A medical system in crisis, and one doctor’s fight to restore the moral compass. We unpack the issues with Paddy Dewan and put an invitation out to the Federal Health Minister Greg Hunt…
There are archetypal roles in human history, representing and maintaining the “moral compass” aspect of our human collectiveness.
Shaman, Cleverman, Kung, Elder, Healer, Judge, Psychologist, Nun, Yogini, Pastor, Rabbi, Journalist, the list of these intended guarding personages goes on. They all share a common fibre; people have looked to them to show us the way, to set the example and uphold safety, truth and care for the good of each other. One such very admired role is that of Doctor.
The learned person who cares for the vulnerable and ill. Yet according to many in the field, it is becoming frighteningly apparent in many Australian medical establishments, the rose of the medical compass is faltering, no longer pointing North but rather bending towards closed doors.
Yet there are those who are relentless in their dedication, these warrior types who continue to strive and fight to uphold the ideal, climbing through the trenches onward to navigate treacherous roads for the people left broken hearted and left wanting.
Missiles and words from colleagues are thrown, twitter grenades are launched and the very processes needed to keep the soles on their warrior shoes and continue the roles they have worked so hard for are being stripped away.
People are hurting. This is real.
The hand on heart promise to ‘remember that there is an art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug. I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.” These are the words formed so long ago adopted and adapted all over the world. The Oath of the Doctor.
Vulnerability, accountability and tough conversations are no longer the growth tanks from which new ideas and ways spring forth. Instead of peer reviews, tainted news reports waxing lyrical into the hearts and minds of the general public seek to control the wheel. The puppet strings are pulled by the powers to be, and brilliant journalists are haunting the halls with silenced mouths, and empty pens.
An underground smattering of Doctors and patients afraid to speak up and operate, patient’s heartbreaking -purposefully buried beneath a decaying process that may have lost its way.
The inability for Surgeon Dr. Paddy Dewan to perform a life-saving operation in a public hospital because he has upheld his oath in favour of kowtowing to the people who have forgotten the face of their teachers.
A surgeon banned from working in a host of public hospitals, not because he is not brilliant at what he does, it is because he says, he has tried to hold people accountable for mistakes, to make sure they don’t happen again.
Yet people like Paddy are accused of the very thing they fight against- power and ego.
There are not enough walls to fill the qualifications, I have never seen so many in one space. Then there are the photos, photos of happy kids and smiling parents. He fights day in day out from a tiny office in Sunshine, with old lino and bare of the glitz and glamour of the Eastern Suburbs. He is a globally respected surgeon, he runs a successful charity called Kind Cuts for Kids, helping save lives of children in developing countries and he gives a shit.
Courage is a tangible and often instinctive response to a threat or a need to protect others, how do you believe it is forged?
I was walking with my nephew many years ago, in a paddock. We were going to dig for worms beside a dam. I looked at my hand on the long-handled shovel as I raised it in the air and thrust it in the direction of his foot. I cut off the head of a snake that was just next to him, between the two of us.
My primitive brain saw, heard and directed the message to the action centre, bypassing the white-matter neocortex that is much slower. When it comes to the survival instinct in my medical career, I obviously prefer the primitive pleasure of the joy of the family to the strategy of ensuring you ingratiate oneself to colleagues – I probably would have died early in the German times of Hitler or the Pol Pot regime in Cambodia.
Courage is also demanding physically and mentally when it is an ongoing requirement to work in your field – where do you find the guts to keep going?
Like the real Patch Adams, I get my inner strength from the families I assist. He rang me a few years ago after one of “my” families arranged for him to come to a charity function in Sydney. He said, “Hi Paddy, its Patch here. I gather your system is as fucked up as ours”. I agreed! His phone call that day was an inspiration.
When the protectors and the lifesavers are desperately trying to uphold the moral compass when their intention is PEOPLE and not power or ego, what can they do to help you, what can everyday people do? Democracy is built on the tribe having a say in their rights.
I am an everyday person; I am a plumber, a boy from the bush but, I roar like a tiger when I see injustice in medicine. If everyday people informed themselves, then reacted, we would have a better world. Others can contact their politicians, contact the regulator and make those that are advocating for them feel they are not alone.
The problem is that most are self-interested – once the champion has solved their problem, they lose interest in the problem they have created for the champion.
You are brave, and you are human, not infallible and not emotionally bulletproof, when you read and hear negative comments from peers and the institution you have invested time, education and faith in, what does that feel like?
Such negative comments led to me writing “Look the Tiger in the eye”, while in the witness box. I am reminded of the father who punched the door when I said his boy needed an operation – because he was so angry with the neglect of others. In the VCAT courtroom, the AHPRA barrister was presenting a barrage of negative comments about me.
That very same father stood up quite fiercely and said: “I am not listening to this fu**ing bullshit any more”.
I am also reminded about Lindy Chamberlain, then I go and use a chainsaw or build a fence, or go to a developing country. Sometimes I am angry, but these days I feel more resolved than angry.
What does it feel like to hear positive and endearing commentary from peers and those who believe in you and what you do each day, preserving health- what does that feel like?
I love hearing the positive comments, and more-so, I enjoy the positive body language. The look and behaviour of friendship, thanks and caring. This is everything.
What do you believe drives a person to protect their career more than the care and life of a person?
Human nature! Selfishness, money, greed, a lack of caring. Often it seems that those who are better at protecting their career have less clinical skills. Within organisations, it appears that those who are not a performance-comparison threat are more likely to be promoted.
The opinions of others are none of your business, and yet they seek to destroy and hurt. What is your go to, to help equalise and keep you focussed on your life and your life’s work?
Writing Poetry, dancing, some art and furniture making, farming, a 1962 Fordson supermajor tractor, developing country visits, my Australian patients and, last but far from least, my wife, Padma. I blame Rudyard Kipling!
What does your family love most about you?
Standing at the kitchen bench typing, as Padma says, “my multiple abilities” – so I remind her I fixed the heating yesterday.
Were you a rebel when you were younger or have you been forced into the perceived role of rebel rather than simply being someone trying to do their job?
I was the “father” in the family home. I learnt to cook and clean had an after-school job and was top of my class. I was good friends with all the teachers and had great friends from all backgrounds. At university, I had little money so wasn’t a pub lad, but couldn’t afford haircuts. But I could dance, which was a bit radical – it certainly didn’t make me popular with the guys!
Then in Ireland, I experienced medicine by the spin doctor (which led me to do a PhD to prove what many were saying was “product driven medicine”.) Then on return to Australia, I found poor standards accepted, false indications for surgery supported. I was soon elevated to the status of a radical when I refused to accept certain events.
I have been presented by the media as a radical as a way of them supporting the poor standards of the regulator, VCAT, the coroner, medical administrators and other surgeons.
Is the moral cost to you submitting to the system trying to force your hand higher than the one to keep going and fighting?
Absolutely, a German officer was quoted to say – something like – If you have a difficult decision to make, look to consider the worst possible outcome of what seems the right decision and, if you can tolerate the consequences, then make the morally correct decision.
If we imagine humanity as a linear story – if you had to choose just one person as the protagonist for choosing good over conformity who would it be?
Nelson Mandela – his time in prison reminds me of the little time since 2003 when I lost my position at a major hospital for choosing justice over conformity.
Favourite photograph and why?
The wedding photo of Padma and I standing by the water of the Woolshed falls, which is on the creek. Our wedding was on the land on which my great-grandparent looked for gold (5 acres), near Beechworth.
We purchased that land, and a little more, on the 10th anniversary of our wedding, on the anniversary of my mothers birthday (23rd May), which was one of our two weddings, the other was on the 50th anniversary of Padma’s parents’ wedding, on 20th June (Padma and I will exchange crystal on Thursday).
We both love the wonderfully romantic story of our two weddings.
Documentary or Netflix binge when travelling? If so, which one do you recommend?
I NEVER watch television when I travel; I watch an occasional movie on a plane – I often crying during movies. But if I was to binge it would be on documentaries.
What irritates you more, losing a sock or being late?
I have a system of keeping track of “one-tys” so that never worries me. And I love mending them, I call it “cycling” (as compared to recycling). I prefer not to be late but relax in a traffic jam.
Are there other people like yourself believing in upholding the moral compass within our institutions that strive as you do regardless of the threat to their credibility and reputation?
Yes, I have met some of them via the Healthcare Excellence Institute Australia – Jane Bannan and Jane Tolman, for instance.
How does it feel when a patient celebrates a birthday because you were brave enough to do an operation or find an anomaly that helps promote life?
Interestingly, this question reminds me of the occasions where I have helped families come to terms with the death of their child. On a visit to PNG, I saw a boy with a big lump on his chest wall. He was about 10 yo.
The next day I saw the family with a chest x-ray that indicated he had a terminal illness. I said in my broken PNG language, “him buggarup algetter” which implied he would die from the illness. They said as I was almost in tears, “we are happy that God has given him to use for 10 good years”.
During the same trip, a judge and his wife were losing their boy to kidney cancer, while he was on his death bed, they were phoning Europe to chase more refined histological interpretation and were falling apart.
The first family taught me how to cope with death, and has helped me teach other families around the world. Not from a religious perspective, from the importance of knowing what can be changed, and accepting it. And, knowing you have saved a life and enabled another birthday celebration is amazing.
How does it feel when a person is diagnosed correctly after misdiagnosis?
Lucky; the more I practice, the luckier I get; the more I listen, the more I know.
Do you cry very much?
Usually while watching “call the midwife”, and while watching “Invictus”, the movie. Sometimes when flying away from the countries, I have gone to treat kids in developing countries – tears of joy really.
How hard is it to separate your emotions when you like a patient?
I like most of my patients. Operating on someone is a very personal thing, with great responsibility. Maybe it is like a pianist and the piano – great music can be created, great admiration for the instrument,
Is there a legislative action that can be taken to protect those that seek to protect us?
We do not have free speech in Australia; the media publish to a formula, not in the pursuit of truth and many politicians are liars and cheats.
What is the point of difference between you and the Doctor who looks a patient and their family in the eye and says “there’s nothing we can do” when in fact they know there is and they know they are being influenced by peers and boards to say no?
I once wrote a poem called “you child becomes mine”, which says it all – just by the title. Others seem to have the attitude that if something went wrong and they were not on-call, it was not their problem. The best example was when I was a registrar in Dunedin. A fellow trainee had operated on a man in his forties for varicose veins.
While operating in the back of the knee, he injured the main vein of the leg. When he was called to suggest he come to help fix the damage, he refused “because he was not on-call”. He got away with what I thought was unthinkable behaviour.
Are there many others like you that have seen the character assassination and are frightened to make a stand?
Yes and there will be more! I work on our farm, volunteer overseas and review coronial cases and report adverse events to the surgeon, the hospital involved and the regulator. I give expert opinion in coronial cases, spend time organising meetings to review the regulatory process, and remain determined to make medicine safer.
Are you a hindered lifesaver?
Yes and No. As a result of the Australian political rubbish, I have made a huge difference in developing countries.
If you could tell the Australian public one compelling aspect you wish they knew about our current medical establishment, what would it be?
Education of the public to enable them to get the best health outcome for their children is not a priority and combined with a failure to listen to and respect parents results in overtreatment, undertreatment and adverse events. I invite the Health Minister to sit down with me to discuss the coronial process and regulations, the system is broken and this is not getting taken seriously.
Dr. Paddy Dewan’s eyes light up when he speaks of his charity, his love of helping others and the curious nature of those possessed by ego. Every day he marches on, fighting for the rights of Australian’s to have access to truthful medical care. We have pondered with him and its the kind of ponder that you leave better than when you started.
So – Hon Greg Hunt MP will you ponder with Dr. Paddy Dewan? Are you prepared to sit down and listen to a man dedicated to the oath he took and the protection of the integrity of our medical system and those whom you represent?