The medical field is plagued by examples of system failure, often disguised as professionalism or heroism. As an opinion piece published in The New York Times highlights, we tend to believe that caregivers' professionalism is an infinite and free resource. The piece acknowledges that most healthcare professionals do the right thing for their patients, even at a high personal cost. However, we must be aware of the availability heuristic that comes into play, which can give us a false sense of security. The truth is that counting on nurses and doctors to work tirelessly for their patients is not a sustainable strategy for the medical field or patients.
Let us take a few minutes to think about this logically. Empathy is usually the best way to convey an idea, but today let us focus on some pertinent analogies. For instance, as we prepare for the COVID-19 tsunami, many governmental healthcare institutes send out a notice for recruiting doctors and nurses for a specific time. My nurse sister commented on how the notice made them feel disposable. It is essential to recognize that healthcare is not a per-need industry but a backup industry. We don't want to use it when things are going smoothly. Instead, any country's healthcare system should stand on its strong ability to deal with crises.
In contrast to most other industries, the healthcare industry cannot do with the number of people already in the industry or let go of people during a disaster. We search for volunteers and temporary hires whenever the public's health is threatened. The notion of just enough or even fewer doctors working in a setting is considered heroic. Can you imagine saying, "Oh! That busy bank has only one teller who works as a receptionist. How heroic of her!"?
In almost every industry, there are reserves. Take the transportation industry, for example. During my childhood vacation to Kathmandu, I met two men who were drivers of a night bus. I was surprised when I learned that the bus only had one steering wheel, and the curious child in me asked, "What would the other driver do!?" My dad, who was semi-asleep, replied, "They will drive for the whole night. Don't you think they need to rest?" As a medical doctor, I would respond, "I sure do, Dad, I sure do!"
In aviation, the first officer is an aircraft's second pilot, also referred to as the co-pilot. The first officer is the second-in-command of the plane to the captain, who is the legal commander. In the event of the captain's incapacitation, the first officer will assume command of the aircraft. Usually, a second officer is used on international or long-haul flights where more than two crews are required to allow for adequate crew rest periods.
While there have been some examples of what would be analogous to a natural disaster in other industries, such as economic ups and downs, healthcare remains unique. For instance, during the great economic recession, business owners had to let go of their employees. They did not have to open up more positions for the work to be carried out. Every time the public's health is threatened in healthcare, we look for volunteers and temporary hires.
I recall feeling proud of one of my seniors, who was portrayed as an ideal healthcare worker. "He was arranging the medicine cabinet when we visited him at his PHC," one of my professors boasted. However, today, I understand that what my senior was doing when my professor reached there was a clear example of system failure. He could have been doing something much more productive.
Let me give you an example of my intern year that demonstrates the lack of consideration of the human element in designing healthcare systems. I had to take leave because I had bad flu.
My fellow interns were working extra shifts to cover for me. The hospital administration had not accounted for the possibility of one of their employees falling sick. They had not built any backup system to handle the situation. The burden was entirely on my fellow interns to work extra shifts without any extra pay or appreciation. They were just expected to do it because they were in the medical profession.
This is not a sustainable system. Healthcare professionals should not be expected to work extra hours without adequate compensation or appreciation. They should not be treated as disposable resources that can be called upon in times of crisis and then discarded once the crisis is over. The healthcare system should be designed to take into account the human element, the fact that healthcare professionals are people with families and personal lives outside of work.