Second Opinion: If doctors don’t advocate for patients, we fail them

‘Doctors, I believe, have a responsibility to advocate on behalf of patients and must continue to do so. There should be and will be no gagging clauses as long as I am Minister, and whistleblowers will be listened to.”

These were the words of Minister for Health Leo Varadkar, in a wide-ranging speech to doctors at the annual meeting of the Irish Medical Organisation recently. I think they are enormously significant.

I have been struck by how medical colleagues have been silenced in recent years when it comes to patient advocacy. It is not that they no longer have patients interests’ at heart; but neither GPs nor consultants have been as vocal as they were when I first became a medical journalist.

Inequality and inequity continue to be part of Irish healthcare. Most of it is not intentional. However, uneven playing fields in terms of equal access to healthcare must be identified and highlighted. Doctors, nurses and allied health professionals are the ones who are most likely to spot these issues first.

Unfortunately, gagging clauses in contracts have been seen as a useful weapon by health-system apparatchiks in recent years. Even relatively innocuous paragraphs to the effect that a doctor’s concerns about any aspect of the health service should be brought to the attention of local health bosses “in the first instance” have been used to intimidate individuals seeking to advocate.

The wish to stamp out debate had progressed to the point where initial iterations of proposed contracts for both hospital consultants and GPs have included the most draconian of gagging clauses. And while these clauses have been watered down before final agreement was reached in contract negotiations, they have not been removed. As a result, a malign message has got out there: talk publicly about perceived deficiencies in the service available to patients at your peril.

Another factor I believe has contributed to doctors’ relative silence about patient advocacy is the fatigue associated with constantly battling to be able to provide even a basic service to a patient in need. This has been well described by psychologists: over time, something that would instinctively have been deemed unacceptable becomes more palatable simply because it is now a daily experience.

For example, if you are an emergency department physician and you can no longer remember the last time you didn’t come to work to find the department overflowing with patients on trolleys and chairs, a new “norm” insidiously takes root in your brain. It is a natural process of self-protection; which of us can maintain a level of anxiety about an ongoing situation before the process, at some point, begins to damage our own health.

Or, if you are a surgeon who has gone for months since being able to operate on a patient on an elective waiting list, do you become hardened to a new reality of constant firefighting, while people you knew needed surgery within months inevitably deteriorate, having spent several years waiting for a slot?

Varadkar went on to say he wanted to see real partnership “so that we can work together to address concerns and identify problems before they escalate and stop things getting to the point of no return.

“ Doctors are right to be advocates for patients and press for reforms, but at the same time none of us wants to undermine public confidence in our health service.”

Patient advocacy remains a central plank of medical professionalism. Regrettably it has been the subject of attacks from vested interests elsewhere in the complex equation that is the health system. However, with this very public backing for a return to active advocacy by the Minister for Health, and palpable support from the Medical Council, doctors must start to run again with a firm grip on the advocacy ball.

Fellow medics, may I respectfully suggest that it’s time for “carpe diem”?

mhouston@irishtimes.com muirishouston.com