Reports of patients, or their relatives, who claim to have suffered at the hands of health professionals or to have been "let down" by the system certainly bring emotive and personal perspectives.
The outcome often sought is that someone must pay, the implication being that someone has made a mistake and a pound of flesh is requested.
The payment may mean the end of a professional career or perhaps financial remuneration.
This is despite unfortunate outcomes usually having more to do with the nature of disease and its progression than with individual competencies.
Clinical medicine has benefited from the aviation industry and its in-depth analysis of aircraft accidents.
It has evolved a systems approach - a root cause analysis - and has clearly identified that systems failures are the most common cause of such events and that the action of one individual, in isolation, is rarely the sole reason.
The health and disability commissioner has taken a similar approach and, not surprisingly, reaches the same conclusions while at the same time not shielding individuals if their performance has been insufficient.
It is also important to understand that the medical profession does not, for the most part, cause the patient's disease.
In my own field, I see patients who suffer from lung cancer.
No matter at what stage the cancer is when diagnosed, or what I may think of the patient's own decision-making, I will do my best to try to achieve the best result.
I, however, take no personal responsibility for a bad outcome if the cancer has been detected in an advanced state and indeed it would be incomprehensible to most fair-minded people even to suggest I should.
Much has been written about the recent court case involving the Otago District Health Board (ODHB) chief information officer Michael Swann.
Understandably, the public has legitimately asked how such a degree of fraudulent activity could go undetected with the resulting loss of nearly $17 million of public funds that should have been spent on Otago healthcare delivery.
One wonders how many people have been compromised by not receiving the care they should have.
Richard Thomson as chairman of the board has ultimate responsibility, a view I'm sure he would share.
It is no surprise and not unreasonable that the Minister of Health should seek a "please explain". What is unreasonable has been the minister's "heads must roll" approach and he clearly has Mr Thomson in the cross hairs of his political point-scoring bazooka.
He also states he no longer has any confidence in Mr Thomson's ability to do the job.
It is worrisome when a fledgling minister demonstrably and publicly displays a lack of appreciation of the issues and seems to think a heavy-handed, archaic and ill-founded approach will somehow advance the cause of both himself and the board.
To use 1960s non-thinking solutions to a 21st-century issue asks questions of either the minister or his advisers and what they have learnt.
Most professions have left the blame-and-shame approach far behind to pursue a greater understanding of systems and their failures so that solutions may be found and implemented.
I would like to suggest that the explanation to the fraud case and its subsequent fallout is very simple.
Some years ago, a cancer-causing agent was planted in the DHB.
Who actually implanted the carcinogen has been debated but it certainly wasn't Mr Thomson.
The resulting cancer grew and like all cancers it put in place mechanisms that protected itself against destruction by the host's (DHB's) natural defences.
It also avoided detection for quite some time - as do real cancers.
As this cancer grew and spread, it began to involve other areas and secondary effects were noticed.
When they were brought to Mr Thomson's attention, he promptly diagnosed the problem and, like a good surgeon, excised the cancer.
He cannot be held responsible for the length of time it took to detect and resolve the issue or for the magnitude of the loss.
Ironically, it would have been better for him if he had acted negligently and ignored the problem as it appears a number of his predecessors tended to do.
As I see it, his biggest crime was his transparency and efficiency.
Some will rightly say the organisation's systems should have diagnosed the problem earlier.
As previously stated, most issues arise out of systems failures and the more we can systemise processes, the more likely we can avoid problems.
It is true, however, that systems still need people and some systems do depend on the skill and, more importantly, integrity of key people.
If one of the key people in the system that monitors and reports on information is working on a lower level than others, then the possibility of dishonesty going undetected increases.
In such a situation, this can go on for some considerable period of time.
This is simply what happened.
Just as importantly, I assume that the minister will also be knocking on the door of Audit New Zealand, which failed to detect this cancer on more than one occasion.
Let me clearly state that the root-cause analysis of what happened at the ODHB does not lie at the feet of Mr Thomson.
He inherited a situation that was already well established and embedded.
Several of his predecessors, who should be feeling very uncomfortable, collectively put in place a system that inevitably led to the outcome.
More importantly, now having had some considerable experience in both the clinical and administrative aspects of medicine, I understand how important it is to have people of Mr Thomson's calibre actively involved.
He is committed to public health.
He has the highest integrity and personal standards.
His main motivation is serving the public good and making a significant contribution to the community he serves.
His, frankly, is a thankless task in being the very public face of a business that is woefully underfunded yet has high expectations from those living within the region.
He has been committed to ensure the people of Otago enjoy one of the highest intervention rates in New Zealand with the health dollar the DHB receives.
The minister has expressed a lack of confidence in Mr Thomson's ability and performance.
Again, I want to make it perfectly clear that I, and I suspect a large number of my colleagues, have the highest confidence in Mr Thomson's ability to serve our community and provide a high standard of leadership.
The minister may consider that Mr Thomson is responsible to him and that, given the commercial structure under which the DHBs operate, is appropriate.
I would, however, put it to the minister that he is responsible to me and every citizen of Otago for his performance.
To me, sacrificing one of our most able and conscientious public servants for political expediency is not only totally unacceptable but must not be allowed to happen.
Should the minister wish to pursue this course, we all must make it perfectly clear to him that the consequences of such action will lead to another Hawkes Bay situation.
Does he really want this?
