The Sunday Magazine

Medicine is a calling, not a business: Henry Mintzberg

The McGill University professor and management guru takes on Canada's healthcare system.
A doctor wearing a white coat and stethoscope.
Management Guru Mintzberg says health care should be focused on treating people, not on saving money or counting widgets. (David Donnelly/CBC)

This segment was originally broadcast on February 4, 2018.

Henry Mintzberg says we need to approach challenges in the field of health care in a radically different way.

Mintzberg is one of Canada's most eminent scholars in the area of management studies and has been teaching at McGill University since 1968. The prolific author of books such as Managers Not MBAs and The Rise and Fall of Strategic Planning has now trained his sights on the field of medicine.

Speaking to The Sunday Edition host Michael Enright, he argued that there are wrong-headed practices that must change. His ideas are grounded,  he said, in the philosophy that health care is a calling, not a business, and that it should be focused on treating people, not on saving money or counting widgets.
'We react to treatment much better when we're treated as people and not as patients,' Mintzerg says.

In his new book, Managing the Myths of Health Care: Bridging the Separations Between Care, Cure, Control and Community, he pinpoints a number of ways we can improve our health care.

One of them is to bring a halt to the "urge to merge." Mintzberg said bigger is not better in the field of health care.

"Economies of scale apply for equipment. Sure, if you have an MRI in two different hospitals and you're not sharing the technology and there's downtime, of course it's expensive and it's wasteful. But a lot of this has to do with personal service and typically you get better personal service in a smaller institution," he said.

The worst kind of hospital mergers, he said, are "non-physical" ones. 

"They take two hospitals and call them as one, even though they're six kilometres apart. And magically they've merged! How have they merged? Because somebody drew some lines on a piece of paper."

Mintzberg says it is easy to lose sight of the fact that patients are people and that populations are communities.

"Communities are living things; populations are statistics. And we react to treatment much better when we're treated as people and not as patients."

In his book, Mintzberg shatters the myth that Canadian health care is publicly funded and Americans have privately  funded care.

"Given how much of our system is private — for example, medications for many people, ambulance services, dentistry, there's all kinds of things that don't fall under medicare — I think we run around 60 or 70 per cent," he told Michael Enright. 

"But if you add up all the things that are government in the United States, with Medicare, Medicaid and Obamacare…it's not that much different than ours in the end."

Mintzberg said that when it comes to health care, "governments are crude and markets are cross." Health care is neither public nor private — it is part of the plural sector, along with organizations such as universities and co-operatives. They are not owned by investors or by the government, but they are funded by the government, he said.

We react to treatment much better when we're treated as people and not as patients.- Henry Mintzberg

His strongest words were in opposition to pharmaceutical companies. Mintzberg said the way they are allowed to price their drugs is "scandalous" and "tantamount to manslaughter."

"A patent is a monopoly," Mintzberg said, "When have we ever allowed monopolies to price the way they'd like? We've never allowed phone companies that had monopolies to do that. We never allowed, and still don't allow, electrical companies that still have monopolies to price how they'd like.

"And yet, with pharmaceutical companies, they price how they'd like. So why shouldn't they charge half-a-million dollars for something that's maybe costing them ten bucks?"

Mintzberg believes the way pharmaceutical companies are allowed to price their drugs is "scandalous" and "tantamount to manslaughter." (CBC)
Mintzberg does not accept the argument that pharmaceutical companies need to charge what they do in order to conduct their research or bring new drugs to the market.

"The three most important pharmaceutical discoveries of the 20th century — namely, insulin, Salk vaccine and antibiotics or penicillin — all came out of not-for-profit labs. We are not beholden to the pharmaceutical companies for research. We are beholden to them for development…carrying the molecule to the market.

"People die for want of affordable medicines. What do I mean by affordable? I mean sufficient profit to cover what they need for profit and to cover their research and so on; but for these obscene profits, people die for want of it. That's manslaughter."

Mintzberg also pointed out that most of the investment in our health care system and most of the income through fundraising is devoted to cure rather than cause.

"People who lose loved ones want to do something and so what they do is put money into cure, which is fine. Cure is great; but if you can deal with cause, you don't need to deal with cure," he said.

"When we run, we run for cure, we don't run for cause. And why? Because you know a friend who died. But Jonas Salk, he didn't cure kids of polio. He found a way to ensure that kids wouldn't get polio. He got to the cause of it."

Click 'listen' above to hear the full interview.