The moral injury of keeping patients waiting
Overseeing clinical work that involves most people missing out on timely care goes hard against the grain of medical training and ethics. Making the least bad decision about a patient’s treatment wears a person down and significantly pushes up burnout risk. Read our opinion piece.
Moral injury: knowing patient care could be better but being unable to make the necessary changes due to constraints that are beyond [a doctor’s] control.
It’s a definition senior hospital doctors are well-acquainted with.
Doctors care deeply for their patients. As part of becoming a doctor, they all must sign the Hippocratic Oath by which they agree to treat the ill to the best of their abilities and do no harm.
Our members – doctors and dentists working in public hospitals – tell us that this is increasingly hard to achieve. Many are burnt-out, fed up working in stretched environments where there are more patients than they can see, where they are covering unfilled vacancies, care is routinely rationed, and short staffing is the norm not the exception.
We now hear reports that patients from Southland and Otago may be sent to neighbouring regions for their surgeries as Southern DHB tries to deal with the hundreds of patients lingering on waiting lists, facing unacceptably long delays. Those are all patients living with pain or illness which is treatable.
Covid lockdowns have created additional delays, but more to the point, they have amplified existing problems and frustrations.
Covid backlogs can’t explain away the endemic staffing shortages which mean there aren’t enough hospital beds or theatre capacity, not to mention the fact that elective surgeries continue to be pushed back because staff are swamped trying to deal with the growing number of patients presenting with urgent or acute needs.
A contributing factor in Southland, which doctors believe has never been properly accounted for, is what they describe as a ‘staggering’ rise in trauma-based accidents and hospitalisations due to the increase in adventure- based sports in the past ten years or so. Well before Covid came along elective surgeries were being routinely cancelled as surgeons tried to juggle very limited acute theatre space.
Last year the Government gave DHBs an extra $282 million to clear the Covid related backlog of deferred elective operations, but that’s a hard ask when you don’t have the staff and hospitals are already running at 100% capacity.
It’s a domino effect. Patients can’t get surgery if doctors can’t access theatre time. Doctors can’t access theatre time because of dire nursing shortages both in theatres and on the wards. Allied health staff such as anaesthetic technicians and physiotherapists are in desperately short supply with dozens of positions vacant.
We’ve been told that surgeons have been ready and waiting to get patients through the door but some weeks they have only been able to do one or two operations due to inadequate staffing levels.
It harks back to moral injury. Overseeing clinical work that involves most people missing out on timely care goes hard against the grain of medical training and ethics. Making the least bad decision about a patient’s treatment wears a person down and significantly pushes up burnout risk.
At the heart of all this is a longstanding failure to invest in the health workforce.
The fact that serious discussions were being had about downgrading Southland Hospital’s maternity service because the clinical director of the Obstetrics and Gynaecology Service could not get back into the country, serves to illustrate this further and shows a worryingly short-sighted grasp on deep-seated health need. We shouldn’t be shutting services down, but building them up
The service is perilously short of both doctors and midwives.
It is magical thinking if the Government and health managers believe we can continue to burn through health workers and more will pop up.
What is needed is proper workforce planning and the re-building of a health system that people want to work in. That means valuing and investing in the health care workers we do have by offering pay and conditions to encourage recruitment and retention.
It also means some honesty from health leaders about the real state of health need and the limits on our system’s ability to meet that need.
The longer the Government waits to act on critical understaffing in our hospitals the harder the fix will be.
The perfect storm we see in Southland is just a microcosm of cracks appearing across the whole of our health system. We all see it – some of us live it day to day. Now it’s time to step up and fix it. It’s time to remember that our public health system (and the people at its heart) belongs to us all. As taxpayers and health system users, it’s time to hold the planners and funders to account. Investing in the people who keep our health system running is in investment in all our health.
– As published in The Southland Times and on Stuff – 3 November 2021