After my second 'run in' with the ward manager I decided to bring my concerns to the ACT Health Minister. I set the scene by outlining Carolie's situation up to this point, particularly the attitude of senior medical staff to alternative therapies. Then I launched into a critique of our experience on this ward:
When we were informed Carolie would
be transferred to Ward ..... for rehabilitation we were pleased at the prospect
of intensive physiotherapy and a healing environment. Whilst we have no
complaint with the various therapists involved in Carolie's recovery, the
overall tenor of management is controlling, regimented and
counter-productive toward a healing approach.
We have not been allowed to
put the beautiful posters that Ainslie school children have lovingly prepared
on the walls of Carolie's room. I have organized a very gentle form of
chiropracture treatment for Carolie. I have been advised this is not
possible because of a policy concerning 'accredited clinicians'. It seems
the neurosurgeons of RPAH and TCH and the senior ICU
consultants/registrars of RPAH have a different and more sophisticated
approach. When I advised the senior doctor who spoke to me today of these
approaches she said they were all wrong.
When I had asked earlier in Ward .....
about public liability policies as they relate to external therapists I was
advised such a policy did not exist. I also expressed a willingness to
indemnify ACT health against liability if necessary. I repeated this
offer in Ward .... but was told this was not possible. This obstruction to
Carolie's healing has been conveyed in an insensitive, authoritative way that
beggars belief. The lack of concern for the well-being of Carolie as an
individual requiring a caring, healing environment is sorely lacking in the
case of these people.
All of the specialists I have approached and most
of the medical and/or nursing staff are supportive of my approach to holistic
healing. However, those in administrative authority appear less
interested in healing and more concerned with a narrow interpretation of their
management function. In my view this type of inflexibility should be anathema
to those interested in healing outcomes.*
My patience was running thin so I wrote what I meant. The
inevitable initial discussion with the medical hierarchy took place during 'rounds' in
the ward gym. The gym was the centre of
daily activities – everything revolved around the physiotherapy regime.
Anyone not engaging in the process was given
a gentle talking to – one bloke recovering from a stroke was clearly in this
category and would sit passively whilst an earnest physiotherapist explained
the benefits of more effort and the obvious downside to not trying enough. I am not sure whether he weighed the relative
merits of the options but he seemed to give the exercises a bit of a go. He
would sit and observe people and smirk to himself occasionally. I believe he had a fairly jaundiced view of
his fellow patients and the ward in general.
At the first opportunity he fled the joint and was found wandering along
a busy road away from the hospital. It
turned out the exercises were working but clearly he had a third option in mind
all along. Security on the ward was
tightened after this episode.
I digress. My
meeting with the senior rehabilitation specialist went to script. I made my usual impassioned pitch for an
enlightened approach to patient recovery and the efficacy of complementary
therapies, as evidenced by Carolie's experience to date. I was given the
'standard' line in medical obfuscation, which went something like this: “We do not agree there is any clinical
indication for the therapies you have requested. Only evidence-based clinical treatments would
be considered under hospital policy.” My
reaction was calmly stoic but underwhelmed.
Images of Escher stairs seeped into my consciousness.
I was weary. My growing unease with the operational 'culture' of the ward was seeping
into every pore. I knew the hospital did
not have a policy on third party therapists accessing patients. I had offered to indemnify the hospital
against liability, but was doubtful this would work. Hospital patients and their family have to
sign forms relentlessly, approving procedures, acknowledging risk and relieving
staff and hospital of responsibility if things go awry in the normal course of
events. How could a third party with no
contractual obligations to the hospital be indemnified? However, I saw the need for a more enlightened approach.
Next
we had a meeting with the Director of Rehabilitation and Director of
Nursing. When I discovered the
lady-in-charge was also to attend I baulked and asked that she not be included
as her attitude was unhelpful. We had a
cordial discussion with the Director, who reiterated the same line as the
rehabilitation specialist. I realized he
was the actual font of the 'party line' and that the specialist was merely a
spear thrower.
It was a well-honed tune that he had mastered some time back; subordinates clearly danced to a familiar beat. I felt caught in a Kafkaesque construct, writ large on his assuredness as to the
'rightness' of everything he said. He confirmed a scepticism concerning the
therapies I was advocating, although threw us a ‘tid-bit’ that his wife was
keen on various alternative therapies.
There is always a 'kicker' in a Kafkaesque space. It was totally ‘civilized’ and totally non-productive from our point of
view.
We were advised the issues raised
regarding external therapists would be referred to the Medical and Dental
Appointments Advisory Committee for advice and recommendations. He thanked us for bringing this area of
confusion to light. That might have been
something if I thought there was a scintilla of a chance that the 'closed shop'
(or, more accurately, 'closed mind') thinking on patient recovery would be
challenged. I got the impression that
this area of medicine, which should be in the forefront of holistic approaches,
would be one of the last bastions to change.
Certain medical strongholds are defended stoutly.
I
wrote several times to the relevant government minister and the head of
Canberra health. I received a formal
response outlining the ‘party line’ in clear 'bureaucratize'. The fact that treating teams in both the ICU in Sydney and the high dependency
wards in RPA and TCH had worked with us to allow complementary therapists
access to Carolie did not register.
This was to be
managed ‘by the book’ and they would brook no opposition. I had to ‘like’ it as ‘lumping it’ was not an
option. I remain convinced that
complementary therapies denied us at this time would have expedited Carolie’s
recovery. I finished my response to the Minister as follows:
It is regrettable that my wife is not able to take
advantage of a more progressive paradigm, but hopefully the issues will be
further reviewed and addressed over time so that patients in future will have
access to the broadest range of healing care in the area of acute rehabilitation.+
In reality my persistence was somewhat futile but at least I had tried to breach the stronghold. There were indications in several areas of the labyrinth that in the future a brave soul with exceptional grappling irons might just succeed.
In reality my persistence was somewhat futile but at least I had tried to breach the stronghold. There were indications in several areas of the labyrinth that in the future a brave soul with exceptional grappling irons might just succeed.
+Email from Mark Thomson to ACT Minister for Health, 16 May 2012
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