A Father's Anger, Health Care Administration and the Philosophy of Science.

It is not unusual for parents of children in 'intensive care' to vent their anger and frustration on staff members. One accepts that people under stress can display the recognised signs of grief; "denial", "bargaining", "anger" and "acceptance". These signs are not confined to the bereaved but can also be manifested in those who grieve for their child's suffering. Thank God that the vast majority of kids on our unit do get better! Our mortality rate is about 4% which compares favourably with comparable units.

Of course, understanably, such statistics cut little ice with parents, for them a death is not a fraction it is the loss of a loved one and that is 100%. Even when seriously ill children recover it should not be inferred that the parents are unscathed psychologically; they still had the fear of loss to contend with. They may also be grieving for the 'loss of innocence' - not their child's neccesarily - but their own! People can have a rather 'Pollyannish' view of life which a visit to PICU rudely contradicts, it isn't surprising then that parents feel a deep sense of anger at society for having sold them a lie - that 'all is for the best in the best of all possible worlds'!

Recently one father had a 'go at me'. He could not comprehend 'how in this day and age' medical science had no clear cut answer to an issue he raised. He was quite angry about it and I listened - I hope with good grace - to his frustrations. Of course I had no answer to his technical question although I could have replied "do you really want to discuss The Philosophy of Science?" I suspected he did not. His frustration arose out of a misconception about science; in his worldview "science" was about concrete facts, settled knowledge which can be looked up in a text book. But the reality is "science" does not deal in such certainties, what Mankind "knows" is only ever provisional - we must constantly re-evaluate our knowledge and revise our practice in the light of new information. Medical science is no exception, especially when one is dealing with complex and dynamic disease processes.

Another naive idea which came to grief was his view, of what I will term, his "entitlement" within the UK's National Health Service. I suppose, again, I could have asked "do you really want to talk about 'Social Policy and Health Administration'?" I suspected he did not. He clearly felt that having paid more than his fair share in taxes he was entitled to more than he felt he was getting. I listened - again I hope with good grace - to his frustrations. The answer I could have given would have been inappropriate; 'however much you have paid in tax it is no where near enough! And I bet at the last election you didn't vote for higher taxation did you?!' The demand for all health care services way outstrips the supply and the electorate needs to wake up to that reality. The government is not some rich uncle who can dig ever deeper into his infinite pockets, it is the tax payer who funds the health service and in a world with 'third party payment' we can always be very generous with other people's money can't we? But we live in a democracy where politicians will promise more and more while the electorate is prepared to pay less and less. This irreconcilable conflict is taken out on the people who have to break the bad news to a naive public that the State cannot always provide what they demand and that is usually the same people who are haplessly trying to make the system work!

Western society has produced a generation with a profound sense of what life owes to them. People feel some sort of entitlement from life which is bolstered by our concepts of 'rights' - as if our 'rights' are absolute and written as immutable laws into the very fabric of the cosmos rather than relative and subject to the vagaries of humanity.

But, of course, I didn't say any of this. This father was grieving, but not for his child, who was ultimately discharged from our unit alive and well - he was grieving for the death of his naive worldview!