The Irish Medical Times - The Medical Power Balance: Is it time for a change?


They want to use those skills, meet their commitments, and help as many people as they can. At times, it can feel that in order to prioritize that talent, the hospitals can overlook the end-user. 

To improve the user experience, we need more consultants.

I think the old notion of a consultant ignoring a patient to play a round of golf is hackneyed and insulting (everybody knows they play pickleball nowadays). Being a consultant is a demanding job, from my perspective as a patient they work very hard, with a lot of responsibility. They are allowed very little room for error, they oversee a multitude of spinning plates, I imagine the pressure must be immense. Like everyone, they are allowed to have sick days and vacations (and play pickleball). 

However, to flip the Spiderman quote, ‘with great responsibility comes great power’. In my experience the system caters to this power the doctors unwittingly wield (some not so unwittingly). This can diminish the patient’s power, which is not very potent in the first place. 

I recently had a family member with a serious chronic condition go in for a checkup. He was feeling very unwell. Two hours went by in the waiting room, no patient was called in to see the doctor. Eventually he managed to catch a passing nurse and found out the doctor was in fact not coming in today and the nurses and admin were concentrating on rearranging the doctor's schedule accordingly. They were so focused on re-establishing appointments, at a time the doctor would be available, they forgot to tell a waiting room full of patients to go home or seek help elsewhere. 

That was a mistake, an oversight, a lack of communication. They were trying their best to rebook patients, rehouse emergencies, help people, their intention was good. But unfortunately a lot of long-term patients have a story of being forgotten. 

In other service providing industries the customer isn’t usually omitted from a change. For years I have brought my daughter to music classes, sports training, etc. I know things can get cancelled at the last minute, that’s understandable (weather, acts of God, etc - weather doesn’t influence music lessons, unless you’re blowing your panpipes down by the waterfalls). But as the person paying for the service I am usually notified as soon as the cancellation decision is made. I am very rarely left standing alone on the hockey pitch with the stick in my hand wondering what’s going on. I will admit I have brought my daughter to the wrong pitch, at the wrong time, on the wrong day, but hey, I’m not promising to deliver her a specific service, other than basic haphazard parenting.

I’m sure there are an endless number of consultant doctors who feel very far removed from a ‘superstar’ status. There are probably a significant number of senior doctors who feel frustrated with decisions, or ‘the system’, who feel their hands are tied, and their calls for resources, action, and need for change go unheard. However, as a patient, even though we are the customer/client, it is not uncommon to feel that the doctor's needs are catered for ahead of our own. For example, if a doctor can only work certain days, the system caters to this, the system doesn’t cater to the patients needs, it works around the doctor - which makes sense because they are providing the service, but without patients there wouldn’t be a service to provide.  

The NHS are starting to disrupt their own organisational model. They are starting to shift around responsibilities, a new initiative allows Pharmacists to prescribe for certain conditions including sore throats, earache, insect bites, shingles and UTIs. The aim is to help overstretched GPs. Another plan, yet to be approved, is to introduce apprentice doctorships (allowing school leavers to skip the traditional medical degree and start on-the-job training). Also, with the advent of AI, patients may be dealing more with bots and less with docs in the future.

These are bold moves, I can feel a little stomach acid starting to roil at the mere thoughts of taking medical advice from anyone other than a fully fledged fleshy doctor, with the scars to prove it. 

But I believe introducing the concept of change may help crack the power imbalance in healthcare and increase the respect of everybodies valuable time. Even if some shockingly innovative ideas are ultimately rejected, having the conversation will move the dial in the direction of enhanced awareness of each other's struggles. 

I see you, I hear you, I wouldn't want to be you - it's time for change.