In my experience, medicine is not always a precise business. There are choices we make, there are choices. We make mistakes and we have to admit them. And we’re better at it when a community of thoughtful, experienced, and smart people put their collective minds to work.
IT IS the story that keeps being told, and Mr. Scott Morrison’s self-appointment to additional ministries reminds me of some important lessons I’ve learned as a clinician. No – no political chatter. let me explain.
Adverse events offer an opportunity to learn and make changes for the better
As a mid-level clinician, the most wonderful thing I learned was that the difficult decisions did not and should not be made alone. It was a relief to understand that. An ethical challenge: seek advice, hold discussions. A moral dilemma: talk to others, listen to others’ stories, read others’ cases. A Diagnostic Puzzle: Ask for an opinion, seek further reading, and have ongoing conversations with people who may have had similar experiences. Unusual Diagnosis: Look at published case studies, talk to those who have experience, through conversation or reading, face to face or online. In fact, I feel relieved every time I remember it!
With the COVID-19 pandemic in early 2020, I (and all healthcare workers) avidly read everything I could, first case reports, early data, small studies. Even now, in the third year of the pandemic, hardly a day goes by that we don’t read, talk to others or seek information about COVID-19, its diagnosis, its treatment, its consequences, its prevention, its consequences.
We look at the work of others in the hope that it will give us direction. We look at other pandemics and history to look for patterns and understand how others have dealt with what we are facing.
Although an obviously experienced and senior politician, Mr Morrison does not appear to have looked to history to understand shared decision-making in times of crisis. According to journalist Ronni Salt writing in The shothe apparently thought “that the ‘greatest emergency in Australia since the Second World War’ made it necessary to save Australia’s federal cabinet from itself – single-handedly”.
He apparently ignored the work of five Prime Ministers before him who served during this war between 1939 and 1945: Arthur Fadden (National Party), Robert Menzies (United Australia Party), John Curtin (Australian Labor Party), Frank Forde (Australian Labor Party ). Party) and Ben Chifley (Australian Labor Party). On September 27, 1939, the first meeting of the War Cabinet was held and it was determined that “matters of important policy should be determined by the full Cabinet” (my emphasis). Later, as Prime Minister, Menzies founded the Advisory War Council in 1940. This included members of the War Cabinet. Importantly, membership has been extended to include the leader and three members of the opposition.
Of course, there are times when a clinician needs to make a quick, accurate, and lonely decision. And we do. However, when given a choice, the support of reading, talking and soliciting opinions, learning from your own and others’ experiences is tremendously helpful. The process of explaining it to someone else helps our own understanding, and the conversation helps us come to a conclusion. And in general practice we’ve certainly learned the lessons of the Solo GP’s solitary autonomy: our work must be measured with an awareness of what others are doing, as others have thought. And in hospitals, if someone is in cardiac arrest, we call for an arrest team.
Nor does it appear that Mr. Morrison has recognized what most clinicians learn in their first year as an intern as a fundamental principle: none of us, absolutely none of us, are indispensable. We can all always be replaced by others.
As we rotated through those first 10-week semesters, I learned if the nurses applauded us or the boss said “good job,” we would still move on and someone else would take our place. I would be forgotten within days. I figured the next doctor wouldn’t do as good a job as I did – I was wrong and so were they. Not in the same way, not in the way I thought was right, but quite well. I liked to think that some of my patients missed me, if only briefly; we continued anyway.
It also appears that the governor-general failed to keep records, so no mention is made of the circumstances (let alone the talks) surrounding his role in Morrison’s additional ministerial appointments. Healthcare workers have learned the lessons of secrecy and poor record keeping. At the end of the last century, Dr. Stephen Nicholas Cluley Bolsin sheds light on the high mortality rate and the work of Bristol’s pediatric cardiac surgeons. The routine investigation of near misses, adverse events, and critical incidents through modern clinical governance processes has fundamentally transformed our practice and thinking. Shining light on both bad and good practices requires careful recording and data collection—essential to inform our quest for improvement.
“Dr. Bolsin collected data and brought it to a growing number of colleagues. Nobody ever said they were wrong about that; rather, he was told to be careful to review his information and discuss it with colleagues, including those whose work gave rise to his concerns.”
Now the Australian government is trying to shore up the “loophole” that is examining whether there should be rules or legislation to prevent a recurrence of a practice that the Attorney General has advised is “incompatible with the conventions and practices which form an integral part of the system of good government”. In clinical care it is simply not possible for us to regulate or experience all the nuances and possibilities. “Never say never” is repeated a lot. We are guided by a commitment to finding the best solution for our patients and we depend on others to offer understanding, insight, experience, thoughtful reflection and common sense. It is our safety net and requires openness and willingness to be questioned.
In my experience, medicine is not always a precise business. There are choices we make, there are choices. We make mistakes and we have to admit them. And we’re better at it when a community of thoughtful, experienced, and smart people put their collective minds to work.
I can’t waive my responsibility. However, to shoulder this, I should seek all the advice and conversations I have access to in a timely manner to make the best possible decision for the moment, especially in times of crisis or when I am faced with the greatest of emergencies.
dr Lilon Bandler is a Sydney-based general practitioner, medical educator and Associate Professor of the Leaders in Indigenous Medical Education Network at the University of Melbourne. She is Medical Director of Health Services at Wayside Chapel.
The statements or opinions expressed in this article reflect the views of the authors and do not necessarily represent the official policies of the AMA, the MJA or InSight+ unless otherwise stated.
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