For generations, if not centuries, the medical profession has contained within it a set of attitudes that at best have been avuncular, at worst brusquely authoritarian. And some nurses, seeing themselves in the past as the hand-maidens of their medically qualified colleagues, have often demonstrated similar attitudes. The nurses are currently in negotiation with the State to try to gain financial and structural recognition of the changes that have occurred in terms of their clinical responsibilities, their professional status and their skills, and it may be that, as their profession develops more independently, these old attitudes will change. But this week's report from the Irish Patients' Association provides evidence that, in some areas at least, such attitudes still exist in both professions.
It would be foolhardy to rely too heavily on the evidence provided by a mere 65 letters from patients in a health service which costs in excess of three billion pounds a year and has a massive overall throughput of patients. But the IPA is still a small association run entirely by volunteers in their spare time, without a listing in the telephone book and wholly devoid of full-time or even part-time staff. It simply could not be possible that a substantial or truly representative sample of patients would make contact with it. But the small number of letters received contain enough consistency to suggest that at least some doctors and some nurses may behave towards their patients quite differently from the manner in which they might relate to other people.
Some patients said that they felt degraded, some that they felt humiliated or powerless. Indifference to them or their feelings was often perceived as the attitude of some health providers. It was as if the patients had ceased to be people and had become mere objects. They were, as the IPA points out in its report, deprived of their human dignity. Their situation was not explained to them and their questions went unanswered. They were used, without their permission and usually without even the courtesy of an introduction, as demonstration objects for students, always without dignity and sometimes without even a shred of clothing.
Small wonder, then, that the IPA is seeking a proper and structured complaints procedure to be introduced within the health care system, and for a revision of the educational system for health care professionals which could improve communications between those professionals and their patients. Small wonder that they are seeking to have the patients' voices heard at all educational and administrative levels within the system. Indeed, the wonder is that so little has been done so far in these areas of concern. It is several decades since the best professional advice within the worlds of both nursing and doctoring was that the carers should try to enter into a therapeutic partnership with their patients, carefully explaining everything that was happening or likely to happen, answering questions in a manner that could be understood by the patients and involving them to the extent that they effectively shared in their care rather than being merely passive recipients of that care.
Scientific evidence has existed for years to indicate that this approach not only affords patients their individual dignity but offers a better therapeutic outcome in many cases. Common sense suggests that it might lessen the number of legal cases which increasingly confront doctors and hospitals. And mere good manners requires that the modest and wholly reasonable requests of the IPA should be granted, and even grant-aided.