Sometimes I feel very alone and vulnerable here.
You see, it is rare that doctors air their views on social media (SM), and I have done a fair bit of that on this forum. If you sift out all my posts pertaining to healthcare and read them in sequence, you will have a pretty representative idea of how the average South African doctor feels about the changes and current status of our profession. It’s all there, every sorry complaint about an industry that in its state of disruption has little to cheer about. These are issues about which you, the lay public, are generally unaware until things fall apart. I believe you should be, because they impact you directly every time your health takes a knock.
Little of what I say is new to my colleagues. There are many other doctors who write far more eloquently than I do about the challenges we face, and by proxy that you, the consumer, face, but they publish predominantly in medical journals or medical newspapers — media that are read by the medical community alone. The issues we fight about impact directly on our ability to offer good medical care to you. You don’t get to read about them. So you, the consumer, have little idea how much angst pervades the doctors you rely on to get you out of a bad health situation. Unless a few of us spill the beans in places like this.
So it is fitting that I bleed my heart out here, for the world of SM is where opinions are aired, challenged, established and changed. SM is a realm of revolt and upheaval, the domain of the common man, where every person has a voice.
You would think that the organisations that profess to recognise doctors’ rights and represent us would have a good grasp of this potential. I hoped that they would. My experience over the past two years suggests that this is not the case.
I have made a careful study of the impact SM will have on the practice of medicine in this country, based on the already remarkable changes that have taken place in the US and Europe. There are rules to be followed, things a doctor should or shouldn’t do, massive advantages of engaging with patients via SM, and equally big risks in doing so. It is an ethical minefield pocked with big rewards. Every point of the SM universe has advantages and pitfalls.
Impressed and enthused by what I saw, I put together a talk on all these elements, encompassing every aspect and the pros and cons thereof. Anxious to share these with my colleagues, I requested recognition for the awarding of Continuing Professional Development (CPD) points to doctors who attend, the carrot on a stick to get them to come to a presentation so that they make up their annual CPD requirements.
The last thing I anticipated was the reaction from my profession’s representative organisations. The South African Medical Association (Sama), of which I am a member, turned down my request for CPD points two years in a row on the basis that there was nothing “ethical” in my presentation, a classic case of what they “didn’t know they didn’t know”. The first time it happened I was able to reverse that decision via contact with Sama’s acting president who knows something about social media and quickly corrected the error. The second time the reaction was exactly the same, with the final decision being made by Sama’s senior legal representative, in the same instance questioning the validity of the decision made a year previously.
The email of refusal sent to me on the first occasion contained a delicious irony in the banner that headed it. “Beyond traditional boundaries,” it said. And yet Sama clearly had no idea what I was talking about, two years in a row.
I phoned the man who made the decision. Lawyers, whose livelihoods exist around delivering and receiving threats, don’t like being spoken to angrily by doctors and perceiving the same — it is a “reversal of the norm”, and my suggestion that I write about this situation using the very medium I was trying to reveal was not well-received. But I cannot think of a better way to demonstrate the power of SM. Sama won’t like it, but at least they can learn from it. I hope.
And so, it leaves me with this. Like in the US, through the power of SM, it is going to be up to YOU — the consumer — to embrace all that the new technology in SM can offer, to become the driving force that creates change. I and a few other like-minded doctors cannot do it on our own.
There are no organisations that ab initio represent the consumer in every aspect in South African healthcare. That could and should change, especially with the wide reach and immediacy of SM and the power to engage. Leaders ignore it at their peril.
You, the consumer, can stand up to the machinations that hamper efficient healthcare in our country. You can ask questions of medical aid administrators as to why their profits are increasing and their benefits decreasing. You can ask why hospital groups see fit to build new hospitals in every new suburb. You can ask pharmaceutical companies why drugs cost so much here in South Africa and so much less in Europe. You can ask our government why your healthcare tax money is so badly and inefficiently spent. On SM your opinion does count. Your voice can be heard.
Sadly, doctors in this country don’t get the power of SM to affect change. Sama certainly didn’t get it. I hope you get it.
I start my talk with a video clip of the asteroid that wiped out the dinosaurs making impact with the earth. SM is that asteroid, and the dinosaurs the Sama-minded doctors and lawyers who are oblivious of the new era. They cannot escape the changes. The SM genie is out the bottle and will not be put back.
I like to think I am the annoying little rat-like mammal in the clip that escapes predation by the last remaining doctorsaur.
It’s a lonely place to be, but one filled with huge potential.