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It’s time to stop sacrificing at the altar of ‘patient’



At some point in the past 20 years, we appear to have joined a cult of sorts. An all-encompassing, self-flagellating, brainwashing cult. We devote our lives, in martyr like fashion, to the deity known as ‘patient’. Sectors of the cults specifically devote themselves to the safety of the great god and produce endless scriptures on the ‘patient experience’.

It is not enough, however, to become a casual member of this religion. No, no. All followers must continually practice perfection to maintain membership and avoid being thrown to the dark pits of hell (known in some cultures as ‘The Daily Mail’). Sacrifices must be offered to the great god in terms of family, social and own health; without these one is considered unworthy and lacking dedication. ‘Think of the patients!’ the warning from above, sending us scuttling back to work.

What started as a positive ideal of patient centred care has gone to extremes. The dictionary definition of patient is ‘a person receiving or registered to receive medical treatment’. Emphasis on the ‘person’ aspect here. Yes! The same word that could describe any doctor or health care worker.

I found it a bit puzzling in the initial clinical days of medical school. Our teaching taught us that respect, empathy and being polite were key aspects of communicating with patients. We nervously trotted on the ward anticipating a ‘patient encounter’ as though on some sort of healthcare safari. I might be being daft but should we not respect, empathise and be polite to other humans generally? Are these really specific skills to be utilised with patients alone? And is it completely unreasonable to expect the same in return from our patients and colleagues?

Being ill is crap. I’m not by any means disputing or belittling this. But working ourselves into the ground to the point where we become unwell is also crap.

During the junior doctor contract dispute last year there seemed to be great reluctance to suggest the dispute was about anything other than our concern for patients. Would it really have been so bad to say, ‘yeah actually, this contract is going to worsen our already bloody awful working conditions and pay us less for the privilege’? If we had admitted our vulnerabilities rather than painting ourselves as selfless angels there might have been more sympathy.

There have been several publicised cases of work related suicide and self-harm amongst doctors in the last year. This is not acceptable on any level. There are teams and teams of people working on patient safety. Is our safety as clinicians irrelevant?

‘Increase your resilience!’ is the cry from the managers and politicians, as though completing an e-learning resilience module will easily solve all. Can you imagine if we, as doctors, were to say the same to our patients? ‘Sorry that your cancer has metastasised Mrs Bloggs. I know it’s hard but you’re just going to have to toughen up.’

It doesn’t bear thinking about does it?

So I’m going to suggest that whilst we continue our work for our patients, we stop sacrificing so much of ourselves. I’m absolutely all for the best possible care for those who are unwell but we need to address the basic human needs of staff too. Whilst our undying devotion to the ‘patient’ lord may be noble it is simply unsustainable if our own health is disregarded. We are not saints or superhumans. We are normal, caring people who chose to become doctors from a desire to help people. It’s time to recognise that.

Now just to get the rest of the world on board with my naïve idealism…

Dr Sarah Merrifield is a GP leadership fellow in Yorkshire