To say that doctors have had a tough time in British Columbia over the past 10 years is something of an understatement. Our gentlemen physicians of the BCMA, charged with our defence, had constructed an impressive Maginot Line, but just like the Germans of 1940, the government simply went round the rear and routed the lot of us, virtually without a fight. Demonized by the government, relegated to the sidelines of the health care battlefield, and stripped of our ability to earn a professional income, many have become frustrated and disillusioned. To express anger and outrage at corporate BCMA or the Ministry of Health is a natural reaction, though somewhat akin to punching into a giant blancmange. Worst of all, however, is to transfer blame or inadvertently punish the sick, the frail, or the frightened.
A close friend died recently of a malignant disease, and the experiences that he described to me over the months prior to his death have forced me to reflect deeply on the nature and direction of our health care system. At the time of initial diagnosis, his surgeon presented the grim prognosis in a very perfunctory, distant manner, and without compassion. “It was as if he was talking about my car” said the doctor’s patient.
Some years ago, I accompanied another friend to the Cancer Agency. A difficult decision had to be made regarding treatment and whether this would influence mortality. To my total astonishment and dismay, the oncologist entered the room, read from the chart without making eye contact, and gave his opinion. At the end of his monologue, he asked if there were any questions and then turned and left. He had described a significant mortality but made no attempt to comfort his patient or to show even a vestige of humanity.
Last year one of my elderly patients was admitted to hospital subsequent to suffering an acute hemiplegia. Although physically disabled, her mental state had been preserved. On one occasion, I asked her to comment on her care. She hesitated for a moment before replying that the care was good, but there was no kindness. During the visit I noticed that her urinary catheter had become disconnected and urine was flowing freely over the floor and into the hallway. I went to the nurses’ station where I encountered numerous people seated at the desk, charting. On reporting the problem, no one recognized the name of the patient. They wanted to know the room number and bed that I was referring to. Her name had become irrelevant.
I do not believe that these incidents are unusual, but rather represent a damning indictment of us all. Somehow we have lost our way and the fix is not financial. More money will not correct such a profound loss of direction. Health care professionals deserve a reasonable salary for the work that they are expected to do and no one responds well to exploitation. Nevertheless it is profoundly disturbing to contemplate that a car mechanic or veterinarian provide greater compassion to their “clients” than many of our physician or nursing colleagues.
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Halpern SD, Ubel PA, Caplan AL, Marion DW, Palmer AM, Schiding JK, et al. Solid-organ transplantation in HIV-infected patients. N Engl J Med. 2002;347:284-7.
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