Contradictions

Health care fascinates me. As a field dedicated to alleviating suffering through service to fellow people, you would assume that providers would be compassionate towards all and work towards helping all. Through conversations with fellow medical students and partner nursing students, I received a much deeper understanding of the realities of the inequities faced and perpetuated by health care providers from different professions. The historically paternalistic roots run deep and persist to contribute to the damage inflicted on those who receive care as well as those who provide it. Are we, as health care professionals, able to serve those who need us most when we can’t even take care of each other?

Contradiction 1: Doctors put nurses down and nurses resent doctors. Doctors put newer doctors (in-training) down and those trainees suffer – personally and professionally. Nurses cause trouble for newer (in-training) nurses and those nurses suffer. The cycle of suffering continues with each new cohort of health care professional trainees. Why are those who are charged with alleviating suffering causing so much of it? There is suffering caused amongst each other and then the hurt experienced by each provider has the potential to be transferred to patients.

There is the old adage, “Give a man a fish and you feed him for a day; teach a man to fish and you feed him for life.” The ability to empower other human beings gives them control over their own lives and allows for more active participation and engagement. As health care providers who are already stretched to the limits with their time and overloaded with high patient volumes, wouldn’t we want the patients we serve to do some self-serving if they can? Shouldn’t we be doing everything we can to empower patients?

Contradiction 2: Not giving patients all the information they need to be an active participant in their own health care, yet being so busy that we are unable to provide appropriate, quality care at times. The whole process of informed consent has become a joke. It is no more than a piece of paper for the provider to obtain a signature; an impediment to treating the patient as it takes time from doing the procedure or providing the care. Does it really? Wouldn’t we want the person with the most knowledge of a problem to participate in devising the solution? So, shouldn’t it follow that the patient should participate in his or her own care?

Note on contradiction 2: Discussing the story of Michael Skolnik really brought to light how the process of informed consent was bypassed and devalued. Not only did the neurosurgeon working on Michael’s case prompt a groggy, post-procedure patient to sign an informed consent form, but he did not present all the information to the parents and patient.

If anyone had to pick between an outdated technology and a newer one, which would s/he choose? By the sales of the latest iPhone compared to the older models, I would conclude the latter. Newer technology, new clothes, new schools of thought always replace older versions, yet in health care the ‘old school’ way of thought seems to prevail.

Contradiction 3: Old school vs. new school. The professionals with the most experience are older and have the old school mentality, while the technology and newer approaches are taught to the newer cohorts of professionals. The newer professionals are already oppressed by the more senior professionals and even if the ideas of the new school are valid, the open-mindedness and adaptability to change isn’t there to allow new school to pick that fight. Old school bully seems to win. Ultimately, the goal of patient safety and patient-centered care suffers when one school of thought prevails over another because the best possible solution, most likely a hybrid of ideas from the two camps, is never presented as an option. “This is the way we have always done this” becomes a threat to the work done to care for the patient.

What are we doing by continuing to allow some of these contradictions to result in disastrous patient outcomes? We are making things harder for ourselves (when we need them to be easier) and we are making things more difficult in a system that has an ever-growing list of problems (that everyone wants to be shorter). So, what’s the solution? Simple. Focusing on doing no harm through transparency, integrity, compassion, innovation . . . wait, aren’t these some of the things we swore to uphold as we all entered the profession?

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