The Blog

Hippocrates and Hypocrisy

Though tomorrow may be indeed a tale told by an idiot, signifying nothing, my tomorrow is a tale told by my idiot, and pride demands that I give my tomorrow the utmost significance, even if to an inevitable, insignificant end. In a style worthy of Shakespeare, I must construct and weave the subplots of all my yesterdays and todays such that my desired tomorrow is a natural consequence: for the potentialities of tomorrow are created by the realities of today which are written by the rigidities of yesterday- much like a physician prescribing treatment for a sick today caused by an ill yesterday and hoping for a healthy tomorrow.

It is true to say that, contra the contrived plot of a story, life is rarely so predictable; that life is so plagued by villainous chance compelling us to make turnings in the road where we would rather go straight, to change our course entirely, maybe even our destination: perhaps predetermined, perhaps random- a question for philosophers and physicists- but always unpredictable. Nevertheless, in all our lives do villains appear who are wholly within our control- villains we can eliminate if we have the will. Akin to the hungry man at a feast- ideally one without the appearance of an apparition- we may not always have the ability to prevent the appearance of these villains (much as the man cannot control his hunger), but we do have the ability to force their disappearance (much as the man can eat). Indeed, in the tale of my life, which being my own must have a happy ending, any villain must be dealt with accordingly.

The villainy in my life's story today, untimely villainy before the climax, with the potential to re-write my happy tomorrow, despite my carefully constructed plots of today and yesterday colluding with favourable fate, concerns the dispute between the doctors and the government. That there is such a dispute is not inherently troublesome: for as long as I can remember, be it about (beware, buzzwords follow) 'a top-down reorganisation,' or 'NHS privatisation,' there has always been some argument or other between the medical profession and the government of the day. There may be some out there inclined to view this current dispute through the nostalgic lens of happy recurrence. After all, history is on the doctors' side. Has not the NHS survived? Is not it still 'free at the point of use?' Are not patients still trusting of their doctors?

Trust. A metaphor for life: it takes years to develop and mature and blossom, and yet a quick, fatal stab to its heart renders it lifeless. Yet doctors not only command trust, but they are privileged with the trust to life of strangers- such trust may not even exist between the closest of family members (the ones you actually like, not the ones you see only at Christmas). How many loud mouths have been shut, how many haughty heads have been brought low by the mere words 'trust me, I'm a doctor?' This dispute has condemned the trust to life to place its head in the noose, and now this trust lives only by the support of the rickety chair of past indebtedness, liable to break at any time.

Now, you might be reading this thinking that I have contradicted myself: that I have stated history is on the side of doctors, and yet I now suggest that the present core relationship of trust between a doctor and his patient is vulnerable which of course only serves to work against doctors. But the nature of this row is different. Yes, in the past doctors have voiced opposition, all the while holding the favour of the public, through acts ranging from boycotts to industrial action, but never before have doctors taken such heavy measures as to withhold emergency services for the most fragile of patients. One is naturally inclined to ask whether this sad situation was the result of an inflexible government imposing its will upon powerless doctors, or of a selfish medical profession determined to keep an acceptable status quo. This question however is not my concern. I, having received no formal training in politics or economics or statistics, am not appropriately qualified to dissect the details of the row. I rely on 'qualified experts' to tell me whether doctors will receive a pay cut or rise, whether doctors will work more or fewer hours, whether patients will be safer or endangered (and even these 'experts' seem to disagree).

I worry about the actual action taken by junior doctors- the 'all out strike, no holds barred-' and the consequences of such an action. The routine, rehearsed reply on these strike days was 'consultants have taken over,' and if anything, in a paradoxical turn of events, patients would be better cared for with more senior expertise. And if adequate cover were the key issue then all would be well.

To view myopically this strike action through the narrow tunnel of doctors' numbers- the distorted issue du jour: 'we're striking, but we'll be covered,' is to misunderstand the entire nature of the profession of, as seen through a patient's eyes, altruism, care and sacrifice. After all, would not we condemn parents who, by choice, forego their duty and give their child to a guardian? Yes, the guardian may do a stellar job, ensuring the child is well-clothed, well-fed, and well-rested, but for that child nothing is more important to it than the love of its parents: that unique bond of love, care, and compassion that can only exist between parents and children.

To regard superficially this strike action as a necessity for the greater good, is to do a disservice to the patients who doctors claim to serve. Setting aside the wise restating of the issue, from one about pay to one about safety (remember initially the doctors complained of their 30% pay cut, and it was only later that patient safety came to the fore), safety-loving doctors are relying on the same fallacious reasoning of any government who takes away our freedoms to protect our freedoms- the reasoning that doctors must harm patients to save them from being harmed. The greater good of patient safety can be achieved, but not by jeopardising it, and certainly not by punishing the innocent.

To see casually this strike action as nothing more than an isolated incident, a single act at a single moment in time, is to misconstrue the minds of the very bodies they seek to treat. Emotions have an ability to shade the light of reason, and long after all is said and done, though they may vaguely recall something about doctors and contracts, patients will not forget the time doctors walked out on them in their hour of need, the time doctors put their own interests above those of the patients', the time doctors played politics with their patients' lives. The act may be temporary, the consequence permanent.

None of this is to say that doctors should have their freedoms curbed. Free speech is the keystone in the splendid arch of a democracy as ours. Hence, if doctors feel it incumbent on them to speak out against, what they perceive to be, deleterious changes to the fine health of the NHS, then we must allow them their freedom. However, this use of freedom must not be abused: the abuse of freedom is the misuse of freedom, and this cannot be supported. Many may champion the right of doctors to act in the face of adversity- petitions, boycotts, even elective strikes; and indeed two-thirds of the public backed the doctors; industrial action. However, fewer would defend (and indeed fewer did defend) doctors who would be willing, against all the moralities of the sacred Hippocratic oath, to treat their life-seeking patients with casual contempt through the refusal of life-giving care.

And so the villain surfaces. Not in the guise of the anger of politics, but in the form of the anger of betrayal and impotence. The cuckolded husband may hate his wife for forcing him to wear the horns, yet that does not excuse him from seeking to punish her by the abuse of their children. The virginal doctors may, rightly or wrongly, feel the government is shafting them: that the government is forcing them to swallow substantive changes, where they would rather spit them all out. This does not give doctors the permission to engage in a three-man conga line, getting shafted at one end, and doing the shafting at the other.

Upon entering the profession, whether on their first day of medical school, or their first day on the wards, medics are made to swear the Hippocratic oath. They promise to help the sick; they promise never to injure; they promise to abstain from intentional wrong-doing and harm. Patients rely on all this. They rely on doctors' competence. They rely on doctors' care. They rely on doctors' integrity. If today's generation of junior doctors are able to cast aside such basic virtues as these (even if in the very name of these patients), if they are able to abandon their exalted position in society, if they are able to neglect their basic civilised duty of saving lives above all else, how can patients ever again put their lives completely in the hands of doctors? Doctors have walked out once, why not again?