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SAMJ: South African Medical Journal

On-line version ISSN 2078-5135
Print version ISSN 0256-9574

SAMJ, S. Afr. med. j. vol.104 n.8 Cape Town Aug. 2014




Postmortem: The Doctor Who Walked Away



By Maria Phalime. Cape Town: Tafelberg, 2014. ISBN 9780624057604

'... I had little time to listen to my patients ... was forced to strip away the colour in the stories of patients' lives in order to get to the black and white of science and fact.'

Postmortem blows the whistle on the sometimes inhumane conditions in facilities meant to provide relief and care. Immense suffering results from mismanagement of systems and resources. The situation is worsening as doctors, afraid for their own mental and physical health, walk away from medicine.

Maria grew up in Soweto, dreaming of becoming a doctor. On qualifying, she was horrified to discover poorly resourced facilities, ill patients discharged prematurely for the next intake, and doctors making critical decisions when they were too exhausted to think straight. No time to reflect or debrief; no time even to show compassion.

Maria didn't like the person she was becoming. After four years, she gave up medicine.

For ten years, she struggled with self-recrimination. Postmortem explores the complex issues involved. Are admission criteria for medical school predictive of good doctors? Could she have been better equipped to deal with the realities? Is it a good or bad thing that newly qualified doctors in understaffed situations have to perform procedures they are not trained for? Is medicine the only way to make an impact on improving people's quality of life? When should doctors increase their resilience, when should they protest, and when should they walk away? Was walking away a personal failure?

Maria interviewed a psychiatrist and doctors who left medicine about the stresses that medical practitioners face in the field. She discovered that her difficulties were not unique. [C] oping and resilience is deeply entrenched ... It starts early on in our training -the hours, the workload, the exposure to gruesome pathology and trauma. Dr Harrison referred to them as "rituals of induction and brutalisation" ... Shutting down and pushing through is often the most expedient way to cope.'

There are pockets in the state health sector where dedicated health carers achieve much with very little. Yet the system is also run through with faults. I hope this book falls into the hands and hearts of the policy makers and doctors in healthcare forums. We must object where patients are too sick and too poor to object when the system fails them.

Dawn Garisch

Author of Eloquent Body (Modjaji, 2012), Cape Town, South Africa.

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