HEARTBEATHealthcare reforms are widening the gap between the sick and the carers - and not for the better, writes Maurice Nelligan
DOROTHY WORDSWORTH wrote in her journal on May 30th, 1800, "I saw a heron swimming with only its neck out of water - it beat and struggled amongst the water when it flew away and was long getting loose".
Familiar as we all are with the heron as "silent watcher" or seeing it progress with stately stride, it was only last week that I saw what Dorothy had described so perfectly more than 200 years ago.
Returning to those long past days of my surgical training sets my feet back on the path that that narrative series was intended to follow. It was to be one surgeon's odyssey of transformation from medical student to cardiac surgeon against the contemporaneous background of the world outside.
That it hasn't been faithful to its original intention is, I think, due to the fact that somewhere along the way imperceptibly and slowly the rules changed.
It was a tale about the practice of medicine and the healing of the sick. For my generation this was understood and nobody questioned this basic premise. Now it has assumed a complexity far removed from the original ideals and governed by two fundamentals both alien to the original purpose.
I refer to the malevolent mix of politics and money, both of which often operate to the detriment of the sick and their carers. It would be simplistic to think that both in the best sense are not essential to the delivery of a modern health service. That said, the uncontrolled mixture which we now have can do great and lasting damage to the ideal they purport to espouse.
All the teaching hospitals in which I learned had their own particular sense of community, sharing the same common aim. Birds in their nests of course did not always agree but the institutions functioned well, never losing sight of patient welfare.
Many were directed by a religious ethos, as were similar foundations throughout the world.
The strength of that ethical dimension formed a strong bulwark against the intrusion of political or purely monetary control. Such strengths have weakened over the years, allowing the intrusion of those who fail to grasp the principal purpose - or, worse, view it simply as a vehicle for making money. Such values come, in time, to affect the whole organism.
Vocation and commitment are early casualties leaving a void quickly filled by those seeking power and money. These become the primary purpose. The hospital's sense of community is dissipated and replaced by individuals doing a job like any other and negotiating wages and conditions.
Continuity of responsibility and care are, seemingly, outmoded precepts. The latest consultant contract is another step in this direction. Once you've done your shift you're out of there, leaving your responsibilities behind to some one else who may be totally unfamiliar with your patients.
That's an essential point: They're no longer your patients - they belong to the institution.
The originally simple concept of the sick and the carers is further blurred by the proliferation of "experts" both individual and corporate who feed off and divert money intended for the care of the sick. It is blurred by media hype of bad events and a perception that in this day and age such things should not happen.
Well they always have, they do and they always will. The human state is frail and fallible and that applies to the medical profession also. Cicero wrote "nor do all sick persons get well, but that does not prove that there is no art of medicine''.
It's not the simple concept I imagined in my early days. It is now beset by absurdities expressed vociferously by those who have never stood in a hospital ward or run a general practice surgery, who have never been in an operating theatre or faced daily the problems of emergency care and trauma, strident armchair warriors who never had to assume the responsibility for somebody else's wellbeing and for their very life.
Our new Chief Elf tells us, when he is not emulating Edmund Burke, that "the whole purpose of the healthcare reforms is to try and take resources from the acute hospital sector and spend more in the community sector''. God help us all if such is his understanding and vision.
Hippocrates wrote: "Life is short and the Art long; the occasion fleeting; experience fallacious and judgement difficult. The physician must not only be prepared to do what is right himself, but also make the patient, the attendants and externals do likewise."
This exhortation is as valid for us doctors now as it was then.
Maurice Neligan is a cardiac surgeon