WHOSE FAULT IS IT ANYWAY?

KATIE BEN, PRESIDENT

It is specialists who bear the real brunt of resourcing decisions higher up an organisation. We need to remind managers of that.

Whose fault is it anyway? It is a question that is being thrown around a lot when it comes to the health system. It is grim reading for anyone working in health right now.

The media is full of stories of people waiting in ambulances for hours and in emergency departments for hours or even days, people languishing on acute operating lists for days and weeks while waiting for a slot, and health care staff working through staffing gaps and working without adequate, essential resources.

As doctors we are required to practise medicine to the highest standards, and there is no allowance made for resource limitations and current working conditions.

We are contractually obligated to meet the ethical standards set by our governing bodies, the Medical Council and our colleges. Each patient we see has the right to the highest standards of care whether they are in Auckland or Invercargill, as laid down in the Code of Health and Disability Services Consumers’ Rights.

When I am working on call, I am the only anaesthetist in the hospital. This often requires me to be in two places at once. I can be in ED with a major trauma, heading to theatres with a long and complex laparotomy and, at the same time, be called to obstetrics for a much-needed epidural in a woman who has been labouring some hours, or (my recurring nightmare) a Category 1 caesarean section when we are already in theatre with another case on the table.

There is no second on-call anaesthetist. There is no backup theatre team. None of my medical training to date has grounded me in this sort of triage decision – the 35-year-old man who may lose his life, or the 35-year-old-woman who may lose her baby?

The stark reality is that those are the sorts of decisions our managers are all asking us to make.

While our senior leaders are making the decisions about where the money is spent, it is the clinicians on the ground who are being forced to make the difficult decisions about where their time is spent. And it is the clinicians on the ground who will be held accountable if –or, more likely, when – something goes wrong.

As clinicians, therefore, we must hold our employers accountable for the resourcing decisions they make.

We have to make them face the cold hard truth that a health service cannot be run on the ever decreasing goodwill of the staff who are doing their best, and we absolutely cannot allow them to pay for the health of the nation with our own health and wellbeing, which is what we sacrifice every time we agree to cover one more session, one more on call, one more extra weekend.

We need more colleagues at every level. We need to remind our employers that the ‘non-patient facing roles’ do as much good for the patients as the ‘patient facing roles’, and that cuts to anything are cuts to frontline services as a whole.

We need to be aware that in continuing to prop up a failing system, we become as responsible for its shortcomings as the managers who expect us to keep on doing so.

I apologise to those who feel angry reading this, and especially to those who feel ASMS could do more. Believe me we are doing as much as we can to highlight the systemic issues, and we will continue to do so.

We know you are struggling. We hear you. We are you. He waka eke noa – we are all in the same boat and all navigating the same storm. Here’s hoping for some clearer skies ahead.