Healthcare must prepare for overload’, warn politicians and healthcare administrators. It’s like urging a galloping horse to gallop even harder. Besides the fact that even the best horse in the stable cannot last long, it carries significant risks. The chance that a horse will overlook certain things or, worse, fall is logically higher when it is galloping. The crucial question is: who is responsible for a fall at a gallop? Answer: the horse itself.
Last week the magazine publishedMedical Contact a disciplinary case against a geriatric specialist. This doctor was single-handedly responsible for the care of 400 elderly people, divided over four residential care locations. That is about four times the workload deemed justified by the professional association. A few months earlier, her only two fellow specialists had left.
Although the doctor had called the management several times and made requests to recruit new staff, she was not heard. She left the organization after five months. In the meantime, a disciplinary complaint was filed against her by a relative of a deceased resident. The investigation by the medical disciplinary committee revealed that the quality of the care provided by the geriatric specialist was substandard. Although the disciplinary committee also realized that this was in large part due to the extreme work pressure and burden of care, the doctor was reprimanded. ‘Because,’ stated the disciplinary committee, ‘it is the responsibility of a care provider not to work in an environment in which responsible care cannot be provided.’
neck hairs on end
When I read that, the hairs on the back of my neck stood up. How is it possible that if a healthcare provider does her very best to care for patients in an understaffed situation, but the care is quantitatively or qualitatively substandard, this is charged to her? And not the management, to whom she has expressed her concerns? Or the fellow specialists who left the toko two months earlier? Should she have let the four hundred elderly people suffocate completely?
Abandon sinking ship advises the disciplinary committee in the middle of a care heart attack. It’s like advising the captain of a ship to disembark if the ship makes water, because only if he’s on board when the ship goes down can he be disciplinary. While ‘disembarking’ goes against the rules of conduct established for doctors. It states that you are obliged to provide assistance in an emergency. Or do we not consider four hundred frail elderly people to be an emergency without decent medical care?
As a healthcare provider, I feel ‘outlawed’ as a result of such decisions by the disciplinary committee. In other words, at the mercy of the elements. Elements that I cannot influence, but that do influence the quality of my work. It makes me even less hungry for a shift at an understaffed GP post where many caregivers gallop past themselves, but also sick patients due to the workload. Unforgivable when you work in an industry where making mistakes is not human.
I understand that it is a difficult matter for a disciplinary committee. If a high workload becomes a legitimate excuse for not performing care tasks or not performing them properly, we end up on a sliding scale. By imposing measures on healthcare professionals, the disciplinary committee may hope that they will not work in certain places, forcing the management there to put things in order.
Theory and reality
In theory then. The reality is that we are in the midst of a devastating health care crisis. In which, I estimate, three quarters of healthcare professionals work under such high pressure that providing responsible care is hardly feasible or can be expected. Both the disciplinary committee and the Dutch healthcare user seem insufficiently aware of this.
Has the elderly care specialist failed in this case? Probably. But should she be blamed for that? That is the question. The fact is, she was there. On her own. A galloping horse, ‘saddled’ with four times the burden of care than is justified according to the guidelines. She took sole responsibility for 400 frail elderly people. In my opinion, she doesn’t deserve a reprimand for that, but a fucking medal.
Thank you is a general practitioner.