When most people go on holiday, they like to relax, maybe head somewhere coastal, kick up the feet, enjoy a long slow drink by the pool. Not Dr. Mohamed Khadra, however. The last time the urologist took a break from work he threw his energies into another project, writing The Patient, an urgent indictment of a health system in need of some serious therapy.
He spent up to 20 hours a day writing non-stop, the culmination of a project he had been thinking about for two years. He likens the process to a pregnancy, and any birthing pains, as it were, seem to have been well worth it; The Patient is a gripping account of one man’s battle with bladder cancer and his slow, sobering realisation that the health system is an impersonal profit-driven machine rather than a compassionate institution able to allay his fears.
With his polished, measured speaking voice and general air of calm, Khadra seems the very embodiment of the clarity and passion that makes The Patient a compelling read. His motivation, he explains in writing it, was not to be a whistle-blower or a doomsayer, but to convey to the public the new realities that confront those struck by illness. Every day he handles test results that will change a patient’s life, pushing them into a journey they never considered. “By and large, (patients) are unprepared for the journey” he says. “They’re unprepared financially, spiritually and emotionally”.
The book’s central character, Jonathan Brewster (a conglomerate of four different patients Khadra has treated), is definitely and tragically unprepared. He constantly deals with frustrating delays, a lack of communication, financial burdens beyond his expectations and the constant challenges of trying not to lose ground in his job and relaying news of his condition to his young children.
With his background including educational work as well as practising medicine, Khadra hopes the book provides readers with not just a more realistic view of the health system, but the means of getting the most out of it. Despite its depiction of at least one especially aloof doctor and an array of harried, jargon-spouting, clock-watching medical hacks, reaction to the work from Khadra’s peers has been “surprisingly, exceptionally good…the vast majority of us in the medical profession are desperate to see better care for our patients”.
Perhaps unsurprisingly, though, the reaction to Khadra’s missive from politicians and senior bureaucrats has been more muted. If politicians were to pay attention to Khadra’s heed for reform, they may be relieved to hear that he does not believe the solution to the current woes of the Australian health system lies in increasing funding. “The US government spends about 15% of GDP on health, we spend about 8%… The US doesn’t have double the health system we have, in fact they have a far worse system. So I’m not sure if we spent more…that we’d get a better system”
What the system needs instead, he feels, is leadership, a concerted move to free the medical profession from the grip of bureaucracy. Currently the prevailing culture is one where pencil-pushers wield more power than doctors and nurses and invariably adopt a conservative approach, knowing that mistakes will harm their career while inactivity and apathy won’t.
Giving further weight to Khadra’s criticisms is an ironic twist in his life story. Ten years ago, this award-winning doctor became sick himself – he was diagnosed with thyroid cancer. While it would be tempting to reason that seeing the health system from the patient’s perspective made Khadra a better doctor, he explains that initially at least, the opposite was true.
“There’s a balance between drowning in the sorrow and suffering we see among our patients and the…detachment needed to decide on an appropriate course of action” he explains. When he first returned to his vocation after recovery, maintaining this balance proved nearly impossible.
Appearing as himself in The Patient as an ambitious professional faced with the challenges of maintaining a work-life balance in a role where opportunities for career advancement are fiercely contested and chronic sleep deprivation is the accepted norm, Khadra does not underestimate the difficulties facing dedicated doctors struggling to maintain motivation. “I see young medical students, and they’re gorgeous. They play the piano, they write, they read poetry, they do sport and they just embrace life. Then I see them again a year or two after they’ve been in the health system and they’re almost hollowed-out”.
The solution to avoiding such burnout, he believes, is maintaining balance. Away from the non-stop dramas of work (incidents from Khadra’s own experience that appear in The Patient include a pencil lodged in a woman’s bladder, a Prince Albert gone painfully wrong and the almost obligatory destructive ice addict), he believes doctors need to find some other passion, something with therapeutic value. “If it’s going surfing that does it, then go have a surf, make sure you find the time” he advises. Failing that, it seems, the odd 20 hour stint in front of the typewriter can also work wonders.
Originally appeared in: The Big Issue