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Jaguar Python

~ Probably a poisonous snake living in Australia

Jaguar Python

Monthly Archives: October 2012

When Doctors Turn Right Wing

19 Friday Oct 2012

Posted by jaguarpython in Australia, Australian Politics, Ethics, Health, Social Issues, Socioeconomics

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Australian Labor Party, Health, Julia Gillard, Liberal Party of Australia, Private healthcare, Public health, right-wing, Tony Abbott

I always find it weird when doctors start spouting ideology that is counter to the ideals of public health, education and social services. More than 90% of doctors support public services for a reason. There is strong evidence that social services, healthcare and education are paramount to improving overall health outcomes. Scratch that – it’s not “strong evidence”, it’s fact.

So when doctors start spouting extreme right wing ideology, I wonder why. Are they stupid, wilfully ignoring the evidence because they are selfish or just evil?

I don’t really know. Some of it is picking and choosing – I don’t really blame those who don’t like Julia Gillard or the Labor Party, and I can understand a desire to liberalise the economy. There are things that are broadly considered “right wing” such as globalisation that are, I feel, necessary and good and have no negative impact on basic services.

What I don’t like is supporting cuts to services while promoting overpriced private healthcare and education. Charging patients excessively. Promoting private schools and full fee places at medical school. Claiming that Tony Abbott will be some sort of saviour for the nation given his atrocious, immoral job as health minister.

I suspect it’s mainly selfishness and greed that drives some people. And some people think that the pursuit of “success” in the form of money is the good and right thing to do (à la the “American Dream“) and that not doing this is morally inexcusable and that such people don’t deserve anything. In which case punishing the poor or unemployed is necessary even though it has the side effect of making everyone worse off due to inefficiency (treatment is far more expensive than prevention) and lack of resources in the health sector.

Additionally, people such as myself who wish to work almost exclusively in the public sector, for lower pay overall, are then losers and enablers, thus also evil and not worthy of any of the prestige that public hospital positions hold.

A similar line of argument is pursued by those who don’t believe that fat people, drinkers or smokers should have public healthcare. Which is a good topic for another post.

Related articles
  • Right wing, Left wing. (jaguarpython.wordpress.com)
  • Mitt Romney and “Legitimate Rape” (slog.thestranger.com)
  • Doctor ‘advised medical students to act less overtly gay’ to pass exam (telegraph.co.uk)
  • The Bad Idea That Doesn’t Go Away: Cutting The Ounce of Prevention (forbes.com)
  • Why are doctors silent? [SciencePunk] (scienceblogs.com)
  • NHS changes ‘risk to sexual healthcare’ (bbc.co.uk)

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Right wing, Left wing.

06 Saturday Oct 2012

Posted by jaguarpython in Australia, Australian Politics, Ethics, Human Rights, International Politics, Philosophy, Social Issues, Socioeconomics, World Affairs

≈ 1 Comment

Tags

Australia, Australian Labor Party, authoritarianism, Conservatism, deregularion, economics, human rights, left-wing, Liberal Party of Australia, liberalism, politics, poverty, right-wing, social welfare

Current Political Leaders And Their Position On The Political Compass

Current Political Leaders And Their Position On The Political Compass

Let me begin by stating that access to the following are human rights:

  • Food
  • Water
  • Shelter
  • Safety
  • Free healthcare (including contraception, dental and psychology services)
  • Free education
  • Personal and political freedoms including democracy and freedom of expression
  • Equity and equality regardless of gender, age, race, religion, sexual orientation etc
  • Certain economic freedoms

A developed civil society should provide the above not just because it is ethical, but also because providing these things is beneficial to a stable, happy, and economically prosperous country in the long term. Studies repeatedly demonstrate the good of ensuring these basic human rights.

There are many ways to provide these things to people. In places like Scandinavia, an extensive social welfare state with high taxes and niche high tech industry and research provide for this. In strategic port cities such as Hong Kong (though significant improvements need to be made in the welfare of the poor and homeless as well as democracy), the financial turnover is so high with many high earning professionals that low corporate and income taxes are sufficient to cover the social welfare budget. In Sri Lanka and Kerala – developing countries with markedly better standards of living than the rest of South and South East Asia – relative food self-sufficiency, large niche export markets and a well-organised, efficient public health system with high levels of literacy provide a foundation.

As you can see, the different taxation systems, different degrees of economic liberalisation and different types of industries are needed for different circumstances. The trick is working out the appropriate strategy for each country.

Right wing and left wing economic policies are more accurately described as “economic deregulation” and “economic regulation”. The extremes of right wing economic policy result in countries like the US or India where even basic public services such as healthcare are non-existent or poor quality. The extremes of left wing economic policy results in broad nationalisation of many assets and businesses such as in communism.

Both extremes are untenable. The question is how to implement appropriate policies for the local resources and population in the middle ground.

Some of these things are seemingly counter-intuitive in that deregulation isn’t always good for the economy, and regulations sometimes improve the economy. New Zealand is a case in point – a small country with a high cost of living, agricultural, tourism and environmental resources but low wages. The increases in the minimum wage under Helen Clark boosted the local economy and created jobs and lowered unemployment because people had enough money to spend on luxuries.

Authoritatianism is not “right wing” or “communist”. It is something that stands on one end of a spectrum with liberalism on the other end.

Australia, then, is in a situation where broadly speaking, the two major parties are both in favour of deregulation and dismantling of public assets. Unfortunately this includes public health and education. Additionally they both espouse a move towards conservatism and authoritarianism, with examples being “anti-terror” legislation, the recent efforts to filter internet pornography and monitor internet usage.

Thus, the Labor and Liberal Parties are neither pro-labour nor pro-liberal. They are both socially conservative, right wing parties. Despite a strong dollar with very low unemployment, services are being cut in the interest of as big a surplus as possible. Large debts are obviously detrimental but the point of a government is not to generate a surplus. Governments are not corporations, they are leaders and service providers. The logical options in the presence of a surplus are really: maintain the status quo, increase spending, reduce taxes. The addiction to the surplus is nonsensical in the current context, especially given the rising costs of health and education and disparities between rich and poor.

Australia is not alone. The international community is generally drifting towards both authoritarianism and right wing economic policy, regardless of whether it is appropriate or not.

UK Party Views Over Time

UK Party Views Over Time

The task of the right wing neo-conservative think tanks is thus complete. Murdoch I’m sure is proud.

Related articles
  • Letting Go of Economic Policy that Entrenches Poverty, Coddles the Wealthy (acslaw.org)
  • Reframing the welfare debate -Winning the Argument (think-left.org)

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The Culture of Medicine

04 Thursday Oct 2012

Posted by jaguarpython in Health, Psychology, Social Issues, Workplace Relations

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bullying, culture of medicine, doctors, Empathy, Health, Medicine, therapeutic relationship, well-being

I remember going to a lecture as a medical student in 1st semester on the “culture of medicine“. The culture they described was distant, unemotional, restricted and impersonal. The lecturer did not critique these qualities but rather stated that they were necessary for the practice of medicine.

I remember walking out, furious. I was actively furious for weeks. I understood the need for professional conduct and a certain level of healthy objectivity and separating one’s emotions from one’s practice. But I did not buy for a minute that a cold, impersonal approach where you feel no sadness or joy for your patients and do not participate in their journey was right.

How can it be right? The therapeutic relationship involves the healthy use of verbal and non-verbal communication to heal. On the one hand we were taught a “biopsychosocial” model where a patient’s circumstances and personality were key to understanding their illness but this was undermined by elevating an emotionally sterile approach as the be all and end all to the healthcare environment.

The journey that I have seen my peers, seniors, fellow colleagues and now my own students go through has been educational.

I saw people begin to talk about patients as objects. A description of disease. The “biopsychosocial” model was roundly disparaged as being a “wank”- the buzzword combined with an absence of intellectual depth and rigour in its teaching destroyed it. And when you objectify patients, you dehumanise them, lose empathy and refuse to understand why they are the way they are.

We started to see patients as pitiful and pathetic. The obese, non compliant chain smoker was the epitome of this. Why couldn’t they stop eating and smoking themselves to death? What was the point of treating them for a self-inflicted disease? They’d been told multiple times that their behaviour was destructive and yet they persisted in this irrational behaviour.

Metabolic Syndrome X. COPD. Alcoholic liver disease. Diabetic renal failure. All the ills and excesses of modern society.

At the same time, friends in medicine and other courses would defensively insist on drinking, smoking, taking speed, neglecting their health. Many of them were adamant that they’d “heard it all before” and were uninterested in hearing “another lecture” from someone about their habits. Studenthood was full of financial nightmares. Intermittent homelessness. Stress. New relationships.

Patients often didn’t really want to talk to us at length. They would get tired and saw our education as unimportant. We were definitely bottom of the heap in the hospital. The medical teams had little interest in tutoring us or including us or explaining management of patients. Several of my friends were told point blank that a particular unit was not interested in 3rd year students, or that there was no point in them being there so they should just go home. Our case presentations were criticised sarcastically, we suffered verbal abuse in various settings about our lack of knowledge.

At the same time, I ate unhealthily. I binge drank on the weekend. I partied. I briefly social smoked despite my disgust at smoking, having had 6 uncles and many cousins with smoking related disease. I went through a multitude of disasters in dating including a couple of destructive physically and emotionally abusive relationships. I was depressed on and off.

This was a fairly common scenario. I was in no way alone in this. I saw a large number of peers go off the rails in one way or another. Many quit their courses on changed direction multiple times. A few ended up with severe depression or psychosis. Me, I plodded along with dead average marks and somehow crammed enough to get through.

I had no idea what I was meant to be doing or contributing to the system. Attending some portions of the course seemed like a complete waste of time for us, the doctors and the patients. I finally fell detached, just like I was meant to.

It was at some point in the middle of my course that I had a fairly major realisation about how I had lost my way. Empathy flooded back. And the very suffering and joy that I had blocked myself from feeling overwhelmed me. I had a huge amount of guilt about the person I had become. But I was free, alive and it was delicious. I could never go back.

It certainly wasn’t easy. The culture of non-empathy is embedded. I remember hearing new interns loudly crapping on about their awful patients, not realising that the point of “the House of God” was to satirically criticise that behaviour. I remember hearing about how one of our fellow medical students talked very loudly and condescendingly to an old woman who snapped back at her that she wasn’t stupid. I remember being the first doctor in an arrest call as an intern, the patient dying and the registrars joking and laughing about things going wrong and the death.

Similarly this milieu impacts on the work environment. I remember some of the unfair, derogatory comments made about other doctors, patients, nurses on the ward in full view of everyone by senior doctors. Every single doctor and nurse I know has had the experience of being humiliated in front of patients by a senior.

When people are overworked, stressed, unsupported and there is a culture of blame, the effect is multiplied. Certain hospitals are notorious for that sort of environment. Some places support the development of awful behaviour – in particular overconfident, narcissistic arrogance and bullying combined with sycophantic yes-man behaviour to similarly blind and narcissistic bosses. Particular specialities are well known for this mentality. The nicer “weaker” people are blamed and burn out while the bullies prosper.

The idea of empathy and pleasantness as a “weakness” is typical of sociopathic behaviour. What happens when an institution develops a sociopathic personality?

Learning how to cope with work stress, patients, carers, colleagues while being empathetic has been a largely unguided process. It took me a long time to develop healthy, appropriate strategies rather than the ones based on aloofness. Since starting work I’ve been lucky enough to work with some genuinely awesome, inspiring doctors, nurses and allied health staff. I’ve met some amazing people and been fortunate enough to be share their lives and hear about their experiences.

These days I am in a position of responsibility for junior doctors and students. I try my best to be pleasant, friendly, to be interested in them as people and to guide and nurture them. Developing rapport and loyalty and knowledge and a good, happy team is sometimes challenging but definitely fun when you get it right. The difference you make it how everyone feels is fantastic.

And I make time to spend time with patients. I talk to them about their lives and interests an things other than medicine. I learn from what they say. And helping them feels that much more important. When I feel sad, I feel sad. When I feel happy, I feel happy. It’s wonderful.

Things are changing in the culture of medicine and I’m glad.

Related articles
  • Docs’ Sensitivity to Patients’ Feelings Tied to Good Outcomes (nlm.nih.gov)
  • Physician’s Empathy Directly Associated With Positive Clinical Outcomes, Confirms Large Study (medicalnewstoday.com)

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