By Tony Whitehouse, Consultant in Critical Care
We need to re-educate the public that sometimes good care means that the patient dies quietly in bed, says Tony Whitehouse. They say that a hippopotamus is a horse designed by committee. The well-intended ‘chipping in’ of ideas by too many people can turn what started out as a sleek, racing stallion into a lumbering (but happy) mud-wallower.
It is therefore not a surprise that the GMC this week announced that the Medical Profession had low morale levels that could put patients at risk (see Independent 27 October 2016).
In the same report, the GMC found that over three years, the number of doctors who applied to train as specialists directly after completing their foundation training dropped by 12 percentage points to just under two thirds. In addition to describing a medical brain drain and burn out, the GMC also described the religious proclivities of the Pope and the toilet habits of Grizzly bears.
A little read part of the same report says that one contributing factor to low morale was the rising expectations of patients and this is particularly true in ICU. I meet families who are worried-sick about their loved ones on ICU every day. The vast majority are extremely supportive and grateful for the care we provide but just occasionally, I come across a family that makes me consider whether I want to carry on working as a doctor. In my professional life, I don’t want admiration and to be honest, I’m not even bothered whether we get thanked for doing our job. But when families start insisting on treatments that are futile and become threatening, I want to give up. I know that these families are demonstrating their care and love but it is in a highly unusually way and turns what would be a stallion of ICU care into a bit of a pig’s ear (or should that be a Hippopotamus’s ear?).
When I was a child, the elderly died in bed at home; today, they die with a nurse performing CPR on their chest, in hospital having just been admitted from a nursing home. It should be flattering that the public think that we can cure even the sickest patients but as we’ve hidden death from the public, the less they trust their doctors to tell them when someone is dying.
Now I know that there will be some who will be up in arms that a doctor should dare to not hang on the every word of a family. Somewhere along the way, the medical profession has gone from being trusted friend to someone whose lifetime worth of experience means very little. We need to re-educate the public that sometimes good care means that the patient dies quietly in bed.