The creed of compliance
In each hospital, a grotesque comedy unfolds: Poor Sod, our hapless affected person, lies gut-shot, aorta spewing like a B-movie fountain. Clinicians, faces clean as overcooked porridge, scurry in a choreographed panic, clutching flowcharts like sacred scrolls. Screens bleep like a refrain of lobotomised parrots. A registrar, mad sufficient to belief his intestine, tries a life-saving stunt not within the Holy Handbook. A nurse, eyes glinting with the zeal of a Spanish Inquisitor, hisses, “That’s not protocol!” Poor Sod expires, however the paperwork? A bureaucratic Mona Lisa, flawless and serene.
“The method was adopted,” chants the ward supervisor, a excessive priest of banality. Medication’s soul slinks off, tail between legs. Compliance, that paper-pushing Pol Pot, reigns supreme. Checklists garrote braveness; types embalm judgment. We’re not healers; we’re clerks in a Kafkaesque circus, dancing for auditors whereas sufferers choke. (U.S. well being care’s “gatekeeping” obsession: security as a clown present of risk-dodging.)
Bureaucratic evil: a Lovecraftian farce
This isn’t evil with a cape and a cackle; no Hannibal Lecters in scrubs. It’s a squamous, bureaucratic monstrosity, a clipboard-wielding Shoggoth oozing pink tape. Respectable clinicians, trembling like scolded spaniels, bow to its mantra: “Comply with the algorithm, and ye shall be absolved.” Deviate? Heresy! Burn on the stake of HR!
Arendt’s banality was newbie hour. Right here, the ideology is course of, a cult the place the algorithm is Cthulhu, and audit committees are its gibbering acolytes. “Tick the field!” they howl, as Poor Sod’s pulse fades. Concern, of lawsuits, audits, or a sternly worded e-mail, drives this lunacy. Medical doctors, as soon as Hippocratic heroes, at the moment are snivelling scribes, failing with pompous precision slightly than saving with reckless brilliance.
The cult of the algorithm
Flowcharts had been as soon as humble Put up-it notes for the frazzled. Now? They’re the Ten Commandments, carved by the trembling fingers of ATLS, ACLS, NICE, and WHO. “Airway, Respiratory, Circulation!” they bellow, as if demise trembles at acronyms. Stray from the scripture, and also you’re frog-marched to Remedial Hell.
Proof-based medication? A sick joke. We’re not practising EBM; we’re staging a Three Stooges skit of it. Information’s mangled, correlations canonised, deviations drawn and quartered. Gunshot aortas die quicker than arrhythmias, so the protocol smirks, “I’m infallible!” (ATLS’s dogma is a dear farce, nice for rookies, deadly for consultants.) The hospital’s a theatre of the absurd: Compliance struts centre stage, sufferers shooed to the wings like stagehands.
Judgment beneath siege
I’ve waltzed this macabre tango. I’ve cracked chests, pumped hearts like soggy bagpipes, and clamped aortas to grab minutes from demise’s jaws, all with out the flowchart’s blessing. Reward? A one-way ticket to ATLS Re-education Camp for botching the ritual chant.
Bureaucratic evil’s core: Process devours judgment like a bureaucratic Pac-Man. The system doesn’t ask, “Did you save Poor Sod?” It calls for, “Did you salute the guidelines?” Phronesis (Aristotle’s time period for not being a brain-dead drone) will get a firing squad. Expertise? A punchline. Outcomes? Meh. The algorithm is a jealous god. (Research nod at deviations saving lives; consultants mock inflexible protocols.) Trauma’s chaos laughs at flowcharts, however attempt telling that to the Clipboard Inquisition.
The false god of audit
Audits are forms’s crack cocaine, addictive, delusional, and courtroom-sexy. Committees swoon over them, mistaking box-ticking for sainthood. It’s as helpful as tattooing a lifeline on Poor Sod’s corpse: pure pantomime. (Paperwork’s bloat jacks up prices, throttles innovation, and lets sufferers slip.) Ticked containers don’t revive; they canonise failure.
Demand reflective peer evaluate: “What occurred? Why? Repeat?” Punish sloth or spite, not daring bets in disaster fog. Something much less is a bureaucratic black mass, incense of pink tape choking the wards.
Ethical cowardice and the career
Medication, as soon as a saga of swashbuckling healers, now grovels earlier than forms’s guillotine. Why? Concern: of lawsuits, inquiries, or a tut-tut from Compliance Officer Doom. Obedience is the golden calf; initiative, a tar-and-feathering. Obligation’s not to Poor Sod however to the Nice Ledger of Ticked Containers. Checkbox ethics castrates ethical creativeness. Braveness? A fossil, like bloodletting.
A life-saving area now cowers, guarding its arse whereas Poor Sod flatlines.
Proof, audit, and the self-fulfilling farce
“Proof-based” medication here’s a clown automobile of unhealthy science. Audits pretend causality, crowning correlations as kings. Protocols preen: “We had been obeyed, so we’re divine!” Excessive-risk circumstances (gut-shot aortas, septic tots) crave improvisation however die anyway, “proving” the flowchart’s gospel. Sufferers are props, their deaths mere stage notes on this bureaucratic vaudeville.
The best way ahead: braveness over clipboard
Hope’s not in committees; these are the farce’s villains, bumbling like Sharpe’s dons. It’s in mutiny: Train judgment, not parrot methods. Reward audacity, not arse-kissing. Embrace medication’s superb mess; no algorithm tames it.
Within the subsequent disaster, ask: Did we dare? Did we expect? Did we save? Shatter the flowchart like an inexpensive piñata. Select lives over ledgers. Bureaucratic evil festers like gangrene: amputate it.
Conclusion
Medication ought to be a Viking saga of guts, wits, and coronary heart. As a substitute, bureaucratic evil, wearing procedural drag, peddles ritual, worry, and spinelessness. It crowns course of emperor, banishes conscience, and tosses care right into a shredder.
We received’t guillotine the forms in a single day, however we will steal again medication’s soul. Practice thinkers, not automatons. Honour Poor Sod, not protocols. Revive ethical creativeness earlier than it’s smothered in types.
As a result of Poor Sod doesn’t care about your bloody flowchart; he desires you to behave.
Bryan Theunissen is an orthopedic surgeon in South Africa.
