Who’s to blame?


I love my job. Working as a paediatric palliative care practitioner over the last 13 years I have had to have some really difficult conversations with both children and their parents. So in the last few years it makes sense that I have been invited to teach final year medical students communication skills.

Believe it or not, it is really quite fun.

I feel really privileged to have time with these young ‘doctors to be’ at this point in their careers; they have seen enough disease, human drama and tragedy to be fully sensitised to reality, but are not yet jaded by their own fatigue and weight of responsibility.

What they have seen though, is numerous senior colleagues that are burnt out or who have developed a protective shell so hard they come across as arrogant and dismissive of both patient and student. It is fascinating to listen to them discussing these issues in a safe place and my hope for a future generation of empathetic doctors that are humble, respectful and good at communication soars.

But I am not naive or optimistic enough to think that this future ideal is a reality. On the contrary – our doctors train in an impossible environment; resources are scarce, language barriers and subtle racism are ever present; hierarchy overwhelms any possibility of a nurturing environment which is actually required to ignite compassion. And compassion begets compassion – seriously lacking in our health care system. Getting further in your career requires proving yourself to our colleagues, not to our patients.

I am sure many reading this will assume I am referring to the public sector. However all doctors start in the public sector and very often when moving into the private sector find themselves  alone, battling the balance between patient expectation and the ever powerful medical aid schemes.

And on the other hand, patients have a lot to answer for. They stand for it. Too often patients are still scared of the doctor. I think of the times that I have received substandard care or poor communication at the hands of some very well acclaimed professional and let it slide. It is easier to complain to friends and family after the fact.  The last time I stood up for patient rights in a personal capacity, the physician accused me of wanting to kill or euthanase my own father!

But perhaps our health care system needs something different. Litigation or suing rude and offensive doctors is not the solution to improving health care. If we are all too busy practicing defensive medicine, where patient and doctor are enemy, there is less investment in improvement in care.

I believe it is time for system change, where complaints can be handled in a constructive manner that results in a ‘win:win’ situation. This requires a paradigm shift where patients feel empowered to complain to have their problems resolved, and can be guaranteed that the complaint or concern will be dealt with in a compassionate manner. Doctors would in turn be able to handle complaints effectively – doctors are human; mistakes will happen – they should be brave enough to acknowledge this without fear of prosecution and punitive measures unless of course they were purposefully negligent.

This seems like a pipe dream but perhaps one day the rights of doctors and patients will merge so that a truly equal health care system based on mutual respect can emerge.