, all that being said, I think it was a great event and I really enjoyed being part of the conversation. Enjoy the video.

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Join me in person tomorrow at SFU!

Hey all,

I realize this is last minute (stupid me for not giving you a heads up) but I will be leading a discussion on hate speech laws in Canada tomorrow morning (Saturday, April 16th) at 11:00 at the SFU Harborfront Centre. Here’s the event blurb:

Hate speech laws remain a controversial issue in Canada. When contrasted with the very libertarian First Amendment to the Constitution of the United States, Canada’s free speech laws are curtailed in such a way that permits the prosecution of hate speech beyond specific incitement of violence. Advocates of unrestricted free speech point out that such restrictions are arbitrary and prone to subjectivity. Proponents of hate speech laws point to events like the Holocaust and the genocide in Rwanda as examples of times when hate speech directly led to horrific violence.

Do hate speech laws protect minorities, or simply drive controversial ideas into the underground? As a minority group, are atheists/agnostics/humanists more likely to benefit from legal protection, or be prosecuted for speaking out against religion? Do skeptics have a particular responsibility to advocate or oppose restrictions on speech? Is there a role that science can play in this discussion? Is there a difference between anti-blasphemy laws and anti-hate laws?

Many of you are already attending, but maybe there are some lurkers or non-CFI members who’d like to come out of the woodwork and participate in the discussion in person. I am going to try and get video to post online, but since most of the talking will be done by those attending the event (rather than yours truly), it may not be worthwhile.

Anyway, hope to see some of you tomorrow!

Movie Friday: The Greatest Story Ever Told

Someone back in the time when there weren’t a lot of phrases that had been popularly coined began calling the Bible “the Greatest Story Ever Told”, and it caught fire. Despite the fact that the Bible is not a story at all (unless you consider it a bizarre, rambling and bloody one that delves into non-sequiturs every chapter or so), it’s far from the greatest. There is much more insight into the human condition from reading Les Miserables or Roots or even some of the better sci-fi/fantasy titles out there than there is to be found in the Torah. Even if you want to stay in the realm of religion, the Bhagavad Gita is breathtakingly beautiful, or even Milton’s Paradise Lost or Dante’s Divine Comedy is better told story than the Bible.

However, there is some appeal to a story that tries to explain the existence of the world, humankind, and to explain how we got here. The Bible gives us a narrative of how that happened – the problem being that it is all either outright fable or sexed-up oral history. David Christian has a much better story:

This one has the added bonus of being true. While it lacks heroes and struggles between good and evil, it does a very good job of both explaining how we got here, and putting our monstrous self-importance in a context that is sorely needed.

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The beatings will continue until morale improves

I’m not a parent, so this hypothetical situation might ring a little hollow, but let’s say you caught your 6 year-old daughter stealing cookies. You had indisputable proof of her theft. Instead of denying it, or looking apologetic, she simply looks you in the eye and says “yes, I stole the cookies, and I will continue to do so given the opportunity.”

Or perhaps you’re an employer who catches an employee making pornographic films on company time. “Yes,” he says “I filmed myself porking some low-rent prostitutes on your desk. However, I am planning on filming myself porking them on other people’s desks too.”

Would you think you’d slipped into Bizarro world? Nope, you’re just a voter in Quebec:

It is “normal” for Conservative ridings to receive more cash from Ottawa than those with opposition MPs, a high-profile Tory candidate in Quebec said Thursday. Larry Smith, a former CFL commissioner now running for the Conservatives in Montreal, said it is part of the political process for governments to be favourable to their supporters. The Tories believe Smith represents their best chance at winning a seat on the island for the first time since 1988. In making his case, Smith said his riding in western Montreal could expect more federal funding if it voted Conservative.

Kinda takes the wind out of the sails of your stinging accusation of vote-buying, don’t it? “Why yes, I am buying votes. You should vote for me, so that I will give you more federal money than if you vote for someone else.” It’s nice to see that the Conservatives don’t even have the capacity to feel shame anymore.

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Systematic abuse? Not our problem…

I’ve spoken before about the value of official apologies for historical wrongdoing. While those on the right will squawk that it’s just a drummed-up excuse to make (group X) feel guilty for being (X), the real consequence of apologies is to take an opportunity to own one’s past. There is the old aphorism that “those who do not learn from history are doomed to repeat it” – basically the longer we continue to deceive ourselves about what is in our history, or try to pave over the bad things, the more likely we are to make the same mistakes again.

But then there are those times when we actively refuse to deal with history:

The government cannot be held legally liable for abuses during the Mau Mau rebellion against British colonial rule in Kenya, a court has heard. Ministers want a claim for compensation from four elderly Kenyans struck out by the High Court in London. The claimants say they were assaulted between 1952 and 1961 by British colonial officers in detention camps. The Foreign Office says Kenya had its own legal colonial government, which was responsible for the camps.

This is the kind of legal jiu-jitsu that only a mob lawyer could really feel good about. The court did not deny the abuse took place, or that the men were victims of the abuse. They just think that the men should go after the real culprit – the colonial government that no longer exists. Never mind that the colonial government was established by the British Empire, for the sole purpose of stripping Kenyans from the right to self-government. Never mind that it is impossible to sue the colonial government since Britain relinquished control of the colony. No, these aren’t relevant details to the case.

What is relevant is that England can avoid having to own up for its shocking history of colonial atrocities committed against military and civilians alike. It’s like something out of The Shawshank Redemption, where Andy Defresne creates a legal identity for a fake person that can never be prosecuted, because he never existed. The colonial government, under the direction of Britain (I can’t, in this context, bring myself to refer to them as Great Britain), committed abuses and was then dissolved at the end of the colonial era. Nice and tidy way of evading culpability, innit?

The judge heard Mr Mutua and Mr Nzili had been castrated, Mr Nyingi was beaten unconscious in an incident in which 11 men were clubbed to death, and Mrs Mara had been subjected to appalling sexual abuse.

Not relevant.

David Anderson, professor of African politics at Oxford University, who has examined some of the withheld documents, said the files proved Whitehall not only knew what was being done to Mau Mau suspects but also had a part in sanctioning their ill-treatment.

Not relevant.

The government says too much time has elapsed since the alleged abuses.

Ah, now see that’s a reasonable argument! Crippling and ongoing psychological trauma? Not our problem – that shit’s old news! Oh wait, you want an apology? Yeah… take it up with the colonial government – that’s who did it, right?

Oh wait, they don’t exist?

Not relevant.

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Belief in a loving god? Go to hell!

I spoke earlier this week about the religious preoccupation with the just world fallacy – the unwarranted assumption that there is a force for justice that exists to balance the world. It is described in great detail in a variety of ways – reincarnation, paradise vs. torment, divine providence, supernatural battles between good and evil – all with the underlying assumption that there is a just and ‘reasonable’ explanation for the disparities we see all around us. The version that has been adopted by Christianity (I say ‘adopted’ because the concept of Satan as we understand it today was borrowed from the Zoroastrians) is particularly vivid.

And now someone done gone and messed with it:

Evangelical megachurch pastor Rob Bell told a Nashville audience he did not anticipate the firestorm he would stir with his book that questions the traditional Christian belief that a select number of believers will spend eternity in heaven while everyone else is tormented in hell. Bell said that he not only didn’t set out to be controversial, he had no idea his bestseller, Love Wins, would bring condemnation from people like Southern Baptist Seminary President Albert Mohler, who claims Bell is leading people astray.

While it might seem ridiculous, this is no trifling matter to many believers. Removing the idea of hell spits in the face of the myth of ultimate justice. If good people are not rewarded in excess of the evil people, what sort of justice is that? If faith and adherence to the bizarre moral strictures of the religious tradition are not rewarded, at least there should be some punishment for those that stray from the flock. If this doesn’t happen, then what sort of justice is at work here?

But of course there is no ultimate justice, either in heaven or in hell. They are both a bunch of cobbled-together images borrowing from Zoroastrian, Jewish, Greek and Islamic folklore. As such, it makes little difference (in a realistic sense) whether you teach that YahwAlladdha is all-encompassing love, a jealous and vengeful dick, or a fluffy bunny that craps rainbows. They’re all equally inaccurate descriptions of a non-existent entity. From a theological sense, however, it makes worlds of difference. If people don’t walk around fearing ‘infinite punishment for a finite crime’ as Christopher Hitchens would say, then what possible motivation could you possibly have to avoid sin?

This is, of course, a problem that seems to uniquely plague the religious. I would like to think and believe that religious people, by and large, don’t go around intending to commit atrocities but stay their hand only because of belief in a punishment meted out later after they die. The very idea flies in the face of my experience of every religious person I’ve ever met (in person at least). Hell seems to be one of those things that is useful for scaring children, like the Boogie Man or monsters under the bed, but can be discarded once one reaches the age of reason. Most serious theologians don’t even believe that there is a literal hell, at least when you manage to pin down exactly what they do believe – theologians are a slippery bunch.

So if fear of hell doesn’t carry any moral force with it, what is the harm in writing a book that says essentially what most of ostensible Christians already believe anyway? Why is it such a heresy to decry the idea that unbaptized babies, anyone who has ever thought about having something her neighbour owns, and the billions of people who have lived and died brought up in other faiths, that all of these people deserve an everlasting horrific punishment? Are Christians really that vindictive?

My suspicion is that, like most absurdities that accompany religious fervor (the religion of peace responsible for ongoing mass civilian deaths, for example), Christians just haven’t thought that hard about it. Either that, or they can only follow the path of rational thought so far before they reach the precipice of faith and have to make a decision about whether or not to follow the version of faith they’ve been taught. It takes a great deal of courage to challenge your entire world view, and most people aren’t that brave. I honestly do believe that even the most fervent, tongues-speaking, Isaiah-quoting, dyed-in-the-wool evangelicals are, at their core, decent and moral people who have just got some crazy ideas about fairness and justice.

But when someone begins to knock down the edifice of your closely-held beliefs, or worse, when someone convinces your children to think differently from you, and you’ve been told that even the slightest deviation from the prescribed path means unspeakable horror for all eternity, you’ve raised the stakes far beyond reasonable disagreement. It then becomes a clear threat not only to your beliefs, but to your soul as well. It is at that point that people stop reasoning and let the feelings take the wheel, which is never good for the side that isn’t willing to kill for what they believe in.

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Patient-view vs. provider-view health care

This will be somewhat of a digression from the usual fare here at the Manifesto. While I moonlight as a commentator about religion, race and free speech, the bulk of my daylight hours are spent applying my skeptical gaze to the Canadian health care system. The story I want to talk about today doesn’t really have much to do with the regular topics here, but I found it interesting, and last time I checked this was my blog :P

Health care is a complex and multifaceted beast that has unique challenges. In many senses it can be thought of in terms of a business – patients are ‘customers’, health care practitioners are ‘employees’, and health is the ‘product’ that you are ‘selling’. This analogy breaks down pretty spectacularly for reasons I will go into later, but for the time being it is helpful to think of it as a business. What would you call something like this?

With the NHL playoffs just around the corner, the College of Physicians and Surgeons of B.C. has issued an advisory to the province’s 11,000 doctors, reminding them that talking about anything other than the task at hand in the operating room is unprofessional and inappropriate. The matter arose after the college received a complaint from a patient who heard his surgeon talking hockey with the scrub nurses during the elective procedure for which he was given a local, not a general, anesthetic.

That’s shitty customer service, right? Imagine you went to the bank, and while they were helping you at the counter, the tellers were talking about the latest gossip about Justin Bieber? You’d be annoyed with their level of unprofessionalism, to say the least. While your business might be completely routine for the tellers, so the point where they didn’t really have to concentrate much to do it, it’s still rude to chat about non-related matters while you’re providing a service to your customers.

This issue highlights an interesting dichotomy in the provision of health care – that of ‘patient-view’ and ‘provider-view’ types of administration. In patient-view administration, the goal is to provide the highest quality services to each patient, and to construct the system in such a way as to maximize the ease that patients move through the system. Provider-view administration seeks to maximize the efficiency of the system, such that the largest number of patients can be served as quickly as possible.

It brings to mind one of my favourite examples of what I call “first-floor/third floor problems”. Picture a hospital that routinely sees patients in the radiology department. In order to streamline the process, patients are routed through offices on the first floor when they come in the door. This ensures that people don’t mistakenly go to the wrong department, and that all of the relevant information is available about each person before they see a doctor. Very efficient, right? Well imagine that the third floor also houses several inpatient beds. A person receiving inpatient care on the third floor that needs a scan needs to go to the first floor for processing, and then back up to the third floor to receive their scan. From a patient-view perspective, this is a huge waste of time and resources, but from a provider-view perspective it is an unfortunate consequence of something that is otherwise a good system.

Similarly, we have an example here of surgeons who, from a provider-view perspective are providing a high-quality service in a quick and efficient way. These are specialists that can perform routine operations with a nearly-perfect success rate, and their chatting does not affect that success in any meaningful way. However, the individual patient doesn’t give a rat’s posterior – she wants the undivided attention of her health care provider.

The part that makes this issue even more interesting is the level of emotional investment in an operation versus at a bank counter. A rude teller is annoying, but even if they screw up it’s no big deal. A distracted surgeon is potentially fatal to the patient, a fact that is made even more urgent considering the expected power dynamic between patient and physician. This is where the business model breaks down – health care is a need that has components that are not within the comprehension of the vast majority of people (including those involved in providing said care). To expect market forces to operate in the same way as they would in a bank (go to a different teller if you don’t like the one you’ve got) is simplistic, because it neglects the phenomenon of need. This will undoubtedly be the topic of a post to follow, but I am butting up against my word limit already and it’s too big to flesh out in the space remaining.

There is a careful balancing act of patient- and provider-view arguments that is required to deliver high-quality and sustainable care. Patient-view care is incredibly resource-intensive to manage, as it requires the consideration of each individual patient’s unique situation. Provider-view care can neglect the non-medical welfare of the patients as they move through the system, and can be quite myopic when it comes to the satisfaction of users of the health care system, thus undermining public support for the system.

In my own small way, I look at this issue from a particular angle and try to influence policy that will result in an equitable and sustainable mix. It is precisely because these issues are so difficult to put a precise handle on that I find them so interesting.

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