International World Patient Safety Day on 17 September this year, is a recent initiative. Sponsored by the World Health Organisation, it was first held in 2019. It addresses the risks that medical patients face, and it calls for all the branches of medical care in surgeries, hospitals and homes to be patient-centred.
This year it occurs at the height of the coronavirus pandemic. That explains why the 2020 theme focuses, not on patients, but on the safety of health care workers. Because they are the people most exposed to the CV virus, they can easily become infected and so leave patients with inadequate medical care. We have seen this risk in Australian hospitals and nursing homes, as also in other nations.
COOPERATIVE RELATIONSHIPS
This patient-centred day reminds us that medicine is ultimately about the health of patients, which in turn depends on a network of cooperative relationships.
If patients’ mental and physical health are to be safeguarded the relationships between patients, their relatives, doctors, nurses, cleaners, pastoral care workers, physios and managers must all be respectful and cooperative In all those relationships; what matters are the health and wellbeing of the patients.
They must be empowered to make the large decisions about their treatment. In the details of their treatment, some central and urgent decisions will need to be made by doctors and nurses, but as far as possible even in these decisions patients should be fully informed and consulted.
This is the ideal. Of course, in practice it is never fully achieved because it involves fallible human beings who are often under great strain, and who come into these complex medical relationships with their own prejudices and attitudes.
Doctors can be convinced that older patients should not be resuscitated or fed, and try to force that opinion on their families. Relatives can be so distressed by the impending death of relatives that they refuse to allow ventilators to be turned off even when the person is clearly dead.
Patients can refuse to cooperate with doctors and nurses who are treating them. Such human weakness and arrogance can make relationships conflictual, as people appeal to conflicting principles in order to justify their position. The good of patients, which is not always the same as their opinion and immediate desire, can easily be forgotten.
INDIVIDUAL AGENCY
It is vitally important that people vulnerable through their health or in other ways have agency in their lives and are consulted in the decisions that affect them and find companions in their journey to a fuller life. This lies at the heart of all our own work.
The 2020 focus on the safety of doctors, nurses and other health workers reminds us that their work often demands self-sacrifice and even heroism.
In times of crisis, such as that created by the coronavirus, they risk their own health. We have been made aware of the complex relationships involved in safeguarding our own health and that of those who are vulnerable. Elderly people, doctors, nurses, hospital staff, and we ourselves depend on the small decisions we and others make to avoid infection and to avoid passing it to others.
The party we attend in the city can contribute to the illness and death of an elderly person in a nursing home in a distant rural town, and to the spread of illness among the people of the region. The safety of patients and of health workers depends not only on what they do and don’t do, but on the behaviour of everyone in the community.
It is also the responsibility of governments to enable it by funding it and regulating it so that it is a service and not a source of profit for private companies.
The patient safety that this day commends is not just the business of doctors and nurses but of all of us.