Reflections on the health service

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“The darker the night, the brighter the stars”(Fyodor Dostoevsky)

Dr Veronica O’Doherty,Head of Psychology Department/Principal Psychologist at Tallaght University Hospital
Dr Veronica O’Doherty, Head of Psychology Department/Principal Psychologist at Tallaght University Hospital

The prospect of leaving the health service or at least the public sector is something like so many, I’ve debated with myself for over a decade, writes Dr Veronica O’Doherty, Head of Psychology Department/Principal Psychologist at Tallaght University Hospital.

Revisiting some literature that influenced my younger thinking self, writers like Dostoevsky, De Beauvoir and Lessing and the many existentialists, has helped concentrate my mind on things that matter. Throw in a pandemic and the challenge to rethink healthcare becomes essential. Often referred to as the first existentialist Dostoevsky wrote “the mystery of human existence lies not in just staying alive, but in finding something to live for.” Simone De Beauvoir’s existentialism called for embracing “….a practical and living attitude to the problems posed to the world today” and goes further as she wrote “we need to look truth in the face.”

For many years I have worked in the public sector. I must admit to a sort of addiction to the cut and thrust of hospital life. With equal moments of heartbreak, frustration, joy and reward. It can be like riding a rollercoaster similar to what our patients’ describe when going through acute or chronic illness. We too share these moments of elation and disappointment when things go well or don’t go to plan. The excitement when a difficult surgery surpasses expectation or a patient comes off the vent and leaves the ICU, the joy of getting funding for a new service so we can provide the care we know should be there or when sadly things go wrong like the chemo drug is no longer effective as the cancer accelerates or the injuries are too severe to repair or the dementia is rapidly deteriorating or the patient gets stuck in the trauma.

During the dark years since the recession of 2008, healthcare has been a hard place for us all. The business model has been the predominant flavour of post the ‘Celtic Tiger’ era. I recall when we had enough staff and enough beds once, probably pre 1995. Our hospitals were in the city and were smaller, everyone knew everyone, and there was always a local pub that many gravitated to on Thursday or Friday nights. Smyths in Baggot Street was our local hospital pub. Hospitals were staffed by student nurses in training. They were paid during this time unlike the students today. I often wonder if we threw the baby out with the bathwater in more ways than one, that maybe a hybrid model that incorporated both university training and apprenticeship style learning could have balanced the staffing deficits without compromising the high level of skill required in today’s healthcare environment. I’ve also witnessed expediential growth of bureaucracy in our health system over three decades and wonder about the efficiencies of that. Have we gone too far in our documentation and multiple layers of accountability? There have to be better ways to improve how we deliver care yet not detracts from it.

Now, we all are going through the most momentous event in our time and the impact is still reverberating and will be for a good few years even when it finally is over. The grief for many perhaps hasn’t been even fully felt yet and the underlying concerns for all those waiting lists we know need attention. Taking time to reflect and learn will happen when we are ready to examine and learn from our responses. From March 2020, the hospital jumped into emergency mode and people literally put their lives on the line. The ICU and ED were in the firing line first and they delivered. All the other services met patient needs from every possible port. New ways of working emerged that brought a whole raft of flexibility to the world of work and whilst many aspects of roles in healthcare are literally hands on, there are many roles that too that can definitely fit a hybrid model of home and onsite work. Certain types of remote consultations, admin, education, remote connections via international conferences and many other forms of sharing information online opened up new accessible worlds to both patients and clinicians. These new ways also support the concepts of a greener planet by reducing cars, air travel and give a bit more scope for increased personal time.

The pandemic also forced an emphasis on our values and as Dostoevsky noted in Crime and Punishment before his character’s imminent execution, that there’s nothing like the facing the possibility of our own death that helps to concentrate the mind.

Values matter as they govern all aspects of our lives and how we live and work. They govern the care we provide for ourselves and others and why we always advocate strongly for the best care possible for the staff and patients we treat. The health of one co exists with the health of the other. Each one of us working in healthcare brings our unique myriad of skill, experience, cultural learning and depth to our roles and teams. When those teams foster full engagement with all members led by a compassionate style of leadership this can bring more honesty, integrity and fulfilment to each person. Facilitating the contribution of others and promoting creative thinking and problem-solving benefits everyone and ultimately our patients.

As I prepare to leave the public sector with some sadness, (I will be continuing to work in the private sector), I also harbour hope and excitement about what is next on the horizon for healthcare. The opportunity for truthful analysis and subsequent growth presents itself to us following many difficult decades which culminated in the current pandemic. In Dostoevsky’s words “but men (and women) love abstract reasoning and neat systemisation so much that they think nothing of distorting the truth, closing their eyes and ears to the contrary evidence to preserve their logical constructions.”

So let’s not waste the crisis we’ve all just endured (and still enduring) and for the many of us fortunate to survive by being courageous enough to elicit meaning from it and resolve to take the necessary subsequent actions to improve what is and isn’t working well. By removing the shackles and dangers of group think only then will we all have done some good and memorialised those who have died.

“Whatever you’re meant to do, do it now. The conditions are always impossible.” 
― Doris Lessing