On "self-censorship"

When resistance seems fruitless, good people sometimes choose the easier way out: doing nothing and hoping for something better.

Every day it’s more bad news in healthcare. Austerity, pushes to privatisation, underfunding, defunding, and pervading it all, gaslighting that cuts are not cuts, and hiring freezes are not hiring freezes.

Anybody would go a bit crazy if they tried to take it all in, let alone tried to fight it all. So some healthcare colleagues are electing to “play out the clock”. Hoping that in 2 years there will be a change. Trying to keep a low profile because this is not a good time in healthcare to talk of ‘better’.

It’s a reasonable self-preservation strategy. But at it’s most extreme, it becomes ‘self-censorship’, where you know you need to do a certain thing because it’s the right thing to do, but you decide not to because it won’t work anyway, or because it’s all just too hard. Better to work within the new rules, keep one’s head down, and focus on the few things you can change. The things within our control. Which is to say, virtually nothing beyond day-to-day employment.

But the risk of this is that good people start doing things they don’t believe in, and not advocating for improvement to the health service for patients. At that point, we’re doing the bad guys’ work for them.

We decide not to ask for more nursing staff, ‘because there’s no chance we’ll get it’. We give up the fight for theatre time to try to clear the backlog of cases that are piling up. We accept that the clinic patients will have to wait dangerous additional months. We calm down and accept it as inevitable when shifts are understaffed and the ED waiting room fills to overflowing…because we know that it’s not fixable. Nothing’s going to change.

This played out before my eyes during the last big 9-year span of National government. I was an elected member of a District Health Board at the time. The executives and top managers knew there would be no funds for maintenance let alone the new builds we desperately needed. The instead concentrated on the littlest stuff, repairing windows so corroded that they were literally falling out of the rusted frame. We dared not dream bigger. We self-censored.

If you know your dad is going to be angry with you for eating dinner, you surely wouldn’t ask for seconds. The government held spending dead flat, despite rising economic prosperity worldwide. Though the population was growing and aging, no one wanted to say there was a bomb coming, because it would displease the big bosses.