Source: Bury, John B. “A Physician on the Front Line of Medicare” Canadian Bulletin of Medical History 26, no. 2 (Fall 2009): 534-538.
Abstract. An English physician describes the hostile attitude and behaviour of medical authorities, medical and nursing staff in 1964 because he was a recruit to the Saskatoon Community Clinic that supported Medicare.
Keywords. Politics, Professional ethics
Résumé. Un médecin anglais décrit l’attitude et le comportement en 1964 des autorités médicales ainsi que du personnel médical et infirmier, hostiles parce qu’il était une recrue de la Saskatoon Community Clinic, laquelle appuyait « Medicare ».
Mots-clés. Politiques, Éthique professionelle
I qualified as a physician in England on 30 March 1948 and started my internship just three months before the National Health Service started on 1 July. I graduated a little later from the London Hospital Medical College, University of London. After internship, I performed my National Service for two years in the Royal Army Medical Corps. Then, when three and a half years as a resident in O and G convinced me that I would never be a great gynaecological surgeon, I entered a partnership with an established general practitioner in a mixed urban and rural practice 30 miles east of London in Essex. Here, I built up a practice of 2000 patients in eight years. I was active in medical affairs, was a member of the executive of the Mid-Essex branch of the British Medical Association, and became the first secretary of a newly formed local learned Medical Society. I tell you all this as evidence that I was considered to be a quite respectable member of my honoured profession before emigrating to Canada.
While serving in the army, I had met Dr. John Garson and we became reacquainted when we discovered we were practising within a few miles of each other. In October 1962, he attended a conference organized by the Medical Practitioners Union where Dr. Sam Wolfe spoke of a cooperative Community Clinic in Saskatoon, owned and operated by a group of patients, in which staff, including the physicians, were paid by salary, and which intended to widen the range of services that would be more able to deal with the social factors that present themselves in primary care practices.
In February, John told me that he was thinking of joining the Community Clinic in Saskatoon and would I like to go as well. I quickly agreed. An 11:30 p.m. phone call to Dr. Wolfe resulted in two new recruits for the Saskatoon Community Clinic. And that is how we arrived with our two families at the Saskatoon Railway Station at eight o’clock in the morning on 13 June 1963, where a crowd of over 100 people were waiting to greet us.
The Saskatoon Community Clinic had developed as part of a movement that developed as the government and doctors moved towards a stalemate over the implementation of the Medical Care Insurance Act. The doctors threatened not to work under the Plan. This stimulated citizens to organize clinics for health professionals that would provide services. In all, 25 community clinics were developed.
By the time the 1 July 1962 implementation day arrived, community clinics in Prince Albert (under Dr. Orville Hjertaas) and Saskatoon were opened. Because of the holiday weekend, the first patient in Saskatoon was not seen until 3 July. There were simply two doctors with their medical bags and one nurse in a room on the third floor of the Avenue building with a telephone and a few chairs. Folding tables from the Union Centre with mattresses became examining tables and they were busy until midnight. With the exception of three physicians, all the doctors in the city shut their offices. Emergency services were provided by a roster of doctors at the hospitals.
Gradually the Community Clinic was reinforced by two doctors brought over in the airlift from Britain that Dr. Wolfe, as a Medical Insurance Commissioner, had helped to organize by an expedition to England in June. By the time we arrived in Saskatoon a year later, the clinic was fully functioning with seven doctors and a full nursing reception and records staff. There was an X-ray department and a minor surgery. With Dr Garson, myself and a surgeon who gave up his lucrative practice in Windsor, we were eight.
With this background, Dr. Garson and I approached the College of Physicians and Surgeons to be licensed. We were warned that the College did not like the community clinic and that we should be careful. Of the doctors, Dr. Wolfe had hospital admitting privileges at both City and St. Paul’s Hospitals. Dr. Margaret Mahood, who had been the deputy Superintendent of the North Battleford Mental Hospital, only had privileges at City Hospital. We were denied privileges at St. Paul’s as no member of the staff would sponsor us.
The next step was to obtain privileges at City. We were interviewed by the Chief of Staff and the Administrator. I was told that this hospital was run properly and did not put patients on the roof like they did in the National Health Service. They accepted my references and sent them off to England by surface mail to delay the process. This resulted in J. F. Goldenberg, the senior partner of our lawyer and a scion of the Liberal Party establishment, attending the Board Meeting of the Hospital with the newly minted Diefenbaker Charter of Human Rights tucked under his arm to demand that we be given admitting privileges. He failed, but eventually our ship came in with our referees’ replies and we were granted privileges after a two-month delay.
However, once in the hospitals, every thing was far from sweetness and light. The medical staff put community clinic doctors in Coventry and removed themselves from the coffee room in the surgical suite to the nurses coffee room. Our surgeon exacerbated this arrangement by spending most of his free time in the morning just sitting in the coffee room reading the paper. The nurses eventually got fed up with having the doctors around and threw them out.
Many of the medical staff would not ride in the elevator with us; the chief of one service was particularly strict in this observance, so when our surgeon got fed up with reading the paper in the coffee room, he and his surgical assistant would each occupy one of the two elevators and enjoy the chief popping in and then quickly popping out when he spied the offending “commie” doctor.
These childish games relieved to some extent the stress of practising in the hostile environment. Nurses were not impartial observers to our presence. Many, if not most of clinical nurses, had stood by “their” doctors during the strike and that attitude persisted in the hospital. Visiting patients and trying to find one’s way around hospital procedure was awkward and often the nurses were frankly unhelpful. Of the 10 head nurses, there were only three who behaved professionally and with whom you could have open discourse.
The first patient I admitted to hospital was in her last weeks of pregnancy with toxaemia. When I saw her in the office, I immediately sent her to the hospital for admission. When my office was over I went to the ward to give orders. Observed by the head and another nurse, I took the order board to write my orders. I prescribed strict bed rest, restricted fluid intake, fluid balance chart, and wrote the usual orders for aperients as required. I showed the nurses the orders, for I hadn’t written a hospital order sheet for over eight years. Every thing seemed okay.
The next morning the patient was somewhat improved. The blood pressure was down and she had some diuresis. I saw her again that evening. The improvement was maintained. On the morning of the third day she was much better. I told her that if this continued she might be able to go home. “Was there anything she wanted,” I asked. “Yes,” she said, “Could I have something to eat?” She had been given nothing to eat or drink except the small amount of water that I had ordered for the nearly 48 hours she had been in hospital. I asked the Head Nurse why that was, “You didn’t order any,” she replied.
It was because of things like this and the behaviour of some of the medical staff that for a time the community clinic doctors took to doing rounds in pairs to check on each other’s orders. One consultant would see our patients but not give us his opinion. We reported him to the College and he was reprimanded.
We were able to provide a good service due to the few medical staff who treated us with proper professional courtesy and assistance. Even though they had been fierce opponents of Medicare, they nevertheless took our consultations, and some even went out their way to give us helpful tips.
Things in hospital did not quieten down until after Mr. Justice Woods’ Royal Commission reported that physician behaviour within the hospitals, spurred on by a hostile College, was unacceptable. Because the sponsorship system operated in all the hospitals in Regina, the Community Clinic doctors had no admitting privileges. The result of this was that 13 of the clinic’s patients had their babies delivered at home rather than hospital, including Anne, the wife of Allan Blakeney, the Minister of Health.
The matter was eventually settled by Davy Stewart, the Liberal Minister of Health.
At a meeting of community clinic representatives, he reported that he had said to the Saskatchewan Medical Association and College, “I have a business in Prince Albert and if a competitor opens up across the street I don’t go around saying how bad they are or interfere with how they do business, I just try and do better than them and that is what I think you should do.” He got us our privileges. However, we were not quite out of the woods. Just before Christmas of 1966, Dr. Samuel Wolfe, our clinic’s medical director, received a summons from the College of Physicians and Surgeons to appear before the Disciplinary Committee charged with unprofessional conduct for unethical advertising. The cause was a pamphlet that the Community Health Association had published entitled, “How to Use the Clinic,” that described the services, hours of operation, and other details. Every member patient would receive a copy of this. One had been lying on the bed of a clinic patient in hospital when it was seen by one of our opponents who took it to the College. Our lawyer applied for an injunction against the College for their attempt to act against the physicians for something done by another party, i.e., the Saskatoon Community Clinic. That injunction has never been answered.
Soon afterwards, cooler heads prevailed and we gradually became partly integrated into the system. I, along with my other colleagues, became members of committees in the hospitals and even in the Saskatchewan Medical Association.
However, some 15 years later in 1977, when the recent honours graduate from the University of Toronto I had recruited for the Saskatoon Community Clinic went to register, the Registrar of the College said to her, “That she was joining that commie clinic and that she should watch her step.” Paranoia has a long prognosis.
