Doug wrote:
> Right here and now the way we practice is determined as much by
> cultural expectations as medical propriety and the cultural
> environment is one increasingly of "I have a right to know".
It is a case of refusing collusion.
I reckon I spend about half of my consultation time trying to:
a) temper expectation
b) marry what is *possible* and *feasable* with what is best for the
well being of my patient
c) not to collude with cultural expectations of what is not possible
d) not to nurture unrealistic demands on me and on the system as a
whole
e) tell people it's OK to cross the road and it's just snot that will
go away by itself, don't expect me to wipe for you!
> Surely this is more appropriate today (tomorrow is another day)
> than the econo-centred (not doctor centred) Risk model.
It's not really a case of Risk econo-centred model. It is a case of
getting real. After all, somebody has to pay for health care. So
far, that somebody's been the taxpayer and the doctor who can not
and will not say no. The former has been saying: "I won't pay but I
want everything" for decades, and the latter still says: "I will
work more for less 'coz I am really a nice guy".
Well, my esteemed Doug, the here and now is a health system that is
cracking up with collapsing A&E, beds blocked with elderly patients
who can't be discharged to nursing homes, more and more secondary
work being dumped on the cheapest professional labour in the land,
hospital closures, dump in the community, rhetoric stolen from Mao,
gp training schemes that go begging for takers across the globe,
consultants who are too scared of the power suits that they became
impotent, nurses who are paid in monkey nuts and being asked to take
on more, politicians who lie through the teeth and inhabit some
weird planet yet to be discovered by the SS Enterprise.
Culture? Don't talk to me about culture when a lot of what I see
around me is despair and we have not the guts to speak out.
Yeah, let's do everything for everybody all of the time and get it
over and done with. Eventually, the cleaning lady from RSA will
come along, pull the plug and finish her song.
And guess what? We will still be under the anaesthetic!
Ahmad
still a refusenic.
_________________________________________
Ahmad Risk MB BCh
tel: +44 1737 240022 fax: +44 1737 244660
http://www.cybermedic.org/
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