“Doctor, aren’t you glad it’s a new year?” asks my patient, who has weathered the many ripple effects of the pandemic. His cancer diagnosis and treatment were delayed but now that the cancer is cured, his “stable” problems are no longer that.
His cataracts prevent him from reading and a “dodgy” hip hampers exercise. The two surgeries to correct this are life-changing, but the elective surgery list is so long that when he asks whether this year will see him “fixed”, I am quick to temper his expectations.
Typically, a new year lifts the hopes of doctors. We dash to the end of the previous year, cramming consultations and procedures, willing ourselves to believe that next year will be different: tired ideas and tired people will make way for change because surely, we can’t keep going on like this. In the hospital, where a new year welcomes nervous students and enthusiastic trainees, the mixing of new and old brings a reassuring renewal.
January used to be a nice time to be a doctor, but this year feels grim thanks to rolling bad news about healthcare. GPs are protesting the dismal state of primary care, the supposed backbone of the healthcare system whose back we don’t have. Nurses are complaining about their inability to care properly for patients. Paramedics are exhausted by unreasonable expectations. Hospitals are overflowing, often with patients who could receive more appropriate care elsewhere, if only “elsewhere” were available and resourced.
Meanwhile, our patients are increasingly dubious that the “universal” in universal healthcare still holds.
In my 25 years of practice, the landscape of medicine has become unrecognisable. A good example is an abundance of effective treatments, from powerful antibiotics to gene therapy and novel anticancer agents. As a trainee, I frequently told people that our hands were tied when it came to a range of conditions – today, we are spoilt for options.
But the workplace has turned more sobering. The ageing of the population is starkly evident, as is the loneliness and dependence of many. No blockbuster drug can alleviate the suffering of the patient whose real problem is loneliness and disconnection from an increasingly preoccupied society. The scourge of mental illness and its frequent companions of homelessness and substance abuse are visible and dreadful.
For an individual clinician, the system looks so large, fragmented, and unresponsive that it can be hard to believe that anyone can change anything. And yet, to succumb to complacency would be self-defeating. As we wait for the healthcare system to be fixed, my students and residents must be tired of my refrain that in fact, we are the system and each one of us must play a role in healing it.
Students can commit to learning their craft with genuine care because a strong foundation is their best chance of becoming an able practitioner. Young professionals can actively seek out good role models, recognising that in the twists and turns of a long career, a solid mentor is a gift that keeps on giving.
And senior doctors must park our dismay and channel our energies into reform. Many doctors are using their voice to protest working conditions and sound an alarm. Their pleas, advocacy, and even resignations will not be in vain – provided they are measured and don’t elevate doctors above other valuable workers.
As politicians, bureaucrats and clinicians bargain, the pace of change itself feels glacial. Just ask anyone waiting for non-clinicians to approve a business case that makes sense to every clinician, or a nurse suggesting a tweak to the status quo. I share the profession’s worry, but I also fear that the difficult years ahead will be easily stripped of joy if we don’t immunise ourselves against the stories of doom.
So, yes, we must rally for structural reform that strengthens primary care, boosts mental health and aged care, improves the hospital experience, and elevates the doctor-patient relationship in this fast-paced and detached world of medicine. But it might help to remember Annie Dillard’s wonderful observation that how we spend our days, is of course, how we spend our lives.
This year, I refuse to begin every day feeling hopeless and will try these things instead.
I will honour Medicare in practice
Fraud rightly outrages people but plain old waste, on the other hand, is legal and rife. Every unnecessary blood test, scan, drug, and intervention is an opportunity to harm the patient and charge the system. With the profusion of newer (but not always better) options, practicing judiciously and teaching young doctors to do the same can be every clinician’s contribution to protecting Medicare.
Patients have an important role, too: in understanding the limitations of medicine and taking responsibility for their own health, especially in an era of increasing evidence that how we eat, drink, think, and move has large implications for health outcomes.
I will remember to be kind
For appreciable reasons, there is a notable kindness deficit in healthcare, but I will not perpetuate it. I recently received a card that stopped me short. It simply said, “You make me feel heard”, with the last word underlined for effect.
For a patient facing the most turbulent time of her life, was that really my most important contribution? If so, I will redouble my efforts to give patients kindness and attention when their other wishes are harder to fulfil.
I will remember my mortality
Being an oncologist is to be surrounded by a daily reminder of life’s fragility but somehow, if you let it, mortality can seem like other people’s business you are just there to defend against. But of course, it’s not. One of the great joys of medicine is service to others, and one of its best perks is imbibing life lessons about our limited time on Earth and the importance of using that time wisely and generously.
Waiting for the major healthcare reforms this country needs shouldn’t stop us from taking small steps.
• Ranjana Srivastava is an Australian oncologist, award-winning author and Fulbright scholar. Her latest book is called A Better Death
