Pain is real, not a myth

Letter, The Age

It is tragic that older people commit suicide (The Age, 17/1). The National Coronial Inquiry Service estimates that two people over the age of 80 are taking their lives every week. The most common method is hanging.

Ian Hickie suggests older people commit suicide because of myths and negative stereotypes about ageing, pain relief, hospitals and how the health system treats elderly people. Are these myths?

Recently, an elderly woman living in an aged care home died in excruciating pain because no one was suitably qualified on the night shift to administer the prescribed morphine. The woman’s daughter was so traumatised she could not remain at her mother’s bedside to hold her hand.

We do not need motherhood statements about healthy ageing. We need political action to ensure older Australians are valued and receive the quality of health care that they deserve.

 

Sarah Russell, Northcote

 

Good bloke or smug thug

The Human Rights Commission’s report The Forgotten Children: National Inquiry into Children in Immigration Detention was tabled in parliament two months ago. The 315-page report provided compelling first-hand evidence of the negative impact that prolonged immigration detention has on children’s mental and physical health. The report also made 16 recommendations.

Since the report was tabled, there has been no substantive discussion in parliament about the report or its recommendations. Our Prime Minister has used all-too-common techniques to stifle debate – attack, shoot the messenger and then ignore the message. These silencing techniques have been effective – they have taken the focus away from an important issue that reflects on Australia’s standing in the world community: children in detention and our obligations under international law.

Tony Abbott’s aggressive behaviour towards the President of the Australian Human Rights Commission, Professor Gillian Triggs, has been named for what it was: bullying.  No doubt, like me, other women have experienced this type of silencing behaviour. In response, Gillian Triggs remained composed and dignified. She is a role model for all of us at the receiving end of such attacks in both public and domestic places.

When Tony Abbott was accused of bullying Gillian Triggs, several colleagues defended him. They described him as a “good bloke”. I don’t know Tony Abbott but I know Tony Abbott Types (TATs). TATs are often described as “good blokes”.  They are men who attended an exclusive private boys’ school. After school, they studied at a sandstone university, lived at an exclusive college and did the ‘right’ courses – law, commerce and medicine. Although many men get over their privileged upbringing, TATs do not.

TATs are men whose sheltered lives as white, private school-educated, professional heterosexuals make them blind to their privilege. They form a network by surrounding themselves with others who share their worldview. They have a toxic sense of entitlement and often say that feminism has “gone too far”.

The upper end of town is filled with TATs. These men huddle together at exclusive clubs where their networking sustains their network. When they attend social functions, they often reminisce about their school and university days – a cricket game or a rowing regatta. The old school tie matters at the MCG’s Long Room.

They do not respond respectfully to alternate views. Instead, they react aggressively. They see disagreement as combat they must win. They either attack people who disagree with them, or ignore them. Either way, they ruthlessly shut down dissent. TATs perceive those who disagree with them as enemies who must be silenced.

They use a range of tactics to quell opposition. They will interrupt, talk loudly and mock. They jeer and insult. They blame others. Recently our Prime Minister described the Opposition Leader as an “arsonist” and “the Dr Goebbels of economic policy”. They dismiss alternate views by describing them as “offensive” and “ridiculous”. All these tactics are used to avoid negotiation and compromise.

They shoot the messenger rather than listen to the message. Personal attacks are common not only in parliament but also in the Australian media. In The Australian’s ‘Cut and Paste’ section and The Saturday Paper’s ‘Gadfly’, ‘argumentum ad hominem’ replaces reasoned arguments.

TATs do not substantiate their views. They don’t need to because they know they are right. They use rhetoric, slogans and dog whistles rather than evidence to support their views. The proposed government-funded ‘stop the boats’ telemovie has been described as “propaganda”. How can propaganda further informed debate?

If the evidence does not fit with their worldview, they will simply ignore the evidence. Statements such as “climate change is crap” and “coal is good for humanity” deny decades of academic research.

TATs do not apologise when they offend others – perhaps because they do not have the insight to know how offensive they can be. Scott Morrison refused to apologise to the Save the Children staff for besmirching their reputations. Instead, he brazenly attempted to justify his actions.

They are also vindictive. Cross a TAT and you will be punished.  Soon after the recent failed spill motion, an outspoken supporter of Tony Abbott, Scott Buchholz, replaced Philip Ruddock as party whip. Philip Ruddock went quietly. Not so Gillian Triggs. Professor Triggs refused to resign. She continues to speak about the plight of children in detention.

I call on all of us who are victims or witnesses of bullying to similarly take a firm stand. The next time our views are attacked, dismissed or ridiculed, we should stay put and stay on message.

A TAT recently told me to “shut up” before abruptly leaving the room and slamming the door. He told me that my views are “offensive”. When I later received a hurtful email, I was told that the email was “only factual and honest”.

The next time I am on the receiving end of a TAT attack, I will ask him to “settle down”. When he responds aggressively to my views, I will substantiate my views. If he treats me dismissively, or attributes malicious motives, I will name his behaviour for what it is: a technique to negate my views.

Now that the tantrum towards Gillian Triggs has passed, it is time for our government to provide a substantive response to the Human Rights Commission’s report and its recommendations.  If the issue of children in detention and Australia’s obligations under international law continue to be ignored, it will be at our peril.

If you really need care, public is the way to go

The Age August 22, 2003

There’s a reason most doctors would prefer to be treated in the public hospital system, writes Sarah Russell.

The recent reporting of “adverse incidents” in Victoria’s public hospitals is welcome. It suggests a significant change in the culture within public hospitals. Rather than cover up mistakes, health-care professionals are being encouraged to report adverse incidents. Such reporting allows us to monitor the types of mistakes that occasionally occur in our busy, understaffed public hospitals. But are private hospitals any better? Do private hospitals provide safer health care?

In a two-tiered health-care system, one may expect the private system to provide better care. Many people who pay for private health insurance expect there to be fewer mistakes in private hospitals. Yet adverse incidents occur in both private and public hospitals. We just hear more about mistakes in the public system.

While public hospitals report adverse incidents, private hospitals are not forthcoming with such data. As a result, there are no official figures comparing adverse incidents in private and public hospitals. However, there is anecdotal evidence that patients with complex medical and nursing needs may be safer in a public hospital.

During a recent bedside “vigil” at a private hospital, I saw some excellent medical and nursing care. I also observed several medication errors, poor communication between doctors, and substandard nursing care. In the intensive care unit, some health-care professionals relied on unit protocols rather than their own clinical judgement. They treated the numbers on the monitor, not the patient in the bed.

Surveys of Australian doctors suggest they prefer the public system. These studies show that most doctors would prefer to be treated in a large public teaching hospital, particularly when they are seriously ill. They think competent, up-to-date health-care professionals are more likely to be found in public, not private, hospitals.

In a public teaching hospital, there are a range of health-care professionals – residents, nurses, registrars, clinical nurse specialists, medical students, nurse managers and consultants. There is nearly always a health-care professional nearby.

In a private hospital, patients may rarely see their specialist doctors. Specialists often just pop in for a short daily visit, to check the medical charts and monitor progress. Unlike the public system, there are few formal medical ward rounds or meetings between the different specialist doctors.

As a result, nurses often mediate important medical communication. Not surprisingly, communication often breaks down.

Although you can choose your doctors in the private system, you are not able to choose your nurses. Quality of nursing care in a private hospital is a bit like the lottery. You might get lucky. Then again, you might not. You may find a kind, competent nurse or you may not.

Like the public system, it is the luck of the draw. However, unlike the public system, there is less medical support when things go wrong.

Elective, uncomplicated procedures, such as routine orthopaedic surgery, may not require medical back-up. It may seem more important that the private system allows patients to bypass the waiting list and choose their own surgeon.

It is also considered a bonus when private health insurance entitles patients to hotel-like accommodation with access to a TV, bar fridge and an ensuite bathroom. Some may even find fresh seafood and wine on their dinner menu.

However, when critically ill or experiencing life-threatening post-operative complications, immediate access to competent health-care professionals is more important than oysters for dinner. Despite the problems with our public health system, many competent, up-to-date health-care professionals choose to work in public hospitals.

Although they may be overworked and under-rewarded, most health-care professionals who work in the public system are committed to high-quality, universal health care.

Melbourne writer Sarah Russell is a former critical-care nurse who has worked in public and private hospitals.