Clinical Ethics >
Volume 3, Number 4 >
Pp. 159
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Editorials |
Brighton and Sussex Medical School, University of Sussex, Falmer, Brighton BN1 9PS, UK
E-mail: s.eckstein{at}bsms.ac.uk
I am whiling away my sick leave, laptop on lap, plastered leg elevated, devising a piece of clinical research. It remains at a very early stage of planning and details are still rather hazy, but it will definitely require consultant surgeons and the most senior National Health Service (NHS) managers to relinquish their suits, don particularly worn, backless, hospital gowns and then sit in a hospital bed for a day or two. It will be very important to generate a sense of lack of control, and a complete absence of information will be crucial to the success of the research. For example, participants will have had to cancel all their regular work commitments but will not know if a bed is available until the morning of the ‘trial’. They will be ‘consented’ by someone who has only the haziest understanding of their allocated ‘condition’, and who is not absolutely sure of what will be happening. Following the procedure, participants will be given very little information, and what information they are given will contradict what they were told before inclusion into the trial. If participants try to find out exactly what went on during the intervention, they will (grudgingly) be granted a short conversation with a junior surgeon, who will be briefed to roll his or her eyes, and announce that the consultant in charge of the procedure never comes up to the ward. Most importantly, they will not be told when a ‘ward round’ might come round so will feel particularly uncomfortable while trying to wash or use a bedpan in case that is the moment the curtains are pulled aside and a group of slightly embarrassed medical students appear. I'm not sure how to get the pain part of it – it will be important that there is pain – past the ethics committee (they have a problem with unnecessary incisions, not to mention anaesthesia, I find) and I've not costed it yet – it won't be cheap finding locum surgeons to fill the gaps or NHS managers to act up in the absence of their bosses, or training actors to play the parts of junior doctors, nurses and tea-trolley people. Recruitment could prove tricky and I'm not yet sure of how it will be evaluated, but, as I said, this is a work in progress.
And of course, a fantasy. But it is a fantasy born out of recent experience and disappointment. I had touched on what it felt like to experience medical ethics in action in an Editorial1 when I first embarked on what would prove to be long and complicated treatment for a rare medical condition. Over the past two years I have had really excellent treatment – very different from the above scenario – proof that it is possible to feel informed and well cared for however complex the condition, however over-worked the hospital staff and however the systems appear to work against the wellbeing of the patient. When something like the scenario outlined in my fantasy research protocol occurs, it is remarkable how disempowering and demoralizing it is and how that ultimately affects both confidence and recovery.
My recent negative experiences and responses to them are by no means unique. No journal paper has resonated with me as much as Eleanor Updale's ‘The ethics of the everyday: problems the professors are too posh to ponder?’2 Neither is my desire to give doctors a taste of their own medicine, in the hope that this will improve the quality of life for their patients, unique. At the end of the 1991 film, The Doctor, the once-arrogant heart surgeon played by William Hurt, humanized by his experience as a frightened, uninformed, hospital patient, instructs his cohort of eager – soon appalled – junior surgeons to remove their suits and smart dresses and get into hospital gowns and go and lie in a hospital bed for a few days. That, he says, will be the most effective training they will ever get.
Medical students are better trained in communication skills than they have ever been. When watching fifth-year medical students going through their Objective Structured Clinical Examinations, I have been hugely impressed by the caring, kind and competent way that they communicate with their ‘patients’. I like to think that they will not evolve into the kind of practitioners whom I would like to recruit into my study.
I would like to keep the ethics of the everyday alive in the minds of patients, health-care practitioners and hospital managers and in journals such as this one. If anyone would like to help me make my fantasy research a reality, please do get in touch. I should be back at work soon.
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