The Bustamante Hospital débâcle


The Bustamante Hospital débâcle


Tuesday, November 26, 2019

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In the past few days social media and different news outlets have been awash with stories of the fracas between politician and doctor at our premier paediatric care institution. In the court of public opinion, both parties are alternatively heroes or villains depending on how one interprets the goings-on based on the relatively scanty information available to the public.

I do not know either of the parties involved; however, I am qualified to perhaps subjectively weigh in on the doctor's dilemma, hopefully without seeming to blindly defend a colleague.

Large swathes of our population believe that the practice of medicine is a glamorous and glitzy endeavour in which wealth and comfort are par for the course. Few appreciate the daily exposure to unpleasant bodily effluents, the frequent risk of instrumentation injury, and the generally suboptimal, at times poor, working conditions, especially in the public setting such as at Bustamante Hospital for Children.

In many hospitals, some doctors, while on duty, sleep in chairs or in their cars. Indeed, the life can be quite unglamorous. This reality is not foremost in the minds of patients and their relatives when they seek attention at the various centres in the country. Therefore, many health-care professionals are viewed as overlords who callously refuse care to those in need or fail to recognise that 'my relative' is deathly ill, although the culprit malady may be a simple cold.

Fears and tensions are often heightened when loved ones are ill and they are often exponentially increased when children are seen to suffer. Under these circumstances, eminently rational and decent people sometimes lose the proverbial 'it', which leads to doctors and nurses sometimes being chased with weapons, threatened with serious harm, or treated to a buffet of choice words and phrases often ending with “dutty gyal” or the like.

It has been ingrained into the psyche of many doctors and nurses that the patients and relatives are always right. This, of course, is not true. The patient or relative, despite the colossal weight of concern they may shoulder in a crisis, must not be allowed to breach certain boundaries. In the current situation, as reported, it beggars belief and stretches the limits of the imagination to concede that there could be justification for knowingly entering a consultation room in which another patient is being treated to demand treatment of a loved one.

That said, it would be disingenuous of me to suggest that all my colleagues are approachable, affable, and endued with excellent bedside manners. The majority share these attributes and are eager to serve, sometimes at significant personal sacrifice. The savage truth, though, is some of us lack warmth and 'nuh know how fi talk to people'. That's a fact. This is not to be confused with the clinical dispassion that is at times necessary, especially in the face of an onerous triage.

A further consideration of import is that what we as clinicians consider mild disease may be construed by the average Joe/Jill as a major illness, and so the perceived nonchalance of the health-care worker is interpreted as insouciance and apathy. Another fact is that the majority of people seeking relief at our different centres will respond favourably to a kind word, a level-appropriate discussion of the patient's condition and a brief but reasonable explanation as to why there may be a delay.

There is, nevertheless, that small subset of people whose sense of entitlement and arrogance deem themselves above the ignominy of patient waiting. This trait is evident in situations of urgency, as may occur in a hospital, or more quotidian activities such as banking or eating out. Many times these people are so-called 'servants of the people'. The irony.

Most hospitals boast a vibrant and helpful customer service department, but financial and other constraints often do not facilitate a round-the-clock presence of customer service personnel. The hours may vary, but certainly between 8:00 pm and 8:00 am in most centres customer service concerns must, of necessity, be dealt with by nursing and medical staff who are usually woefully undermanned during these hours.

Perhaps, in light of the fairly frequent displays of animosity between medical staff and their clients, serious thought should be given to the provision of trained customer service intervention once the facility is open for care. This would provide several benefits; not least among them the opportunity for doctors and nurses to adhere to their areas of expertise uninterrupted.

A simple scenario would be for a customer service representative to periodically visit the waiting areas to allow venting of concerns and to transmit progress updates. This pendular exchange of information is all but guaranteed to improve goodwill and the perception of the health-seeking public.


Dr André Christopher Vaccianna is a consultant general surgeon.

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