Saturday, 22 March 2014

Physician, Heal Thyse… Oh. You’ve Got That In Hand.

Declan Green (Melbourne GP) is worried about the physical threat posed by the mentally ill.

Yes, really! A turn up for the books, eh?

Oh, wait. Turns out he only means ‘for healthcare professionals’:
Hospital colleagues discuss the disturbing regularity of Code Greys and Blacks chiming over loudspeakers that the calls become part of the usual hospital ward din. Paramedics talk of being physically assaulted while treating people with life threatening injuries. Even accounting for the increase in drug and alcohol fuelled violence, assaults against health workers is rising and has reached pandemic levels. Can we inoculate against it?
Suddenly, it's a concern because you are the victims? Hmmm...
… medical care is an intimate art performed in the privacy of a consulting room or cubicle and it is here that most assaults occur. No extra panic buttons, physical barriers, guards, improved lighting or CCTVs can protect a health professional once the consulting room door closes. A patient’s fundamental right to privacy and confidentiality will always trump a health worker’s right to security and that is why the health professions and society need to alter the health professional-patient dynamic if we wish to see a drop in violence.
"Screw that Hippocratic Oath thing! I might get thrown into traffic, not some random member of the public! This is serious now!""
Nurses, doctors and paramedics are trained to treat patients with respect, autonomy and without judgement. We are taught to advocate for our patients and often put their needs above our own. This sense of duty leads to personal risk and creates a blind spot in our appraisal of potentially dangerous situations. In my experience, what little training I received in diffusing harm had a patient-centric focus rather than my personal safety. To reduce the potential for harm, health providers need the assurance that sometimes, the patient doesn’t come first.
Pity the harm that can be caused to members of the public isn't uppermost in your mind...
There has also been a shift in the doctor-patient relationship due to a change in societal values and medical advancement. A few decades ago, doctors were venerated and their authority was rarely challenged or questioned. Communications skills were irrelevant; paternalism was the norm. Thankfully, though the profession has some way to go, doctors are far more accepting of having their opinion questioned and are inclined to guide patients in discussing treatment options while respecting patient choices. Nurses and doctors frequently rate at the top of trustworthiness surveys, yet more than ever, patients are more likely to be critical of the medical profession, have higher expectations of care and level of service and are less accepting of any perceived failure of treatment.
"Oh, if only we could go back to the good old days when we were treated like gods!"


Anonymous said...


Many years ago I managed to dislocate my left shoulder while playing rugby, I was in a small operating room waiting for the orthopaedic surgeon a very big ex-rugby player to come into drag everything back into place. He had just left for a minute to attend something else. When a drug user accosted him because his friend who had over dosed was left on his own. Said rather large and powerfully built orthopaedic surgeon was somewhat judgemental and aggressive in his dealing with drug addicts friend.

The long and short of it was that my self, the anaesthetist and other associated people about to put my left shoulder back together cheered this bloke when he came back. So medics if necessary can be judgemental and aggressive and should be if the need requires it.

Mark Wadsworth said...

Agreed. It is a bit like 'special pleading'. It wouldn't have done their cause any harm to mention other groups at risk of attack by natters, i.e. everybody.

Anonymous said...

Cattle prod.

JuliaM said...

"So medics if necessary can be judgemental and aggressive and should be if the need requires it."

We should hire more huge, imposing doctors! Most of the ones I've seen couldn't handle me...

"It is a bit like 'special pleading'. It wouldn't have done their cause any harm to mention other groups at risk of attack by natters, i.e. everybody."

It does seem as if some like to take their work home with them.

"Cattle prod."

For whom..? ;)