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Who cares about those who care?

Minister for Health Leo Varadkar said that he was “ashamed” at the way patients were treated without respect and compassion by members of my own profession and other caring professions, regarding Portlaoise Hospital maternity care.

His comments point the shaming finger at front-line medical staff, while ignoring the more powerful managers, systems and political forces that have such an enormous influence on how carers work. These forces and systems have ignored the cries from Portlaoise for many years.

Now a crisis is exposed again, and Leo is surprised and aghast again. Of course he will say that he cannot be held responsible for past politicians. Well, unfortunately, that is exactly what he must do. He must apologise on behalf of the political classes for the treatment of patients and staff in Portlaoise Hospital.

And then we carers can also tell the public about the dehumanising effect of the health system on us and explain how bad systems get in the way of us doing our job to the best of our ability.
Power analysis and systems thinking would dictate that Leo is probably reflecting the five most influential people and ideas around him. These ideas dictate that powerful people and powerful systems of management are never responsible. It is always the front-line workers who are named and shamed. As if shaming ever made bad systems work better.

The generals are always immune from the finger of blame.
When terrible standards are seen in workers, it is imperative to look at how they are treated by those in power. I always wonder how health workers are expected to hold on to their humanity and compassion for patients, while being managed with coldness and raw inhumanity, shaming and bullying. This sea of abuse and neglect has the effect of wearing carers down over time, and with repetition.

Working ‘with’ the patient is the mantra while we are worked ‘upon’ by management

Caring can only take so much constant dripping on its forehead.
If you expect health workers to show compassion and respect, you need to treat them with compassion and respect. The daily miracle is how nurses and doctors continue to show respect and compassion in most situations, while feeling under attack and undermined by a variety of forces. Ask any health worker whether they feel supported or undermined by the systems in which they work. Where we should be supported by our management structures, we are often perplexed at best. At worst, we feel actively undermined and disrespected. Working ‘with’ the patient is the mantra while we are worked ‘upon’ by management.

I am confident that healthcare workers do not enter healthcare to oppress patients. Some are better than others at withstanding the dehumanising effects of the healthcare system on them. There is little sense of caring for the carers themselves from the HSE, HIQA, or Government currently or recently. The results are predictable. Many leave the system because they can’t bear the effects on their caring attitudes and on their own minimum standards.

Great stress is not caused by patients. Far more stressful is knowing that you are becoming embroiled in a system of poor standards and bullied by the same system. That you are doing less than you know you could and should do. Survival influences your behaviour in a dysfunctional, cruel system. You become absorbed into it.

To swim against the tide, even as a Minister of Health, as Noel Browne knew, can be very costly. Valuable young doctors’ lives have also been lost in these stressful places. Yet the system and management struggle to listen like a good doctor, to care like a good doctor, to act like a good doctor. Acting on scientific evidence, reflective practice, or having real discussions with front-line staff, all seems like a foreign concept.

Compassion is a culture. You know it the minute you walk into a home or an office. As a doctor and straight-talker, I had high hopes for Leo, but the ‘Yes, Minister’ effect is taking an increasing hold of him, as it has on others in the past. There is no system. No managers. Just healthcare workers cruelly mistreating patients in isolation. This has always been the slippery narrative and abusive way of power.

The system proclaims through Leo: ‘Professionals cannot just hide behind lack of resources.’ The ‘hide behind’ metaphor gives the imagery of invisibility and lack of courage, while it is those who run the system who are rarely named individually and never made accountable. It is they who hide behind anonymity and behind their Minister, with the false courage of those on secure pensions, high salaries and guaranteed jobs.

So when the Minister points a finger at medical professionals while making his own role invisible and the role of the other management classes invisible, he is doing a great disservice to us all. We all want change. But ignoring those systems that strangle us all is never going to work. It only makes things worse.

What occurred in Portlaoise was wrong. We need better management and better systems. A little more humanity and support for those of us who are actually doing the caring will go a long way to create a more caring culture for all.

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