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Phillida Bunkle is a former MP and women’s health researcher who co-authored the book An Unfortunate Experiment at National Women’s Hospital with Sandra Coney, and was a party to the Cartwright Inquiry.
OPINION: In recent months various friends, whānau and I have unexpectedly become patients. The Code of Rights, prominently displayed in Nelson Hospital expressed a set of principles: Respect; Fair Treatment; Dignity and Independence; Proper Standards; Communication; Information; and Support.
These fundamental values underlie New Zealand’s Code of Health and Disability Consumers Rights which is one of the most important outcomes of the Cartwright Inquiry.
Dr Helen Overton has recently claimed that the Cartwright Inquiry and the Cartwright reforms which followed damaged the morale of the medical profession and the quality of the service they provide.
In Nelson Hospital, however, I recently experienced the results of a culture change for the better. Consent was obtained and information provided at every step of examination and treatment. I observed treatment in five of the hospital’s departments. Not only were patients treated respectfully but clinical teams communicated collegially and effectively co-ordinated their work. I observed the justifiable satisfaction they derived from working together.
The Cartwright Report was published in 1988 and the code became operative in 1996. Legislation enshrining the code took long, focused organisation and voluntarily sustained arduous advocacy by The Women’s Health Movement and our medical, legal and community allies.
The code changed patient attitudes and expectations, which bewildered and even angered some old-school medical doctors. Some feared they would have to adapt. But now, despite real resource constraints, I observed that it is bearing fruit in new generations of doctors.
Effective communication makes doctors, nurses and their skilled colleagues accessible to each other and more effective than they were in the old command and control culture. The fear that once had held the professional hierarchy in place is now replaced by “respect”. Only relevant professional demarcations remain. Experienced senior nurses are acknowledged as colleagues, in practice, if not in pay and conditions.
I noted resource constraints and stress but also that closer, more open communication is achieving real efficiencies as well as providing individuals with greater satisfaction in being part of these teams. The code, based on the ethical requirement of informed consent has laid the foundation of a new trust by patients and among medical teams.
The consultant remains the, extremely well-paid, head of the team. But the king and his retinue no longer arrives on the ward, rings for attention and throws a tantrum because the pillow slip openings are not turned away from his regal gaze.
Last week I observed a senior consultant get down on his knees and lower his mask to introduce himself to my sick grandchild face to face. Her trust was important to him.
I commented to an ophthalmology registrar that I was sure there were places he would rather be late on a Friday night than completing a long examination. He replied with quiet, well-deserved pride that “this was his place”.
I watched the monitor in an ambulance and in Accident and Emergency as a friend’s blood pressure improved with the information provided for each careful step of a night-long examination. She stepped into the sunshine next morning with the reassurance of clear, agreed, written strategy for her next steps.
This respect is light years away from the lack of information and consent described by patients in evidence to the Cartwright Inquiry, and experienced by many others in New Zealand hospitals in the 1970s and 1980s.
But one critical concern remains; lack of justice for patients damaged by medical malpractice. In this, New Zealand lags far behind more enlightened countries.
The Cartwright reforms entrusted this important task to the Health Commissioner. It is now clear that this trust was misplaced. The commissioner cannot deliver justice to these severely damaged and legally voiceless patients.
The Cartwright collective and our legal and medical colleagues now advocate that the decisions of the Health Commissioner be appealable to the Human Rights Commission. This is the last essential step in the long passage of the Cartwright reforms which have proved otherwise so effective in improving our safety and in hospital.
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