Why doctors must make their voices heard from within corridors of power PAUL YEWCHUK, MD, MP
Medical men and women must become more actively involved in the political affairs of this nation. Scientists in general, including practising physicians and surgeons, have traditionally looked at politics as an unattractive and unimportant field to them; one they did not want to mess around in. The result has been that outsiders have been making decisions and imposing them upon doctors. It has become obvious that the medical profession is more and more controlled by federal and provincial laws imposed by politicians, bureaucrats, administrators and others who are not necessarily either sympathetic to the medical profession or well informed on the health field in general. The federal government has shown in recent years that it is quite prepared to take unilateral action when politically expedient and to restrict budgets that directly affect the income of the physicians. The provincial governments in some cases have not shown a great deal more regard for the profession. Health care costs have been skyrocketing it is true, but the increases have been largely on the institutional side. However, doctors have been blamed for these increased costs. Bureaucrats and to some extent the public have accused doctors of channelling all these increased costs into their own pockets. The fact is that increases in doctors' incomes have been very modest in recent years. It is now obvious that passage of the medicare legislation 10 years ago places severe constraint on the incomes of physicians in this country, because physicians have not taken enough care to ensure that their incomes are properly protected. Political action The time has arrived when physicians in this country should reassess their general attitude toward the political process, if they are to have any significant impact on the direction our health care system takes. The input can only come from more active
participation in the political system itself. For too long, doctors in Canada have looked inward and have concentrated simply on providing a good service. Doctors have felt that doing so xvas sufficient cause for expecting reasonable treatment by legislators and the public in general. However, we know now that a physician who is doing a good job is still liable to abuse by the political process. If he wants to avoid or minimize this abuse, he must take a more active role in seeing to it that the laws of the land are developed in such a way that his profession and the health care delivery system itself are not adversely affected. The medical profession should take a greater part in directing and developing the health care delivery system, in developing resources to pay for it and in informing bureaucrats insofar as the health care system is concerned. When I am talking about political action I do not simply mean contributing to political parties or presenting briefs to government or contributing a few hours to help somebody in his political election campain. I am suggesting that physicians should seek nominations for elected office to a far wider degree than they have done thus far. Currently, there are only 9 doctors (4% of the total membership of 264) in the House of Commons compared to 69 lawyers (28%), 18 teachers (7%), 17 farmers (7%), and 12 university professors (5%). The medical profession has been making its point of view known from a position of severe political disadvantage. The situation will not change overnight. But it will change with the development of political power from within the profession itself and from a new attitude on the part of the profession, that it is willing and able to develop and use political power. Only if that kind of strategy is followed can one expect a change in the behaviour of government and in the public attitude toward the profession. That is not to say that doctors in federal or provincial politics should be there purely for the protection of
1444 CMA JOURNAL/JUNE 10, 1978/VOL. 118
.222. Tablets INDICATIONS: For relief of mild to moderate pain, fever and inflammation as in influenza, common cold, low back and neck pain, headache, trauma, following dental and surgical procedures. DOSAGE-Adults-i or 2 tablets one to three times daily; Children's dosage, when recommended by a physician: 10 to 14 years, one tablet, one to three times daily; 5 to 10 years, one-half tablet, one to three times daily. CONTRAI NDICATIONS: Gastrointestinal ulceration and sensitivity to any of the components. WARNINGS: Salicylates increase the effects of anticoagulants. Caution is necessary when salicylates and anticoagulants are prescribed concurrently. Also, salicylates may depress the concentration of prothrombin in the plasma. Large doses of salicylates may affect insulin requirements of diabetics. Salicylates may potentiate sulfonylurea hypoglycemic agents. Analgesic abuse (excessive and prolonged therapy) has been associated with nephropathy. TOAVOID ACCIDENTAL POISONING ACETYLSALICYLIC ACID PREPARATIONS MUST BE KEPT WELL OUT OF REACH OF CHILDREN. PRECAUTIONS: Give with caution to patients with asthma, other allergic conditions, bleeding tendencies, or hypoprothrombinemia. Salicylates can produce changes in thyroid function tests. Observe care in use of codeine, although tolerance and addiction are rare. Give codeine with caution to patients with severe respiratory depression. Its depressant effect may be enhanced by concurrent administration of sedatives and tranquilizers. ADVERSE REACTIONS: Acetylsalicylic acid: Gastrointestinal: dyspepsia, heartburn, nausea, vomiting, diarrhea, gastrointestinal ulceration and bleeding. Ear reactions: tinnitus, hearing loss. Hematologic: anemia, leukopenia, thrombocytopenia, purpura. Dermatologic and Hypersensitivity: urticaria, angioedema, pruritus, various skin eruptions, asthma and anaphylaxis. Miscellaneous: mental confusion, drowsiness, sweating and thirst. Codeine: Average or large doses may cause various gastrointestinal symptoms such as nausea, vomiting and constipation. Caffeine: May cause nausea, nervousness, insomnia, headache, vomiting, palpitation, vertigo, muscle tremor, sensory disturbances, excessive diuresis in sensitive patients. Large doses may cause gastric ulceration. FULL INFORMATION AVAILABLE ON REQUEST HOW SUPPLIED 0222* Tablets-White, scored, engraved 222 on one side. Each tablet contains: acetylsalicylic acid 375 mg, caffeine citrate 30 mg, codeine phosphate 8 mg. Available in tubes of 12; bottles of 40, 100 and 250, also bottles of 60 with safety cap. Weiss, H.J.: AspIrin-a dangerous drug? 1. JAMA 229(9): 1221-1222, Aug. 26, 1974. Beaver, W.T.: Mild analgesics In the 2. treatment of pain, pp. 1094-1120. .Trademark
JJLo.t CHARLES E. FROSST & CO. KIRKLAND (MONTREAL) CANADA
2227-7-71 9-JA
EED
the medical profession. That would subject them to charges of simply being elected to serve their own self interest. While I am suggesting that there be more doctors active in politics, I want to make it clear that no doctor can get elected to Parliament or to the legislature simply by the vote of his medical colleagues. He gets elected by the people at large and therefore his primary concern must be to serve the people at large. But if there were 50, 60, or 70 MDs in a parliament of 264 people, the mere presence of such numbers would be bound to have a beneficial effect from the point of view of the profession as well as the public. Since Confederation, the government of Canada has had only two medical doctors as ministers of national health and welfare: Dr. James Horace King, 1928-1930, and Dr. Murray MacLaren, 1930-1934. This department of government, perhaps the most cherished by prospective cabinet hopefuls, alone exercises responsibility for a budget of $12.7 billion. With the mass of legislation churned out in the Department of National Health and Welfare each year, doctors in parliament have an important role to play. A physician's contribution could be especially significant in the area of medical and scientific research legislation. Since 1970, the medical and scientific research communities have been suffering from a steady decrease in funding. The small increases the Medical Research Council receives every year are more than completely eroded by inflation, so that there has been a drastic reduction in the number and value of grants. The lack of funding due to the ignorance of federal government policies has had a depressing and frustrating effect not only on researchers themselves, but on the progress of research in Canadian medical education and on the national self-respect itself. Because of the federal government's unenlightened approach, Canada is developing a reputation internationally of not being a good place to do research. In the long run the country will be harmed. Federal medical care legislation and fiscal arrangements trespass into the field of medical fees. The federal government has attempted to place itself in a position where it decides
Paul Yewchuk: time to reassess attihide to political process.
for you what is a reasonable increase in your income. Medical care legislation limited 1976-77 federal medicare expenditures to 113% of those of the previous year and 1977-78 expenditures to 110.5% of the 197677 levels. Doctors cannot hope for anything better unless it comes from the provinces, with their more limited resources. Collision course This is only one matter falling under the purview of recent federal legislation. There are other issues such as medical advertising, the right of doctors to sue hospitals that refuse them privileges and physician immigration. We are probably going to see a collision between federal legislation and the medical profession on the issue of ethics committees used to prevent professional advertising. The federal government has suggested that this practice could contravene its proposed competition rules. Consider a young doctor or dentist, keen to build up a practice on his own, who advertises his presence to the public and asks lower rates than those quoted in the fee schedule. If attempts were made to squelch this sort of behaviour by hauling the offender before an ethics committee, the association concerned could be prosecuted under federal legislation. This same legislation can be interpreted as enabling hospitals to be prosecuted for unfair dispensing of admitting privileges. Then there is the problem of phy-
1446 CMA JOURNAL/JUNE 10, 1978/VOL. 118
sician immigration. There is some speculation that federal legislation might open the door to greatly increased immigration of doctors. Would more doctors mean greater competition and hence lower medical care costs? Or would more doctors simply mean more individuals to be paid for their services? The Department of Employment and Immigration has begun work on a plan to direct the flow of immigrant doctors into the places where they are most needed. Already the department has concluded bilateral agreements with some provinces to review all job offers to doctors overseas. Negotiations are underway with the remaining provinces. This is definitely an area requiring input from the profession. I believe that better representation of the medical profession in Parliament would decrease bureaucratic harassment of the profession and thus reduce the mass exodus of doctors from Canada to the United States. In 1977, the number of doctors leaving the country exceeded 500. According to CMA statistics, between 1974 and 1977, there was an increase of 800% in inquiries, 500% in applications; and 300% in the number of US licences issued to physicians from Canada. The reason: economic frustration in the Canadian medical profession. The buying power of a doctor's pay 20 years ago was far greater than it is today. Between 1971 and 1976, the real net disposable income for doctors in Canada has decreased by 17%. Current data indicate that lawyers and dentists passed doctors in net income in 1976. In the United States, income tax levels for MDs are lower and allowable deductions are greater. It is also reported that a physician who moves south may anticipate a net annual income increase of $1 5-20 000 for a comparable workload. Many Canadian doctors feel that their earnings are not comparable to their training and the number of hours they work per day. A plumber gets more for a housecall than does a doctor. The significant factor for Canada is that emigration is now almost exclusively of graduates from Canadian universities and represents a figure comparable to the total 1978 physician production of the four Quebec medical schools or the five Ontario
medical schools or the five medical schools of western Canada. I contend that stronger medical representation in the House of Commons would help make a government more aware of the high costs of training a physician and the need to mitigate the bureaucratic harassment of the profession in order to reduce the loss of potential leaders in both medicine and community affairs. There are other aspects of medi-
cine with which one or another government may try to tinker in the next few years. Licensing, rigid fee-setting, patients' rights, policing of the profession. In all these areas you could see infringement of the autonomy that has always been enjoyed in the past. The medical profession is plagued by governmental interference, the health care delivery system is threatened by lack of funding to medical
and scientific research communities and Canadians are losing some of their most brilliant physicians to the United States. As a nation with such great potential, we must demand a better state of affairs. Lobbies can only do so much and their effectiveness only causes a slight ripple. A voice from within is the only solution to providing Canadians with the best. health care delivery system in the world. U
Monique Begin: a minister who knows how poor people feel JIM GARNER
Ottawa's Confederation Building stands like a second-rate Victorian imitation of a gothic cathedral, and the heavy brass-plated door of the office of the minister of national health and welfare looks onto a gloomy corridor. But inside, the light-carpeted, high-ceilinged suite has an air of relaxed elegance. There's much about Monique B6gin in official Ottawa that reflects the contrast. In an atmosphere of shrewd political wheelers and smoke-filled backrooms she moves with an air of chic. One of her friends says she has a sense of fun, and certainly in a recent interview with CMAJ she two or three times broke into peals of laughter. Our interview could have begun badly. B6gin had just come from a difficult meeting and was breathing fiery remarks about somebody's pigheadedness. But when asked about her childhood and home life, she relaxed rapidly and talked freely. "I am a part of all that I have met," declared Tennyson's Ulysses, and it seemed to CMAJ that those who would understand our minister of national health and welfare should learn a little of her background and there are some interesting parts. How she was born in Mussolini's Rome in 1936, the eldest child of an itinerant Canadian movie sound engineer and a Flemish mother. How the B6gins were caught in Paris in 1940 by the German advance. How they journeyed 3 years, mostly on foot, to reach neutral Spain. The young Monique was brought
up in the tough St. Henri district of Montreal, and when the middle-class sociologists today come to talk to her about poverty, she knows something of the subject that they don't; she experienced it herself and was in day-to-day contact with poor neighbours. She even had a spell in hospital because of malnutrition. Her father, who had to work outside Canada because his type of work didn't exist here, was himself one of a large and impoverished Quebec family, and even though he could have afforded the cost of university for his eldest child, he believed she should make her own way. Begin seems to like talking about her father, whom she described as a strong personality. "He would question all the rules of society," she explained. He left on a potato train to the United States, adventured, travelled the world and became an engineer. Her mother, she .said, was a balanced woman who kept the home together during the father's long absences. Higher education Monique Begin became a teacher because in the 50s that was the way into higher education for what today are euphemistically known as the disadvantaged. And she went back St. Henri to teach, gathering together the resources needed for her Paris university education. She was in Paris in her twenties. She missed the hot dogs! She came to Ottawa in 1968. Mrs. Florence Bird (now a senator), had
been appointed to chair the Royal Commission on the Status of Women and was looking for an executive secretary. B6gin at the time was working on social research projects in Quebec and had done a great deal to stimulate the Federation of Quebec Women, of which she is a founding member. "I was anxious to get somebody young, because the average age of the Royal Commissioners was high," Bird told CMAJ. "I wanted a good French Canadian - somebody who knew the Quebec scene... It was Begin's first exposure to the political process, and she was not impressed. One of her complaints, for instance, was the lack of input by nonministerial MPs, and she seems to have done something about that: certainly her parliamentary secretary, Ken Robinson (Lib Toronto Lakeshore), told CMAJ he has been very pleased about the way she has delegated duties to him - in contrast to certain other ministers, who tend to ignore their parliamentary secretaries. At the royal commission, Begin revealed a horrendous appetite for work - being not the complete workoholic, says Senator Bird, but none the less somewhat compulsive. "When she came to me she was very inexperienced," Senator Bird said. "She learned a great deal on the royal commission. She's learned to keep her cool - she's actually highly emotional but she's learned to control it. She's learned to field questions in Parliament. People do
CMA JOURNAL/JUNE 10, 1978/VOL. 118 1447
Medical men and women must become more actively involved in the political affairs of this nation. Scientists in general, including practising physicians and surgeons, have traditionally looked at politics as an unattractive and unimportant field to them; one they did not want to mess around in. The result has been that outsiders have been making decisions and imposing them upon doctors. It has become obvious that the medical profession is more and more controlled by federal and provincial laws imposed by politicians, bureaucrats, administrators and others who are not necessarily either sympathetic to the medical profession or well informed on the health field in general. The federal government has shown in recent years that it is quite prepared to take unilateral action when politically expedient and to restrict budgets that directly affect the income of the physicians. The provincial governments in some cases have not shown a great deal more regard for the profession. Health care costs have been skyrocketing it is true, but the increases have been largely on the institutional side. However, doctors have been blamed for these increased costs. Bureaucrats and to some extent the public have accused doctors of channelling all these increased costs into their own pockets. The fact is that increases in doctors' incomes have been very modest in recent years. It is now obvious that passage of the medicare legislation 10 years ago places severe constraint on the incomes of physicians in this country, because physicians have not taken enough care to ensure that their incomes are properly protected. Political action The time has arrived when physicians in this country should reassess their general attitude toward the political process, if they are to have any significant impact on the direction our health care system takes. The input can only come from more active
participation in the political system itself. For too long, doctors in Canada have looked inward and have concentrated simply on providing a good service. Doctors have felt that doing so xvas sufficient cause for expecting reasonable treatment by legislators and the public in general. However, we know now that a physician who is doing a good job is still liable to abuse by the political process. If he wants to avoid or minimize this abuse, he must take a more active role in seeing to it that the laws of the land are developed in such a way that his profession and the health care delivery system itself are not adversely affected. The medical profession should take a greater part in directing and developing the health care delivery system, in developing resources to pay for it and in informing bureaucrats insofar as the health care system is concerned. When I am talking about political action I do not simply mean contributing to political parties or presenting briefs to government or contributing a few hours to help somebody in his political election campain. I am suggesting that physicians should seek nominations for elected office to a far wider degree than they have done thus far. Currently, there are only 9 doctors (4% of the total membership of 264) in the House of Commons compared to 69 lawyers (28%), 18 teachers (7%), 17 farmers (7%), and 12 university professors (5%). The medical profession has been making its point of view known from a position of severe political disadvantage. The situation will not change overnight. But it will change with the development of political power from within the profession itself and from a new attitude on the part of the profession, that it is willing and able to develop and use political power. Only if that kind of strategy is followed can one expect a change in the behaviour of government and in the public attitude toward the profession. That is not to say that doctors in federal or provincial politics should be there purely for the protection of
1444 CMA JOURNAL/JUNE 10, 1978/VOL. 118
.222. Tablets INDICATIONS: For relief of mild to moderate pain, fever and inflammation as in influenza, common cold, low back and neck pain, headache, trauma, following dental and surgical procedures. DOSAGE-Adults-i or 2 tablets one to three times daily; Children's dosage, when recommended by a physician: 10 to 14 years, one tablet, one to three times daily; 5 to 10 years, one-half tablet, one to three times daily. CONTRAI NDICATIONS: Gastrointestinal ulceration and sensitivity to any of the components. WARNINGS: Salicylates increase the effects of anticoagulants. Caution is necessary when salicylates and anticoagulants are prescribed concurrently. Also, salicylates may depress the concentration of prothrombin in the plasma. Large doses of salicylates may affect insulin requirements of diabetics. Salicylates may potentiate sulfonylurea hypoglycemic agents. Analgesic abuse (excessive and prolonged therapy) has been associated with nephropathy. TOAVOID ACCIDENTAL POISONING ACETYLSALICYLIC ACID PREPARATIONS MUST BE KEPT WELL OUT OF REACH OF CHILDREN. PRECAUTIONS: Give with caution to patients with asthma, other allergic conditions, bleeding tendencies, or hypoprothrombinemia. Salicylates can produce changes in thyroid function tests. Observe care in use of codeine, although tolerance and addiction are rare. Give codeine with caution to patients with severe respiratory depression. Its depressant effect may be enhanced by concurrent administration of sedatives and tranquilizers. ADVERSE REACTIONS: Acetylsalicylic acid: Gastrointestinal: dyspepsia, heartburn, nausea, vomiting, diarrhea, gastrointestinal ulceration and bleeding. Ear reactions: tinnitus, hearing loss. Hematologic: anemia, leukopenia, thrombocytopenia, purpura. Dermatologic and Hypersensitivity: urticaria, angioedema, pruritus, various skin eruptions, asthma and anaphylaxis. Miscellaneous: mental confusion, drowsiness, sweating and thirst. Codeine: Average or large doses may cause various gastrointestinal symptoms such as nausea, vomiting and constipation. Caffeine: May cause nausea, nervousness, insomnia, headache, vomiting, palpitation, vertigo, muscle tremor, sensory disturbances, excessive diuresis in sensitive patients. Large doses may cause gastric ulceration. FULL INFORMATION AVAILABLE ON REQUEST HOW SUPPLIED 0222* Tablets-White, scored, engraved 222 on one side. Each tablet contains: acetylsalicylic acid 375 mg, caffeine citrate 30 mg, codeine phosphate 8 mg. Available in tubes of 12; bottles of 40, 100 and 250, also bottles of 60 with safety cap. Weiss, H.J.: AspIrin-a dangerous drug? 1. JAMA 229(9): 1221-1222, Aug. 26, 1974. Beaver, W.T.: Mild analgesics In the 2. treatment of pain, pp. 1094-1120. .Trademark
JJLo.t CHARLES E. FROSST & CO. KIRKLAND (MONTREAL) CANADA
2227-7-71 9-JA
EED
the medical profession. That would subject them to charges of simply being elected to serve their own self interest. While I am suggesting that there be more doctors active in politics, I want to make it clear that no doctor can get elected to Parliament or to the legislature simply by the vote of his medical colleagues. He gets elected by the people at large and therefore his primary concern must be to serve the people at large. But if there were 50, 60, or 70 MDs in a parliament of 264 people, the mere presence of such numbers would be bound to have a beneficial effect from the point of view of the profession as well as the public. Since Confederation, the government of Canada has had only two medical doctors as ministers of national health and welfare: Dr. James Horace King, 1928-1930, and Dr. Murray MacLaren, 1930-1934. This department of government, perhaps the most cherished by prospective cabinet hopefuls, alone exercises responsibility for a budget of $12.7 billion. With the mass of legislation churned out in the Department of National Health and Welfare each year, doctors in parliament have an important role to play. A physician's contribution could be especially significant in the area of medical and scientific research legislation. Since 1970, the medical and scientific research communities have been suffering from a steady decrease in funding. The small increases the Medical Research Council receives every year are more than completely eroded by inflation, so that there has been a drastic reduction in the number and value of grants. The lack of funding due to the ignorance of federal government policies has had a depressing and frustrating effect not only on researchers themselves, but on the progress of research in Canadian medical education and on the national self-respect itself. Because of the federal government's unenlightened approach, Canada is developing a reputation internationally of not being a good place to do research. In the long run the country will be harmed. Federal medical care legislation and fiscal arrangements trespass into the field of medical fees. The federal government has attempted to place itself in a position where it decides
Paul Yewchuk: time to reassess attihide to political process.
for you what is a reasonable increase in your income. Medical care legislation limited 1976-77 federal medicare expenditures to 113% of those of the previous year and 1977-78 expenditures to 110.5% of the 197677 levels. Doctors cannot hope for anything better unless it comes from the provinces, with their more limited resources. Collision course This is only one matter falling under the purview of recent federal legislation. There are other issues such as medical advertising, the right of doctors to sue hospitals that refuse them privileges and physician immigration. We are probably going to see a collision between federal legislation and the medical profession on the issue of ethics committees used to prevent professional advertising. The federal government has suggested that this practice could contravene its proposed competition rules. Consider a young doctor or dentist, keen to build up a practice on his own, who advertises his presence to the public and asks lower rates than those quoted in the fee schedule. If attempts were made to squelch this sort of behaviour by hauling the offender before an ethics committee, the association concerned could be prosecuted under federal legislation. This same legislation can be interpreted as enabling hospitals to be prosecuted for unfair dispensing of admitting privileges. Then there is the problem of phy-
1446 CMA JOURNAL/JUNE 10, 1978/VOL. 118
sician immigration. There is some speculation that federal legislation might open the door to greatly increased immigration of doctors. Would more doctors mean greater competition and hence lower medical care costs? Or would more doctors simply mean more individuals to be paid for their services? The Department of Employment and Immigration has begun work on a plan to direct the flow of immigrant doctors into the places where they are most needed. Already the department has concluded bilateral agreements with some provinces to review all job offers to doctors overseas. Negotiations are underway with the remaining provinces. This is definitely an area requiring input from the profession. I believe that better representation of the medical profession in Parliament would decrease bureaucratic harassment of the profession and thus reduce the mass exodus of doctors from Canada to the United States. In 1977, the number of doctors leaving the country exceeded 500. According to CMA statistics, between 1974 and 1977, there was an increase of 800% in inquiries, 500% in applications; and 300% in the number of US licences issued to physicians from Canada. The reason: economic frustration in the Canadian medical profession. The buying power of a doctor's pay 20 years ago was far greater than it is today. Between 1971 and 1976, the real net disposable income for doctors in Canada has decreased by 17%. Current data indicate that lawyers and dentists passed doctors in net income in 1976. In the United States, income tax levels for MDs are lower and allowable deductions are greater. It is also reported that a physician who moves south may anticipate a net annual income increase of $1 5-20 000 for a comparable workload. Many Canadian doctors feel that their earnings are not comparable to their training and the number of hours they work per day. A plumber gets more for a housecall than does a doctor. The significant factor for Canada is that emigration is now almost exclusively of graduates from Canadian universities and represents a figure comparable to the total 1978 physician production of the four Quebec medical schools or the five Ontario
medical schools or the five medical schools of western Canada. I contend that stronger medical representation in the House of Commons would help make a government more aware of the high costs of training a physician and the need to mitigate the bureaucratic harassment of the profession in order to reduce the loss of potential leaders in both medicine and community affairs. There are other aspects of medi-
cine with which one or another government may try to tinker in the next few years. Licensing, rigid fee-setting, patients' rights, policing of the profession. In all these areas you could see infringement of the autonomy that has always been enjoyed in the past. The medical profession is plagued by governmental interference, the health care delivery system is threatened by lack of funding to medical
and scientific research communities and Canadians are losing some of their most brilliant physicians to the United States. As a nation with such great potential, we must demand a better state of affairs. Lobbies can only do so much and their effectiveness only causes a slight ripple. A voice from within is the only solution to providing Canadians with the best. health care delivery system in the world. U
Monique Begin: a minister who knows how poor people feel JIM GARNER
Ottawa's Confederation Building stands like a second-rate Victorian imitation of a gothic cathedral, and the heavy brass-plated door of the office of the minister of national health and welfare looks onto a gloomy corridor. But inside, the light-carpeted, high-ceilinged suite has an air of relaxed elegance. There's much about Monique B6gin in official Ottawa that reflects the contrast. In an atmosphere of shrewd political wheelers and smoke-filled backrooms she moves with an air of chic. One of her friends says she has a sense of fun, and certainly in a recent interview with CMAJ she two or three times broke into peals of laughter. Our interview could have begun badly. B6gin had just come from a difficult meeting and was breathing fiery remarks about somebody's pigheadedness. But when asked about her childhood and home life, she relaxed rapidly and talked freely. "I am a part of all that I have met," declared Tennyson's Ulysses, and it seemed to CMAJ that those who would understand our minister of national health and welfare should learn a little of her background and there are some interesting parts. How she was born in Mussolini's Rome in 1936, the eldest child of an itinerant Canadian movie sound engineer and a Flemish mother. How the B6gins were caught in Paris in 1940 by the German advance. How they journeyed 3 years, mostly on foot, to reach neutral Spain. The young Monique was brought
up in the tough St. Henri district of Montreal, and when the middle-class sociologists today come to talk to her about poverty, she knows something of the subject that they don't; she experienced it herself and was in day-to-day contact with poor neighbours. She even had a spell in hospital because of malnutrition. Her father, who had to work outside Canada because his type of work didn't exist here, was himself one of a large and impoverished Quebec family, and even though he could have afforded the cost of university for his eldest child, he believed she should make her own way. Begin seems to like talking about her father, whom she described as a strong personality. "He would question all the rules of society," she explained. He left on a potato train to the United States, adventured, travelled the world and became an engineer. Her mother, she .said, was a balanced woman who kept the home together during the father's long absences. Higher education Monique Begin became a teacher because in the 50s that was the way into higher education for what today are euphemistically known as the disadvantaged. And she went back St. Henri to teach, gathering together the resources needed for her Paris university education. She was in Paris in her twenties. She missed the hot dogs! She came to Ottawa in 1968. Mrs. Florence Bird (now a senator), had
been appointed to chair the Royal Commission on the Status of Women and was looking for an executive secretary. B6gin at the time was working on social research projects in Quebec and had done a great deal to stimulate the Federation of Quebec Women, of which she is a founding member. "I was anxious to get somebody young, because the average age of the Royal Commissioners was high," Bird told CMAJ. "I wanted a good French Canadian - somebody who knew the Quebec scene... It was Begin's first exposure to the political process, and she was not impressed. One of her complaints, for instance, was the lack of input by nonministerial MPs, and she seems to have done something about that: certainly her parliamentary secretary, Ken Robinson (Lib Toronto Lakeshore), told CMAJ he has been very pleased about the way she has delegated duties to him - in contrast to certain other ministers, who tend to ignore their parliamentary secretaries. At the royal commission, Begin revealed a horrendous appetite for work - being not the complete workoholic, says Senator Bird, but none the less somewhat compulsive. "When she came to me she was very inexperienced," Senator Bird said. "She learned a great deal on the royal commission. She's learned to keep her cool - she's actually highly emotional but she's learned to control it. She's learned to field questions in Parliament. People do
CMA JOURNAL/JUNE 10, 1978/VOL. 118 1447
