- The Empire Club of Canada Addresses (Toronto, Canada), 5 Jan 1956, p. 149-160
- Routley, Dr. T. Clarence, Speaker
- Media Type
- Item Type
- Looking at some of the problems that confront people and their doctors—in the aggregate, problems of national importance to all Canadians—problems of health and happiness without which no nation can hope to reach its optimum of accomplishment. The great strides in social security in Canada. What has prompted this ever widening and expanding effort in the field of human welfare. The question of government health insurance. What the public means when they say they want health insurance. What the doctors think of health insurance. The position and attitude of the Canadian Medical Association with respect to health insurance. Other efforts needed to maintain constant progress in health protection and health care. Factors essential to the achievement of good health. Taking community responsibility. The granting of licenses to practise medicine. Medical schools in Canada. Requirement for standards of medical services. Measures to ensure economy and efficiency in the provision of health services. Benefits of a health insurance plan. Methods of remuneration of medical practitioners and the rates thereof. The introduction of health insurance legislation, preceded by adequate consultation with the organized medical profession and other groups affected. Administering health insurance. Health in the full meaning of the word as one of life's most priceless possessions.
- Date of Original
- 5 Jan 1956
- Language of Item
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- Full Text
- "YOU AND YOUR DOCTOR"
An Address by DR. T. CLARENCE ROUTLEY, C.B.E., M.D., LI.D. President, The British Medical Association, President, The Canadain Medical Association.
Thursday, January 5th, 1956
CHAIRMAN: The President, Dr. C. C. Goldring.
DR. C. C. GOLDRING: Today we welcome as our guest speaker a resident of Toronto who has attained prominence in his chosen profession in Canada, in Great Britain, and in world organizations.
After graduating from Parkdale Collegiate Institute, Clarence Routley attended the University of Toronto, graduating in Medicine in 1915. He served for four years in World War I. In 1918 he became Secretary of the Ontario Medical Association and held that position for twenty years. He was also General Secretary of the Canadian Medical Association from 1923 to 1954. In World War II he served for four years as Executive Director of the Canadian Medical Procurement and Assignment Board. He was awarded the C.B.E. in 1945 in recognition of his war service. He has taken a prominent part in the organization and work of the World Medical Association and was Chairman of its Organizing Committee in 1946, and of its Council from 1947 to 1951.
Dr. Routley has been honoured by receiving an Honorary LL.D. degree from three universities, namely, Queen's, Dalhousie, and Toronto. Now, at the beginning of 1956, our guest holds the following important offices:
President, British Medical Association;
President, British Commonwealth Medical Conference; President, Canadian Medical Association;
Consultant, The World Health Organization; Consultant General, The World Medical Association.
It is a matter of pride to the citizens of Toronto that Dr. Routley has attained such prominence in the medical profession and has given such significant leadership in his chosen field. We extend to him a warm welcome to this meeting of the Empire Club of Canada and congratulate him on the high offices he now holds. He will address us on the subject "You and Your Doctor."
DR. ROUTLEY: It is indeed an honour to be invited to address the Empire Club of Toronto and I wish to thank you most cordially for your kind reception.
I am informed that among the aims and objects of the Club, established more than fifty years ago, the advancement of understanding and harmony throughout the Empire has been most assiduously promoted and cultivated. In these days we do not refer to the grouping of the British Nations as an Empire, although I must confess that I still like that word and it is pleasant to realize that it will live on in the terminology of Clubs such as your own.
As President of the British Medical Association, the British Commonwealth Medical Conference and The Canadian Medical Association, all three bodies cherishing aspirations similar to your own, I am happy to bring you greetings from more than one hundred thousand physicians encircling the Globe-truly a family within the Commonwealth with a common denominator of service to humanity, and a common allegiance to a gracious Queen.
This is your first meeting of the new year. There is always something interesting and intriguing about first things, be it the winter's first flake of snow or the first flower of spring, or a baby's first tooth, and I venture to think that part of our interest in the dawning of a new year derives from the fact that in a sense we begin life over again - the slate is cleaned and a fresh start is made.
According to Roman mythology, January derived its name from the god Janus, known as the "spirit of beginnings", the deity who was invoked at the commencement of all undertakings-the god of the beginning of the day, the beginning of the year,-a double headed deity with one face looking backward and one looking forward, truly symbolic of the month which inspires in all of us thoughts of the past as well as speculations and resolves for the future.
For many of us, perhaps all of us, this is a time of reassessment and decision, of realistic self appraisal and optimistic planning. But our plans, if they are to reach fruition, must be built upon sound foundations. It is out of our yesterdays that we gather the ingredients for future planning. It is out of our tomorrows that we anticipate hopefully the course which we desire to follow.
May each one of us like Janus be permitted to look backward and forward in the sure confidence that, come what may in 1956, our way shall be illuminated and our path made straight.
It is in this atmosphere of looking backward and forward that I would like to direct your attention to some of the problems which confront you and your doctor in the aggregate, problems of national importance to all Canadians-problems of health and happiness without which no nation can hope to reach its optimum of accomplishment.
Our yesterdays have witnessed great strides in social security in Canada. Each year since the date of Confederation has seen an extension of Government responsibility for the citizen with considerable acceleration of interest and action during the past ten years.
We have come to accept without question our social responsibilities to the aged, to the infirm, to the blind, to the motherless, to the burned out war veteran, to the indigent and to the unemployed. We have long since taken for granted the need for state participation and intervention in the field of public health. We have recognized that to a considerable degree the welfare of all of us is the responsibility of each of us and we have found ourselves contributing both voluntarily and compulsorily to philanthropic and Governmental funds to make social services available and possible to an increasing number of our fellow citizens.
What has prompted this ever widening and expanding effort in the field of human welfare? Some of these changes have been brought forward by Government in answer to public pressure. If the people clamor loud and long enough, inevitably those in authority will answer, if only for political expediency. But that is by no means the full answer. The major advances in social security have been accomplished in this country because of the honest and honourable desires of man to help his less fortunate brother - the sharing of goods and services - an outpouring of man's humanity to man. Although Canada cannot be said to have become a welfare state, Canadians, per capita, spread their incomes across the entire population as creditably as any other nation in the world.
Without question I think it may be said of us Canadians that our yesterdays have witnessed the laying of foundations upon which future well conceived plans of social welfare may be built. Our major problem, it seems to me, is not what has happened in the past but what may happen in the future and how much wisdom and judgment and common sense will be brought to bear in the making of plans which will permit the individual in all walks of life to retain his self respect while he carries his full share, whatever that may be, in the financing of such plans.
And this brings me to the focal point in this presentation - the question - the very broad question of medical care - "You and your doctor", multiplied by all of the individuals and all of the doctors in our country.
Perhaps no greater clamor has been set up in Canada in recent years than that which is currently being sounded in political meetings, in the press, in committee rooms, on the street, wherever men congregate - "We want government health insurance". What does the public mean when they say they want health insurance? What does it mean to you? If I may venture an answer to the question, I think it means that the provident individual seeks a method or plan by which he can utilize the insurance principle to budget for illness just as he insures against the hazards of fire or accident or loss of life. That, it seems to me, is what the self respecting individual who pays as he goes would appear to desire. To many others I think it means that they hope to pass along to someone else, and it doesn't matter to whom, the responsibility of paying for their hospital and medical care.
At this point I think you have a right to ask me, "Well, what do our doctors think about all this? What does The Canadian Medical Association, the organized body of Canadian doctors have to say on the subject?" I am glad to tell you that the doctors of Canada, as represented by The Canadian Medical Association, have been studying this problem intensively for at least twenty-five years. Not only has the Association studied it but it has done something about it by assisting in the establishment of eleven voluntary non-profit medical care plans in which more than 21/4 million Canadians enjoy certain privileges and benefits of health insurance. And may I emphasize that all but two of these plans were begun by the doctors themselves, not only to provide medical care to subscribers at cost, but also to demonstrate that the insurance principle as applied to medical care is sound and can be operated on a voluntary basis quite as economically and satisfactorily as any Government health insurance scheme with which I am familiar. And I make this statement after having visited more than a score of countries in which government health insurance schemes are in operation.
Not infrequently one hears it said that the doctors of Canada are opposed to National Health Insurance - that they give the idea lip service but do not really mean it. In order that there be no misunderstanding with respect to the attitude of the medical profession of Canada on this subject, I would like to refer to the Statement of Policy which was adopted by The Canadian Medical Association at its Annual Meeting in Toronto in June, 1955.
The Association strives for the best medical care for all of the people of Canada and reaffirms its long established policy of giving consideration to and co-operating in proposals, official or unofficial that are in the public interest and genuinely aimed at the improvement of the health of the people.
In addition to developing its own voluntary plans, the Association and its ten Provincial Divisions has indicated to Governments, both National and Provincial, over and over again, its willingness to co-operate sympathetically and helpfully in the development of any sound plans by which the Canadian people can budget for the cost of illness.
The Association will gladly participate in the formation of programs designed to make high quality medical service more readily available and which respect the essential principles of medical practice, and by essential principles we mean not only high standards of medical care but the preservation of that relationship between those who render the service and those who receive it on a basis which for centuries has proven to be in the best interests of all concerned. You and every other Canadian have a right to expect and demand nothing less than the best in medical care. There is no substitute for diagnostic ability and proper treatment, and the best does not require to be embroidered by unnecessary frills.
The Association approves of the adoption of the principle of contributory health insurance and favours a plan or plans which will assure the development and provision of the highest standards of health services, preventive, curative and rehabilitative, providing the plan be fair both to the insured and all those rendering the services.
The unit of service in the last analysis involves two persons - the patient and the doctor, and whatever scheme is finally made applicable in a community must be entirely satisfactory to the patient and the doctor or it will fail to achieve its purpose.
Having seen demonstrated the successful application of the insurance principle in the establishment of the voluntary prepaid medical care plans, the Association recommends the extension of these plans to cover all residents of Canada, with financial assistance from public funds where this is required. Why should it be necessary for any level of Government to set up an intricate, highly involved piece of bureaucracy to administer a health insurance plan when already there have been organized and demonstrated with complete satisfaction, a dozen such schemes in Canada now serving a good percentage of the entire population?
From what has been said I hope no one will misunderstand where The Canadian Medical Association stands on the question of health insurance. Furthermore I would like to repeat that the Association was the first body in Canada to stimulate and assist in the organization of voluntary health insurance plans which have proven to be of great satisfaction not only to several million Canadians, but have also demonstrated beyond question the ability of the medical profession to organize and operate such schemes for the benefit of all concerned. The profit motive should never rear its head in these schemes, and of course all of the Medical Association's plans are on a nonprofit basis.
Now having stated its attitude and position with respect to the principle of health insurance, The Canadian Medical Association further recognizes that health insurance by no means answers all of the problems associated with the maintenance of good health. To maintain constant progress in health protection and health care, the following points should be stressed and underlined, and heeded by all citizens who are interested in health preservation, including their own health.
The World Health Organization has said that health is a state of complete physical, mental and social well-being and not merely the absence of disease. Among the factors essential to the achievement of good health are adequate nutrition, good housing and healthful environmental conditions generally; facilities for education, exercise and leisure; and not least, wise and sensible conduct of the individual and his acceptance of personal responsibility for maintenance of health.
Far too many people look upon their own health care as something to be taken in hand when health breaks down. Of course the body then needs fixing if the deterioration has not gone too far. But how much wiser it is to keep the machine in good running order before it breaks down. This is considered to be good common sense in the care of material things, an excellent example being our motor cars. How much more important and wise it is to apply the same common sense to our bodies.
Each province should be adequately served by a well-organized Department of Public Health providing personal preventive services wherever possible through the practising physician. Canada's ten Provinces may point with considerable pride to their Departments of Public Health. We in Toronto have, for many years, taken genuine pride in our first class Health Department. Your doctor is most anxious at all times to co-operate with the Department in any worthwhile community effort which is calculated to preserve and foster better health.
The community's responsibility for health services includes not only maintenance of a high level of environmental conditions and the provision of an efficient preventive service, but assurance that adequate medical facilities and services are available to every member of the community whether or not he can afford the full cost. Herein lies a tremendous responsibility placed squarely on your shoulders and mine as citizens. Toronto provides an excellent example of how this challenge is being met, but not all communities in Canada are so well served.
The confidential nature of the patient-doctor relationship must remain inviolate. The patient must have freedom of choice of doctor, and the doctor free acceptance of patient except in emergency or on humanitarian grounds. One could enlarge upon this principle at great length. No greater trust can one man place in another than is found in the patient-doctor relationship. This unique and priceless relationship must never be sacrificed by any plan or package deal which might tend to depersonalize medical services.
The granting of a license to practise medicine was designed primarily to protect the public. Therefore it is in the interest of the patient that all who desire licensure to practise a healing art should be required to conform to a uniformly high standard of preliminary education and of training in the recognized basic sciences, as well as to furnish proof of adequate preparation in the clinical and technical subjects.
Canada is fortunate in having twelve medical schools of Class A standard. They are producing close upon a thousand medical graduates a year which supply seems to be meeting the needs for medical personnel in this country. Canada has between fifteen and sixteen thousand doctors, or roughly one per thousand population. During the past ten years there has been a certain inflow of foreign born doctors into Canada, a number of whom are well established in practice and rendering first class service. The Association has been accused from time to time of making it difficult for doctors from other countries to obtain licenses to practise in this country. May I assure you that the Association has never at any time raised its voice in opposition to any foreign born doctor who could meet the educational and other requirements which are demanded of our own Canadian graduates before they are granted a license to practise. Our one concern for the Canadian people in the realm of health care is that every man and woman who undertakes to accept the responsibility of dealing with the health of a fellow citizen must possess qualifications and qualities of heart and mind to make him or her safe as a practitioner. You expect such a standard of your doctor. Every Canadian has a right to expect and demand a similar standard.
Standards of medical services must be maintained at the highest possible level and demand constant vigilance and effort. Among such requirements are:
(a) adequate facilities for clinical teaching in the medical colleges and hospitals. No health insurance scheme must ever be permitted to jeopardize this programme.
(b) postgraduate training for all medical practitioners at frequent intervals must be maintained.
(c) expanded programmes of medical research must be supported and accelerated until the secrets of all diseases are discovered.
Now, having endeavoured to indicate where The Canadian Medical Association stands on the question of health insurance, and having expressed its suggestions whereby consistent progress may be maintained in health care, may I go further and set forth our thinking on those measures which we believe to be essential in assuring economy and efficiency in the provision' of health services.
Hospitals, health departments, and all other health agencies should co-ordinate their activities so as to provide their services more effectively and economically.
Hospitals should be located, and their facilities and size determined on a planned, regionalized basis to assure the availability of hospitals where they are needed, the provision of technical assistance to smaller hospitals by the larger, and the ready transfer of patients as required.
An adequate system of institutional facilities and services requires the balanced development of diagnostic facilities, active treatment general hospitals, rehabilitation centres, chronic care facilities (including mental and tuberculosis hospitals) and home care programmes.
Lay and professional organizations and government health agencies should participate in community, provincial and federal health planning activities.
A word about costs - how should they be met? - one of the most important questions concerning each of us. It is The Canadian Medical Association's belief that in the application of the insurance principle to payment for medical services, the opportunity of insuring through a prepayment medical care plan should be available to every Canadian, including dependents.
Benefits of a health insurance plan should include preventive, diagnostic, treatment and rehabilitation services, and the services of specialists and consultants should be available as required.
The methods of remuneration of medical practitioners and the rates thereof should be as agreed upon by the representative bodies of the profession and the insuring agency. In the provision of personal health services where the usual doctor-patient relationship exists, it is the view of The Canadian Medical Association that remuneration on a basis of fee for services rendered promotes high quality of medical care. You pay for what you receive just as you do in respect of other commodities.
The provision of medical services under any plan of health insurance should be undertaken only by qualified and licensed physicians.
In the event of Government participation in the universal extension of health insurance to all citizens, the introduction of health insurance legislation should be preceded by adequate consultation with the organized medical profession and other groups affected.
Health insurance should be administered by an independent, non-political commission representative of those providing and those receiving the services. Matters of professional detail should be determined by committees of the professional groups concerned.
Appointments of medical personnel to the commission and its staff should be made only with the approval of organized medicine in the respective province.
The various services should be introduced as benefits by stages, careful planning being given to the order in which each is introduced.
Cash sickness benefits, if provided, and the health services benefits should be administered from separate funds. In the brief time at our disposal I have tried to present to you the position which your doctor takes on this broad question of health insurance. I hope that in your busy lives you may find time to analyse the doctors' attitude in this matter. If you do, I am inclined to think you will conclude that his one objective is to serve you to the best of his ability, at the same time being quite willing to join hands with you and every other Canadian citizen in developing plans which will recognize the insurance principle as one which can and does take the shock and sting out of the financial aspects of catastrophic illness and furthermore spreads the cost of medical care in a manner to meet the citizen's ability to pay for that care.
Sometime during this winter another Dominion-Provincial Health Conference will likely be held in Ottawa to consider plans which have been proposed to extend the benefits of health insurance to our people. What, if anything, may come of these discussions one is unable to say, but of one thing I am quite certain-that whatever plans are accepted they are going to call for the expenditure of large sums of money. Where is this money to come from? There are two possible sources-taxation and premiums. Taxation alone with free medical care would spell out state medicine, something which one hopes and prays will never rear its head in Canada. Premiums, therefore, should be exacted from every person who can pay according to his ability to pay, leaving the consolidated revenue of the country to provide the funds for those who are unable to pay.
In very sketchy form I have tried to portray to you the thinking of Canada's doctors on the broad question of health insurance. I have endeavoured to make clear that The Canadian Medical Association believes in the principle of health insurance and has translated its belief into action in the establishment of voluntary health care plans; that health insurance can be made available to all Canadians on a pay as you go basis by Government paying the costs for those less fortunate citizens who are unable to pay their premiums; that any schemes which are worked out must never interfere with the doctor-patient relationship which is so essential to good medical care; that medical care is the concern of all of us, beginning always with yourself.
Health in the full meaning of the word is one of life's most priceless possessions. Your doctor should be one of your very best friends. In him you confide your innermost thoughts and sooner or later you place your life in his hands. He is not unmindful of the trust which he shares with you. He, like all other citizens, requires money to live, but his greatest joy and satisfaction comes from the realization that he is privileged in a high degree to serve his fellow man.