Pain and parsimony

Dr Julian Vyas | ASMS President

Medical care has evolved over time. Not just with scientific breakthroughs, but also in terms of recognising that partnership between clinician and patient is in the best interest of the person presenting.

We hear the patient’s history and ask about symptomatology, and then consider a differential diagnosis of causes. Even if the symptoms presented are not indicative of definitive pathology, we know that if a patient repeatedly complains of the same problems, there is likely to be some ‘dis – ease’ at work which still needs further investigation and management. When providing care we act promptly, to the best of our ability, and to address the symptoms as best we can. This approach is adopted for anyone for whom we have a duty of care. It is basic good practice. In the MECA negotiations, and in general dealings with our employers, we as clinicians have been reporting symptoms of a health system suffering serious difficulty in performing its routine daily activities. The DHBs are responsible for evaluating those symptoms and responding in good faith and with good intention. Instead, in this topsy-turvy world, the DHBs have spent many years telling us that we are wrong, that the symptoms we report don’t exist or that we simply need to be more resilient. Any evidence we offer to prove the veracity of our symptoms and concerns is either disregarded or not acted upon adequately. …the DHBs have spent many years telling us that we are wrong, that the symptoms we report don’t exist or that we simply need to be more resilient. In short, this is basic bad practice. There is no small irony here. If we took a similar dilatory approach to our clinical work, we would not only be roundly censured for failing in our duty to act in the patient’s best interests, we would also risk losing our authority to practise. This is not the case for employers. Members will know that meaningful action over adequate staffing and safe workloads can be deferred ad nauseam, yet somehow DHBs avoid suffering any consequences for not properly meeting their duty of care to their staff. If we took a similar dilatory approach to our clinical work, we would not only be roundly censured for failing in our duty to act in the patient’s best interests, we would also risk losing our authority to practise. By the time you read this I sincerely hope we will be close to a fair settlement of our MECA claims. The DHBs have talked loftily about ‘valuing’ the work our members do. Yet they simultaneously undercut themselves by sticking to a pay offer that has remained unaltered despite months of negotiation. Confusing ‘cost’ with ‘value’ is a famous description of cynicism. The phrase from the DHB negotiators about having to have ‘a year of pain’, which all members will now be familiar with, is similarly cynical. It suggests that we must be made to suffer some form of punishment for problems that are not of our making. It also talks to a notion that DHBs don’t understand the ‘pain’ our members have endured over several years (preexisting excessive workload affecting personal and family wellbeing, unpaid additional work, and moral injury from not being able to give patients the standard of care they need). Our claim is predicated on measures intended to improve safe staffing and our members’ workplace wellbeing, including an acknowledgement of the damaging effects of overnight shift work. The aim is to increase the health system’s ability to provide high quality care without causing further harm to its staff. Our pay claim is to ensure we do not have to suffer a ‘real-terms’ pay cut, which no workforce should be required to take. For many years our employers have responded to our reporting of symptoms with platitudes, prevarication, and parsimony. As I write (late February 2022), Omicron is picking up steam and will markedly worsen the strain on a system which was already close to breaking point before Covid-19 came along. Our members tell us that, for the reasons outlined, the years of them routinely going the extra mile for the good of the health system are coming to an end. On the off chance that our employers are reading this article, I would like to close by saying that the pay settlement you have tabled is derisory. A pay increase that keeps pace with CPI cannot be argued as excessive. The responsibility to prevent further loss of senior doctors’ goodwill, if not actual workforce numbers, lies squarely with you. Recognise what is basic good practice and do the right thing. Kia kaha