The BMJ Today: Going beyond the call of duty

Move over the automation of clinical algorithms and etiquette based checklists, suggests Brian Secemsky, a physician, as he shares a touching account of a patient consultation. Choosing to build a rapport with his patient over several appointments helped unravel the real cause of her suffering, and facilitated appropriate management, which would have otherwise been missed or taken longer. Advocating for a change in physicians’ approach to patients, Secemsky writes: “The medical community should aspire to treat interpersonal communication not as a daily chore to accomplish, but rather as an essential part of becoming a seasoned clinician, as important as excelling in clinical reasoning and resource utilisation.”

Also going above and beyond the call of duty are health workers in West Africa. Keeping death at arm’s length, they wage a daily battle against Ebola for the patients and communities they serve. Margaret McCartney, in her column, pays tribute to this true healthcare heroism of modern times. The world lost a brave doctor in Sheik Umar Khan—declared a national hero in Sierra Leone for being at the forefront of efforts to curb the spread of Ebola. “I am afraid for my life,” he had said, “because I cherish my life. Health workers are prone to the disease because we are the first port of call for somebody who is sickened by the disease.”

“Their bravery calls on notions of concomitant fearlessness,” writes McCartney. “They fear, yet choose to accept risk or hardship.”

Such bravery is also required of those who stand up against unethical practices in their workplace. Integrity is a key principle of the Code of Medical Ethics, laid out by the World Medical Association, which states that “a physician shall report to the appropriate authorities those physicians who practice unethically or incompetently or who engage in fraud or deception.” Sadly, in the real world, physicians often have to face severe bullying if they stand true to this principle.

A report from the Public Accounts Committee in the UK found that departments had largely failed to protect whistleblowers or provide them with systematic support and advice. In the Department of Health, only 54% of employees reported that they felt confident they could speak up against wrongdoing. Blowing the whistle can make an individual vulnerable, and the fear of reprisal is very real.

I am reminded of Meg Cabot’s famous lines: “Courage is not the absence of fear but rather the judgement that something else is more important than fear. The brave may not live forever, but the cautious do not live at all.”

More needs to be done to protect and safeguard the bravehearts among us. May they continue to inspire others to action.

Anita Jain is India editor for The BMJ.