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It Makes You Think…

(ACNEM Journal, Vol. 23 No. 2, September 2004)

Who's Responsible Here?

In my earlier career as a lawyer I often had to deal with righteously angry people who were champing at the bit to sue someone who had wronged them. The normal response from a red-blooded lawyer in those days was to go for it. Maybe I wasn’t red-blooded enough. Maybe I just didn’t have a taste for confrontation.

My response was to listen to the angry person’s story (and take notes). I would then ask what result the person wanted out of all this. The answer was rarely that they wanted retribution. What most wanted was, firstly, recognition that they had been wronged and, secondly, an apology; sometimes they wanted some compensation to reimburse them for a loss.

As a result of this approach, most people I dealt with ended up with an acceptable, and usually good, result. Costs were kept at a minimum and if there was any compensation involved, the ‘client’ ended up with most of it (rather than the lawyers).

What does this have to do with doctors? (In using the term ‘doctor’ I include all healthcare professionals.)

Doctors are in a service profession – they serve their patients. Unfortunately we live in an environment of increasing litigiousness. The blame for much of this can be sheeted home to the legal system and, especially, to some lawyers. This environment makes the provision of any service more difficult, as each player has to continually look over their shoulder. Traditionally, Australians have had a much more laid-back attitude to professional relationships than their counterparts in the USA, but we seem to be trying to catch up with them.

Burdening any service with the requirement that everything must go 100% to expectation is counterproductive. It unduly restricts the service provider (doctor) and allows the consumer (patient) to expect that nothing will ever go wrong. When it does – sue.

This does not mean that anyone should be allowed to take a slap-dash attitude. Doctors owe a duty to their patients that they will do everything they can and do it to the best of their ability, to provide the service the patient wants or needs. The only reason we have doctors is that people get unwell. It should be seen as a privilege to be allowed to offer such a service. It is a sacred duty to a fellow human. Ideally, only those who have a true calling to be healers should be allowed to become doctors, but that would probably create a greater shortage than exists now.

Through their training, doctors have an insight into issues of health and disease which most patients do not have. However, each patient has a unique insight into his/her condition denied to any other person, and the patient’s experience and wishes need to be respected.

A doctor’s role is not that of a dictator, nor that of a slave. The role is one which involves partnership, compassion, advice, knowledge, insight, experience, learning and humility. The doctor has a right to be heard by the patient, but not the right to tell the patient what to do.

A patient’s role, once having put themself in that position, is to be clear about their experience (e.g. symptoms) and to listen to the advice given by the doctor and then to consider that advice carefully. The patient has the right to ignore that advice and decide on their actions. The patient then takes responsibility for their treatment and the outcome of any treatment.

(There is the issue of incompetence and gross negligence. These are hopefully not common, but room needs to be made in any system to deal with them. I will treat these as the exception rather than the rule – an injured party should have the right to seek compensation in this instance.)

The patient has the right to choose the style of treatment he or she will accept, and the right to choose not to have any treatment. The State (government) has no right to dictate to the patient which treatments are acceptable and which are not. The State has a role to play in ensuring that the patient is properly and adequately informed, so that they may make informed choices. Doctors and their professional organisations (colleges) have absolutely no right to dictate treatment choices.

The doctor serves the patient. The doctor does not serve the State, professional organisations or industry. And the State itself is in the service of the patient, governments having been elected by the patients.

This does not mean that the State has no role to play. It is in a unique position to regulate any profession or industry, but it must not do so unnecessarily or in order to protect vested interests. If the State pays for some healthcare, it also has a right to say how that money is to be spent – but not to make it difficult or impossible to access those styles of healthcare which it does not fund. And the State must not use its power to victimise practitioners who do not conform to current orthodoxy – every patient has the right to free choice.

In the real world, industries and professions grow up to meet real or perceived needs of consumers. Eventually these industries and professions can grow so large and powerful that they become a law unto themselves through the influence they can exert on governments. Patients then find that they have to fit in with what works best for the prevailing industry or profession, whether it be medical, pharmaceutical, ‘complementary’ or hospitals.

So, who is responsible here? I place responsibility squarely on the shoulders of the patient, provided that s/he is properly informed and properly advised. This means that the system has to change to provide the information every patient needs to exercise free choice. The responsibility for that lies with patients to demand it and the State to ensure that it is provided.

It will not do for patients to expect their doctors to take the responsibility for making them well and then to sue their doctors when things go wrong. Doctors should be able to work in a more secure environment where, if they apply their skills in a proper way, they should be safe from being sued if something goes wrong. Things can go wrong without it being anyone’s fault and without there being negligence. What is more important is to find out, if possible, why it went wrong and learn from it.

I am reminded of a story of a girl who’s leg injury, requiring surgery, was actually worsened by that surgery. The girl’s father, a doctor, compassionately and wisely understood that suing would not help either his daughter heal or the surgeon to work with more presence of mind. She used the time to read and consequently markedly improved her next semester’s results and, in the long term, she gained valuable insight through her father’s decision.

First published in Journal of Australasian College of Nutritional & Environmental Medicine,
Vol 23 No 2, September 2004, pp 17 & 5