Thursday, 11 April 2013


Mr. Jason Luan
#29, 735 Ranchlands Blvd NW
Calgary, AB
T3G 3A9

Dear Mr. Luan,

Many years ago, I wanted to be a physician.

My interest in science started at an early age. In primary school, I loved dinosaurs. In middle school, astronomy was my passion. As I grew older, I was fascinated with biology, then genetics, biochemistry, and finally medicine.

The road to becoming a doctor was challenging, but I learned many things along the way: about the world, its inhabitants, and myself. Had I not been accepted into my preferred field, I would have been content with any number of other professions. Ideally one involving food, because I love to eat. That, or playing music. I like music a lot.

When my dream of getting into medical school came true, though, I was ecstatic. As a physician, not only would I be deeply rooted in science, evidence, and rational decision-making—I would, more importantly, be helping people.

The sick and the suffering would benefit from my knowledge and compassion. If I couldn't cure, I would relieve; if I couldn't relieve, I would comfort. I would be a healer, teacher, advocate, and support. I wouldn't save the world, but I'd make certain to at least improve it to the degree I could. I would earn respect through my skill and congeniality, and I would have a satisfying career.

I was a fool.

I finished my specialty training in psychiatry in 2008. My first job was at Alberta Hospital Edmonton (AHE) as a consultant psychiatrist with a special interest in geriatrics. The colleagues and staff who worked there were incredible. I spent over two wonderful years there before our program was made the casualty of Mr. Stephen Duckett's ambition and ideology. His initial intent was to close the entire hospital down (after years of promises from the Weatherill administration that AHE was slated for redevelopment): instead, the geriatric psychiatry program was made the sacrificial lamb. We were excised from our historical home at Alberta Hospital Edmonton and transferred to a non-purpose-built facility in the west of Edmonton, Villa Caritas, so that the remaining programs at AHE would be left alone. Those in power could pat themselves on the back for having done “something”.

The haphazard and cavalier manner with which government and health system administration colluded to tear the program away from AHE was my first insight into how short-sighted, self-serving, and intransigent the people who make these decisions can be. The transfer of the program was made with token physician consultation—ostensibly enough to satisfy any critics of the move that the decision was made without input from doctors—and the result has been an unmitigated disaster. We lost many capable and dedicated staff in the move—some of whom were indeed replaced by equally competent and caring people—but the damage to morale and the solid foundation upon which the program rested have not been repaired, even after two years. Administration would interfere with patient admissions and discharges, patients languished in hospital for months because of bureaucratic shortcomings, and our admission wait-list was so lengthy that we were completely unable to bring patients into hospital in a timely manner. Physician concerns were heard, but not heeded, by administration. Nurses were hung out to dry by their managers when abusive family members verbally and physically attacked them. Without respect and trust, there was no dialogue. Without dialogue, nothing could change. And things still have yet to change.

It was depressing, but I thought we were still making a difference. I thought I could still cure sometimes, relieve often, and comfort always.

I was still a fool.

The haphazard and cavalier manner which pervaded the decision-making around the transfer of our beloved geriatric psychiatry program appears equally manifest in the recent “negotiations” with physicians. After having signed an Agreement In Principle last year, the current regime has decided to renege on the AIP, which is causing the same demoralization, dissatisfaction, and suspicion so evident at Villa Caritas. Instead of approaching physicians, cap in hand; instead of apologizing for his government's financial mismanagement that has resulted in the fiscal dire straits he keeps referring to; instead of asking for our collaboration in fixing the problem, Mr. Horne instead publicly demonized physicians—and continues to do so. We have been made out to be greedy, inconsiderate, and in it only for the money. No matter that this is about honouring commitments; no matter that many of the physicians I've spoken with would gladly take a pay cut if it would guarantee that the government is willing to make concessions and truly involve us in health care planning; no matter that the majority of the public is completely supportive of the physicians' position over that of the government—none of that matters. What matters is that those in charge must be obeyed at all cost, and never ever questioned.

And I am grateful. I'm grateful that the government, specifically Mr. Horne and Ms. Redford, have made it clear that they will not engage in arbitration. I'm pleased that there's no question that it's either their way or the highway. Thank goodness that we're getting a pay cut, not a pay raise. I'm singing the praises of this government that I am unimportant—worse, a liability.

Because now my eyes are opened. I am a fool no more. All the years that I spent lying to myself about the nobility of the cause that I chose, the positive influence I thought I would be, were a waste. I may have helped a few people along the way in my few years of practice...but big deal. I am a drain on the system. I reek of avarice and ego. I am unworthy of the office to which I aspire.

I am enlightened. I have options. I need leech from the system no more, should I choose not to. I need not burden the taxpayers and my employers any longer, should I find another calling.

If I am, and can only hope to ever be, a middling physician—inconsequential, a nuisance, disposable—perhaps it is time for me to aspire to something greater, where I make a real difference...perhaps as a gourmet chef or musician.

Or maybe I'll just keep my head down, punch my metaphorical time card, and keep plying my trade like a phantom, bereft of the passion, the voice, or the lasting benefit to the community I always thought I would have.

Thank you, Mr. Luan, for hearing me. I expect absolutely nothing to change, and I find strange comfort in that. It confirms that all that I can hope to change is myself.

Most sincerely,

Robert Granger, MD FRCPC
Consultant Psychiatrist?

Honourable Fred Horne
Premier Alison Redford
AMA President Dr. Michael Giuffre
Party leaders: Danielle Smith, Dr. Raj Sherman, Brian Mason

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