Ages ago, following an election, I had a call from
a staffer in the new Minister for Health’s office. He was breathless with
excitement.
“I’m new to this job,” he said.
“If I came and met you,” he continued, “could you
fill me in about Medicare and everything about how the health system works?”
I replied that I would be pleased to meet but that
I laid no claim to knowing everything about how the health system worked.
He had not heard of Heath Robinson, the English
cartoonist who drew complex inventions that achieved absurdly simple results
around the time of World War I.
I suggested that he study Heath Robinson’s art as a
clue to what the health service looks like, with its multiple disciplines,
specialties, facilities, cultures, management practices and more, linked
together optimistically to serve the patient’s needs.
It is hard enough for a novice nurse or doctor to
understand the nature of the ‘system’, let alone an uninitiated staffer or
journalist.
Read more: Change is hard, but
that’s what the health system needs
The complexity of the system means that an
understanding of it is fragmented and widely distributed among many
groups — providers, users and managers.
As a hospital inpatient, I gained a comprehensive
view of what goes into hospital care. You see it 24 hours each day and night.
You value clear communication, quick response to
calls for help with toileting and pain, the value of regular ‘obs’, the
pressures on the nursing staff, the perspective and world view of physios,
occupational therapists and others. You learn to admire cheery porters taking
you for an X-ray or scan. All these experiences are educational.
For us doctors, the insights gained from our
studies are enhanced by our experience.
A recent 6minutes article on Dr Ben Bravery’s experience as a
patient with colon cancer that led him to a career in medicine shows just how
valuable this is.
The widespread acknowledgment in recent
decades of the special insights patients bring has led to advocacy from patient
groups — frequently successful — for there to be patient
representatives in all major governance instruments in healthcare and research.
Human research ethics committees have lay members
who bring a community perspective to discussions about proposed studies — be it clinical
trials of new therapies, or descriptive qualitative surveys.
Having chaired a research ethics committee for many
years at Sydney’s Westmead Hospital, I appreciate the immense value that lay
members, who are not involved in the care of patients, bring to its
discussions.
They hear the story from the perspective of users
rather than providers. They can challenge the value of research.
More from Professor Stephen
Leeder:
The Consumers Health Forum of Australia tackles
many thorny topics: for example, it has participated strongly in Australia’s
response to COVID-19 and in demythologising mental health problems.
Medical education has progressively included
consumers to provide their unique perspective
An important feature of consumer involvement in
medical education is to demonstrate how varied the experience of illness can
be.
Our teaching inevitably focuses on
the mean, the average; however, consumers remind us that we all see and
experience the world differently — there is no
one-size-fits-all.
Consumers may place quite a different value on
health, define it differently to providers and value other things more.
In 1979, when it was still something of a novelty,
we ran a diabetes session for students in Newcastle University’s new medical
school, with the late Dr Paul Moffitt (who died in 2019, at 92), a local
physician with a major interest in managing patients with diabetes.
