MANY readers will have heard the old aphorism “those who can, do, and those who can’t, teach”. This saying seriously underestimates the value and skill of teaching, not to mention the Hippocratic obligations in medicine to do both. So, I would like to propose my own version: those who neither do nor teach should be cautious about criticising those who do.
This comes to mind due to a confluence of situations which, in my observation, contribute to the pervasive malaise that affects many parts of the health workforce at the moment.
First, there are well intentioned but poorly executed risk management systems, including that tool of the quality and safety industry known as the root cause analysis. Applied with insight and in situations where there is an identifiable root cause for an incident, the resulting recommendations can assist in prevention of future occurrences. Hopefully, this will occur without causing other sidestream harms worse than the ones being mitigated.
Applied inappropriately, however, as may be done when teams are unskilled or lack insight into the work process, they can be another tool for blame and result in yet even more cumbersome procedures. A health care workforce labouring under conditions of fear and overburdened by “risk management” procedures will not be able to use their skills for optimal patient care. More sophisticated tools for clinical risk management do exist, including the so-called London Protocol.
Next, there is the frequent bombardment of “conventional medicine” by the non-conventional – those providers who hold little responsibility for their advice, products or outcomes, and yet constantly criticise those of us who do. In selling their services or their wares, many “alternative” health care providers use a constant critique of conventional medicine, diminishing its benefits and exaggerating its harms. Ethical providers may be frustrated in finding that those who sell simplistic, magical solutions may be held in higher esteem than those who do their best to convey accurate, evidence-based advice.
Finally, there are those within our own profession who provide expert advice on the performance of others. This may occur in the workplace, in the regulatory system, or for the courts. We all know of a minority of people who are too ready to hold colleagues to standards that they have never met themselves.
The safe and ethical practice of medicine requires constant self-reflection, sharpened by an understanding of cognitive science, medical science and emotional intelligence. The same approach is needed when appraising the work of others.
In my view, the question we should ask ourselves is not just “what would I have done in that situation?”, but also “what HAVE I done in that situation?” If the answer is that we have never directly experienced it, or have never been held to account for the outcome of such a situation, we must be very careful in judging the actions of those who have – especially with the benefit of hindsight.
Dr Sue Ieraci is a specialist emergency physician with 30 years’ experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. She is an executive member of Friends of Science in Medicine.
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