The Theresa Brown furor has got me thinking.  To be honest, I don’t think the doctor’s apparent offense was really that bad.  I remember giving and taking worse.

When I was at medical school and in specialist training, there were senior doctors and nurses of legendary temper and bad disposition.  Tiptoeing around them, and working to their satisfaction, however unreasonable, was an accepted part of the job.  But the work got done, and something tells me it may have been done better than in the more docile and politically correct environments I have experienced thereafter.

Let’s explore this further.

Being a good doctor or a good nurse is a very difficult job.  Mistakes are inevitable.  Personalities are going to clash.  Bullies will exist, as will passive aggressive victims.  Among these will be both caregivers and patients.  This is an inescapable part of providing healthcare, however unfortunate.  Patients, being ill and under pressure, can hardly be expected always to be of sunny and meek disposition.  But the new openness of social media and communication technology have brought this into the open domain, causing what can be thought of as a quiet revolution in healthcare.

So are we tough enough to cope with this environment?

I see doctors and nurses as being frontline troops in a war against illness.  And wars are tough.  I know – I was in one too.  Without training to be tough, troops are not going to do a proper job without taking high casualties.  That’s why boot camp is the tough place it is.  It’s not personal.  It’s to build character and strength under pressure, so that the job can be done when it counts.  We had a motto in the army “Train hard, fight easy.”  Train hard we did.  I became very tough, and that toughness has remained as a resource to fall back on long after my war has ended.

So much that is wrong with modern healthcare all over the world is going to be difficult to change, and conflict is inevitable.  Removal of bullies from the system will have to involve victims standing up to those bullies.  Good doctors and nurses will have to pick out bad doctors and nurses and raise the standards.  This is not “doctor bashing” or “whistle blowing” – it is a critical aspect of policing our profession ourselves, our own peer review process.  If we don’t do it for ourselves, others will.

I am not for a moment supporting bullying or doctor bashing.  Medical practice is already tough enough, and no one needs it.  But a high standard of discipline is expected in medical environments, and when indiscretions occur, and there is due cause for conflict, an open and transparent process has to be implemented. This is bound to be difficult.

Perhaps this process needs to start at medical school, where would-be doctors learn the communication and conflict resolution skills to minimize issues in real practice. And to take the military analogy further, those who want to do medicine need to know that the fight against sickness will have its casualties.

So being a doctor is like being a Marine – if you know you’re not tough enough, don’t even think of applying.

Martin Young is an otolaryngologist and founder and CEO of ConsentCare.

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