7 Things I’ve Learned After 12 Years Of Private Relationship-Based Direct Care In Canada

I’m a hand surgeon. After six years of academic practice, I opted out of the public and universal health care system my country is famous for to create the first private hand surgery practice in Montreal, Canada. That was 12 years ago.

Opting out of the system means that I do not get any payment or reimbursement from the government in a country where private insurance does not pay for private medical or surgical care. Yes, you got it. That means out-of-pocket. Patients pay their bill in full, much like they would pay their lawyer or notary.

It also means operating the business side of medicine on top of being the doctor patients need and want. Over time, I have learned a thing or two about the world of private and personalized care delivery. I wish to share a few with you.

1. Not all doctors are equal. It sounds self-explanatory, but it is not. Indeed, few things are more Canadian than universal health care. The problem is nothing is truly universal about it. And frankly, how could it?

The system is trying to guarantee access to a doctor to any patient in a huge country dealing with an aging population that is not being replaced. This is all funded by tax dollars. But access to a doctor does not mean access to the right doctor for you or for your condition.

An orthopedic surgeon specializing in spine surgery might not be the best choice to fix your ankle. No more than a plastic surgeon who is an expert in breast reconstruction is the best choice to fix your broken hand.

You would not consult a divorce lawyer to take care of a complex corporate tax issue … would you? Even if their services were funded by the government? Our system does not guarantee access to the doctor you really need. In fact, it fails to guarantee access to any doctor at all.

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Universal also means it is supposed to be the same everywhere for everyone. And that, sadly, is not the case either. There are too many discrepancies and inequalities for the system to still be called what it is not — universal.

2. Not all patients are equal. Patients are unique and varied. As a result, they can’t and should not all be treated the same way, with a “cookie cutter approach.” “A one-size-fits-all solution” doesn’t fit anyone.

Confidence and trust are necessary for the establishment of the patient-physician relationship. Medicine is a very human experience. You should be able to choose a physician you trust instead of relying on a system you need to trust. Medicine is a very personal experience, and it should be personalized. A system cannot do that well.

3. Patients don’t care about my degrees or where I went to school. What? No, they don’t. Well, not entirely. What patients care about is that I did go to medical school and got trained and certified. But all my degrees have a date on them, confirming that on a specific date, I did meet the requirements for practice. But beyond that, they care much more about what I can do for them today and how I would do it than what I have done in the past.

Don’t get me wrong, certifications are essential but simply prerequisites. Patients have a problem and need a solution. All they care about is if you can genuinely help them with it.

And it makes sense. That is why none of my hard-earned degrees are on my office walls. They represent the past, not the present or the future.

4. My reputation is only as good as my next patient’s opinion. I have a reputation built over years of patient care. It matters. It inspires trust. But it is only what gets them through the door. What happens next matters even more. Will patients be better after meeting me than before? If so, then my reputation will grow. If not, it might take a hit. Nothing is gained forever. You are constantly being judged and scored. And that is a good thing. The day you don’t want to be evaluated is a day you should probably reconsider your life choices. By embracing that concept, you will constantly look for ways to learn and improve and everyone benefits.

5. Showing empathy trumps being the best. I believe you should aim at continuously improving your game so you can be the best doctor you can be every day. But even more than a super competent doctor, patients want and need an empathetic doctor — a human doctor. We all know of a terrible colleague that patients rave about in spite of their poor results. The reason is that they have great people skills. They have empathy and compassion (or at the very least, they can fake them, despite their lack of self-awareness).

But you can be both. If you work on your empathy and communication skills as much as you do on your technical skills and medical knowledge, you will be a more successful doctor as a result. And a happier one too.

6. Patients will pay for superior and more personalized medical care. When I started my private self-pay practice, I was told by my colleagues that I had gone nuts, as no Canadian in their right mind would pay for hand surgery.

Well, 12 years later, I can confirm that was a wrong assumption. They (not all) are happy to pay for better choices. They will gladly pay for convenience, better and less invasive techniques, ease of scheduling, an hour-long consultation to get the answers to their questions and for feeling heard, understood, and seen.

Above all, today’s patients, more than ever, care about the patient experience. Those aspects of medical care are simply not taken into serious consideration by our failing health care system. Patients have become consumers of medicine and health care, just like they are of education, legal advice, or other professional services.

“People will forget your name, but will never forget how you made them feel” are famous words by Maya Angelou and remain a great guiding principle for me every day.

7. Focusing on creating a superior patient experience is spiritual work. A better experience correlates with better treatment compliance and outcomes. But focusing on delivering a better patient experience (i.e., how a patient feels with you as a doctor throughout the journey) benefits the physician too. The Western health care model is experiencing an epidemic of moral distress, burnout, anxiety, depression, and even suicides among physicians and medical students.

Among the many reasons why lies, the increasing sense of loss of autonomy and disconnection physicians feel, with increasing pressures from patients needing care, decreasing resources, and freedom of choice. This can result in a spin out of control.

By focusing on what you can, instead of what you cannot, you can regain a little bit of control. By bringing your focus on how the patient feels and how you can make that a little better by showing you care (kindness and empathy), you can distance yourself from yourself, worries and concerns.

But you know what? Distancing yourself from the constant flow of thoughts in your mind (most of them negative anyways), and doing it often is essentially meditating.

Meditation is taking a break from associating with your thoughts to focus on something other than you.

Try it. It does wonders to feel better. Happy doctors make happy patients — and vice versa.

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