The Dark Side of Medicine

‘Injustice anywhere is a threat to justice everywhere’- Martin Luther King, Jr.

WE MOURN the passing of a colleague, Dr A Mazwi, an intern medical doctor who lost his life at work owing to brutal working conditions and a destructive medical hierarchy.

His death was tragic and preventable.The craft of medicine embodies a core set of principles including, but not limited to, compassion, humanity and empathy, with the ultimate objective of healing the sick.

Attaining optimal health requires a deep holistic understanding of the patient in his context, accounting for spheres of life extending beyond the physical, including psychological, social, cultural and spiritual. That is what makes us human.

I am, therefore, deeply disturbed by the current events which shake the medical community, if not the world. A doctor has died owing to a system which does not protect the psychological safety of its employees, especially juniors. Seniors often approach juniors in the workplace in a manner which echoes a lack of respect, empathy and accountability, propagating a destructive cycle, with devastating consequences.

Dr Mazwi, who was critically ill at the time, was denied his sick leave and was, nevertheless, instructed by his consultant to arrive at work and complete his daily duties. His health status continued to deteriorate throughout his shift, exacerbated by his working conditions, and he allegedly collapsed on duty at Prince Mshiyeni Memorial Hospital. He did not recover.

Similarly, three other healthcare professionals recently lost their lives in separate incidents at different hospitals. How many more must it take?

Harsh working conditions are not uncommon in the healthcare sector in South Africa. Doctors at the front line are overwhelmed: unforgivable patient case-loads in resource- limited settings coupled with exhausting working hours are major drivers of physician burnout. Poor patient outcomes often have a subtle yet significant impact on caring healthcare providers, culminating in pernicious mental health conditions, such as depression and even suicide.

Bullying exacerbates the current situation. Junior interns are often too intimidated to raise questions or admit to mistakes, owing to fear of humiliation by a senior. Seniors also chastise juniors publicly for errors they themselves have made, evading the direct wrath of the consultant and shamelessly deflecting the blame towards an ‘easier target’.

It is through this harrowing lack of psychological safety that juniors often lose curiosity and passion for their art. Patient outcomes are endangered owing to a lack of honesty by seniors with defined leadership roles. It is also unfortunate that talented, resilient individuals, such as Dr Mazwi, lose their lives as a result.

I often recall my journey through surgery as a medical officer during my community service at a busy hospital in Johannesburg. 30 hour plus shifts are considered normal practice, with no post call. My thirst for knowledge and my hunger for learning would be undermined by physical exhaustion and missing meals throughout the day to attend to my patients. My mind throbbed as I maintained concentration in a full clinic the next day, with patient capacity often reaching one hundred.

My aching calves buckled as I tried to focus in the operating theatre during the early hours of the morning. Waves of sleep hit me as I tried to stay awake at the wheel on my way home. A single lapse in focus could have resulted in the unimaginable. A seemingly insurmountable work-load is ideally divided equally among members of the medical team.

Daily tasks would be manageable and patient care optimized. However, seniors may choose to delegate a significant portion of duties to capable and enthusiastic juniors to accelerate learning, improve diagnostic independence and hopefully boost confidence in the clinical setting. This is true, to an extent.Although, I feel that boundaries may be crossed when a senior does not respond to requests for help from a junior who is unsure.

I feel that patient’s lives are jeopardized  when the senior on call will not review a critical patient in the middle of the night who the junior has clerked to the best of his ability. The morale of the junior may also be dimmed by a senior, who chastises him before a respected medical team due to the occurrence of a complication for which the junior is not wholly responsible.

The intern would merely accept, apologise and ‘do better next time’.  Such is the culture of medicine.Don’t let me scare you. Medicine is a noble profession. It is both an art and a science which may be incredibly rewarding if practiced with curiosity and fine skill. Excellence in the field may translate to resilience concerning its complex challenges, including working well as a team.‘Saving a life’ is the end goal conceptualized by a team of medical professionals entirely dedicated to a patient’s care.

Kindness, empathy and understanding of our team members, including junior doctors, is integral to their overall wellbeing. Heightened awareness of those around us may be their only salvation before it is too late.We are not there yet and more work needs to be done.

A paradigm shift in healthcare systems across all levels of care is required to address bullying and fear in the workplace to stop a vicious cycle. We cannot undo what is already done; however, we may still honour those heroes who have fallen and be the change they truly deserved.I extend my deepest condolences to Dr Mazwi’s loved ones, friends and family during this difficult time

Dr Ishq Pramchand, 27, of Durban, graduated at the Nelson R Mandela School of Medicine in 2021. Email ishqpram@icloud.com 

** The views expressed do not necessarily reflect the views of IOL or Independent Media.

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