Dr. Jason Strachan: Professionalism Within the Jamaican Health Care System

Hello friends,

This is a Jim Nantzian way to begin this discussion, but I think it needs to start off with a

friendly tone. The topic of professionalism within medicine, especially amongst doctors, is one

that is bound to make a lot of practitioners extremely defensive. That is not the purpose of this article, instead, I want to improve and standardize patient interaction and highlight some of the systemic flaws and inequities that are pervasive in our system and may hinder our advancement as a society. There are a lot of ills that plague our society, and the practice of medicine is not exempt from that reality, however, not every issue or concern can be discussed in this medium.

Anything I do not discuss does not mean that I do not think it should be discussed, it simply

means that I chose not to and or did not think to discuss it at this time.

Jamaica’s culture is one where cat-calling is the norm and misogyny is the order of the day. Acknowledging this reality will help us come to terms with why unprofessionalism reigns

supreme in our healthcare system. In “A Guide to Ethical Practice in Jamaica” it states “Medical

practitioners are therefore warned to avoid any unnecessary attention or intimacy which may

lead to serious misunderstanding and accusations”, that statement means that our intent is not what makes something an ethical violation, it’s how what we do is interpreted that constitutes the violation. When we read that assertion it is easy to assume that whoever transcribed it is devoid of the experience of living in Jamaica.

A lot of Jamaicans are generally very touchy and descriptive in our communication, and

a bit of it (read as a lot) is cultural in nature. However, while our understanding and our

interpretation of our culture may vary, that statement on what is expected has no ambiguity. As clinicians, our actions must be above reproach across the board. We can’t act in a way that if someone hears about it will reasonably draw serious questions because then we have failed to act in a way that does not lead to serious misunderstanding or accusation.

The hyper-sexual culture of Jamaica prevents some of us from drawing the line between what is appropriate for a patient care setting versus what should be said in a club. This is not entirely the fault of the doctors, this is more the fault of the institutions that train and employ doctors. These institutions do not enforce the need for professionalism and how the lack of professionalism stands to create a hostile environment for patients because they, so many, often have a “God complex”when it comes to doctors, so they will just take whatever we give them. This may result in the patient leaving the consultation feeling victimized or marginalized but they will continue to suffer in silence.

The other issue I will discuss is the treatment of women in the healthcare system. I won’t

discuss the ingrained misogyny in Jamaican society or the obvious differences in salary

structure and upward mobility, women working twice as hard and are half as liked (shout out to

Fun-Some Nights), or even women often making 70c on the dollar compared to men. I will step

on that soapbox and champion that cause in another article.

Women in healthcare are demeaned, degraded, and belittled in Jamaica in alarming ways. Doctors, nurses, patient care assistants, technicians, clerks, janitors, security guards, and

others are treated much differently from how their male counterparts are treated. There is a vim, vigor, and vitality that a lot of Jamaicans have when women in patient care approach them,

which is much different when men in patient care approach them. There is a strength that they

develop when the women approach them that’s not present when the men are there. They will respond and be rude when women approach them, but when the men say the same thing it

becomes “yes sir or no sir”. A lot of men at the hospital feel like they have a right to women at

the hospital. By that I mean, male patients, male doctors, male nurses, male security guards,

male clerks etc. feel that they have the right to see, speak and do whatever they feel to female

patients, female doctors, female nurses, female clerks, female security guards etc. There is a

lack of training at the tertiary education level and at the health authority level to address sexual

harassment and professionalism within the workplace. The training must be mandatory, they

must be enforced and regularly reinforced, the content must be electronic and persons must be

sanctioned for not completing the necessary training which should be conducted biannually.

Professionalism will not come about just because we speak about it. We have to act on it

and prioritize it. We also have to be very deliberate with policies and procedures in place

because as it is right now, it just seems like they are in place as a footnote. It takes only one

rogue person breaking rank for the healthcare system and the agents acting within it to be

deemed inappropriate. We must have specifics that are going to be appropriately addressed

and investigated when allegations of unprofessional behaviour arise.

Unprofessional behaviour creates a hostile work environment, which the person who commits the act is usually unaware of. A hostile workplace does not mean that everyone wants to be violent or feels physically unsafe. It means the action of one person reasonably made any person feel violated or marginalized. There is a societal divide which we must address if we ever hope

to incrementally lessen the divide and create workplace equality for patients and healthcare

workers.

Dr. Jason Strachan

The views and opinions in this article are those of the author and do not necessarily reflect the views of thelaymansdoctor.com.