Friday, 20 June 2014

I’ll scratch your back..and guess what? You don’t have to scratch mine

Animals have genes for altruism, and those genes have been selected in the evolution of many creatures because of the advantage they confer for the continuing survival of the species.  Lewis Thomas

I had not previously been to a ‘coffee tasting’ so was interested to go along when a friend invited me to ‘3FC’ in Grand Canal Street in Dublin to taste the coffees. Fergal’s wife, Siobhán is about to open her third bistro, restaurant, foodstore and Siobhán had given Fergal the task of choosing the coffees for the new Clontarf bistro.

Fergal is Irish (what else!) and as such is bubbling with knowledge, ideas and opinions; some brilliant and some whacky. He is also a lawyer and for a time headed ‘Legal’ in one of the big banks. Between sips of coffee Fergal opined that the misery inflicted on the Irish people during the global financial crisis was a product of stupid government, greedy business and complicit lawyers. Only the teaching and healthcare sectors stood apart and above all that incompetence and skulduggery; all those dreadful sins of omission and commission.

It is certainly true that in public surveys politicians and lawyers (and, since the GFC, bankers!) are consistently listed last on qualities like honesty and integrity and teachers and doctors are consistently listed first. Why is this so? After all, in the case of clinicians, salaries are generally high and physicians lifestyles envied by many. People in other walks of life who make a lot of money are also envied but not so universally admired and respected as are doctors. Much of it has to do with the public perception of why people enter the medical profession. And this perception is that they do so not for material benefit but for altruistic reasons. Is the perception the reality?

The answer that I am going to offer to this question is an answer I always criticise as a ‘cop out’ when others give it in other circumstances – but it is the right answer in this case – and that is…. ‘Yes and No’.

The literature on this suggests that one of the motivating factors is material gain.

But, hang on, material gain? On average, in recent times, medicos salaries have dropped on average by 7% while there has been a rise of 7% across other professions – a net loss to the docs of 14%. And as Erich H. Loewy 1 , points out, in the former Soviet Union and even today in the newly independent former Russian states, the demand for places in medical schools was astronomical despite the prospect of a meagre salary on graduation.

Loewy goes on to cite examples of the enormous amount of selfless pro-bono work undertaken across the healthcare profession when work is done for no material benefit and often in the most inhospitable of 
Interplast Australia
conditions. I can cite many examples of this too. The Pacific Islands Project of the Royal Australasian College of Surgeons saw teams comprised of surgeons, internists, nurses, anaesthetists and technicians spending time in the most trying of settings delivering life saving and life enhancing medical care without any financial return while still bearing the costs of their practices at home, usually from their savings. Similarly, the training, mentoring, advising and hand holding of the next generation of doctors by the current generation is done for love, not money. I am reminded of a leading Neurosurgeon, who was senior examiner for the College of Surgeons, being reported to the local council for disturbing the amenity of the neighbourhood in which he lived because he was in the habit of attaching a floodlight to the front of his lawnmower and mowing his lawn at 5am. It so happened that this always coincided with the weekends on which he was officiating at the surgical exams where each day started at 7am and finished at 11 pm.  No money changed hands for this.


I like Lowey’s story of a cardiac surgeon who was so busy with his pro-bono work that he could only enjoy his hobby of car restoration vicariously; that’s right, he hired someone to restore his cars for him.

I know there are healthcare workers whose prime motivation in plying their trade is for the material rewards, I know this because I have worked with such people. But I can count them on the fingers of one hand and they are soon forgotten because they are not the healthcare workers that make a difference.

So, to all you altruists out there, well done and thank you, it is you who are shaping the future.

So, back to where all this started, a discussion over coffee. Fergal and I liked the Ethiopian coffee the best so the Bistro in *Clontarf will be the place for you to go for great coffee when next in Dublin.

Footnote* This year celebrates the 1000 anniversary of the Battle of Clontarf.

“Battle of Clontarf” 
oil on canvas painting by Hugh Frazer, 1826

The Battle of Clontarf (Irish: Cath Chluain Tarbh) was a battle that took place on 23 April 1014 at Clontarf, near Dublin, on the east coast of Ireland. It pitted the forces of Brian Boru, High King of Ireland, against a Viking-Irish alliance comprising the forces of Sigtrygg Silkbeard, King of Dublin, Máel Mórda mac Murchada, King of Leinster, and a Viking contingent led by Sigurd of Orkney and Brodir of Mann. 

It lasted from sunrise to sunset, and ended in a rout of the Viking and Leinster forces. It is estimated that between 7,000 and 10,000 men were killed. Although Brian's forces were victorious, Brian himself was killed, as were his son Murchad and his grandson Toirdelbach. Leinster King Máel Mórda and Viking leaders Sigurd and Brodir were also slain. After the battle, the Vikings of Dublin were reduced to a secondary power. Brian's family was temporarily eclipsed, and there was no undisputed High King of Ireland until the late 12th century.

The battle was an important event in Irish history and is recorded in both Irish and Norse chronicles. In Ireland, the battle came to be seen as an event that freed the Irish from foreign domination, and Brian was hailed as a national hero. This view was especially popular during English and British rule in Ireland.
(With thanks to Wikipedia) 

1 Healthcare Systems and Motivation,  Erich H. Loewy, MD, FACP   Medscape: Thursday, June 19, 2014

Peter Carter
Chief Executive Officer
June 2014

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