It is a tricky business selling time for a living when that time is so delicately laced with moral and ethical obligation.
This is true of many professions, but medicine carries a particular immediacy. When a doctor is unavailable, a result is not reviewed or a clinical decision is delayed, the consequences may be profound. This makes medical time feel different – not necessarily more valuable than anyone else’s, but burdened by a distinctive kind of responsibility.
Most of the doctors I know entered medicine with a genuine desire to be useful. We are not immune to ego, ambition or financial incentive, and the history of medicine should caution us against romanticising the profession. Yet in family medicine especially, it would be difficult to sustain the years of training, the continuing study and the emotional demands of the work without some deeper commitment to service.
Doctors earn a living through time, but the care we provide rarely fits neatly into the time that is sold.
On my travels, I often overhear people talking about their health: the doctor who communicated beautifully, the one whose bedside manner disappointed them, or how quickly—or slowly—they received feedback on their blood results. These experiences matter. What is less visible is when that feedback was prepared: perhaps between patients, after the working day had officially ended, or at ten o’clock at night.
Patients may not see the family event missed because a consultation ran over, or the weekend hours devoted to continued professional development. They do not necessarily see the reports, referrals, blood forms, repeat prescriptions and email queries that accumulate around the formal consulting day. Nor should patients be expected to know every detail of their doctor’s private sacrifices. But it may be helpful to recognise that the appointment is often only the visible portion of the work.
Healthcare is also, for most people, a reluctant purchase. Few of us want to spend hard-earned money on an unexpected illness or injury. We would rather educate our children, repair our homes, save for the future or take a holiday. A medical bill seldom arrives at a welcome moment.
Perhaps that is partly why the value of medical care can be difficult to perceive. We are not buying an object we can hold. We are paying for judgement: for years of accumulated learning, for the ability to recognise what is dangerous and what can safely wait, and for someone to carry responsibility while helping us make decisions under conditions of uncertainty.
That responsibility is not always straightforward. Consider informed consent. Every medicine has potential adverse effects, and every intervention carries some degree of risk. If every possibility were presented without context, many people might feel too frightened to accept treatment at all. The clinician’s work is not merely to recite a list of complications, but to translate evidence into meaning: to explain what is likely, what is serious, what the alternatives are and how those considerations apply to the particular person sitting in front of us.
This task has become still more complicated in an age of abundant information. Patients arrive with greater access to knowledge, which can be enormously valuable. Informed and curious patients often become excellent partners in their own care. But reliable evidence now circulates alongside confident opinion, commercial influence and personal anecdote. A single individual’s experience can acquire the authority of universal truth, while careful clinical advice may appear tentative because responsible medicine acknowledges uncertainty.
Doctors must navigate that landscape while remaining human and therefore fallible.
A mistake in medicine may have consequences far beyond an uncomfortable conversation with a manager. It may harm a patient, threaten a practitioner’s professional standing and lead to a regulatory complaint or civil claim. Accountability is indispensable: medicine has power, and both its history and its present practice show why patients need effective routes to challenge negligence, exploitation and unethical conduct.
Yet the process of accountability has a human impact on practitioners too. Complaints and claims are not resolved overnight. I know excellent physicians who have lived for years with unresolved matters hanging over them. Even when a complaint is ultimately dismissed, the intervening uncertainty can shape how a doctor works, sleeps and relates to patients. It may encourage defensive practice, erode confidence and slowly diminish the joy that once drew someone to medicine.
The South African figures reveal an interesting tension. In 2021/22, more than 95% of complaints registered with the HPCSA were directed at private-sector practitioners. At the same time, the public sector carries a medico-legal burden measured in tens of billions of rand, with Parliament citing a cumulative figure of R77 billion.
These figures measure different things and should not be directly equated. An HPCSA complaint is an allegation concerning professional conduct; a medico-legal claim against the state is a demand for compensation that may be contested, withdrawn, settled or found to be fraudulent. Nevertheless, the contrast invites reflection.
Private patients generally know the name of the doctor responsible for their care. They expect continuity, explanation, accessibility and individual accountability. When those expectations are disappointed, the practitioner is readily identifiable and the pathway to complaint is relatively visible.
In an overstretched public system, responsibility may be dispersed across teams, facilities and departments. Patients may struggle to identify the responsible clinician, access their records or navigate the complaints system. Harm is then more likely to become a claim against an institution or the state, with individual responsibility absorbed into a much larger system.
This does not mean that private practitioners deserve less scrutiny, or that public-sector patients should expect less. It suggests that proximity and accessibility carry their own exposure. The doctor who is available, known and reachable may also become the person upon whom the frustrations of a complex healthcare experience are most easily placed.
There are always two sides to the relationship. Patients bring fear, financial pressure, vulnerability and, sometimes, histories of not being heard. Doctors bring knowledge and authority, but also finite attention, personal responsibilities and the cumulative weight of caring for many people at once. A healthy therapeutic relationship asks something of both.
For doctors, it asks that we communicate clearly, charge transparently, acknowledge our limitations and remain accountable when care falls short.
For patients, perhaps it asks for a moment of recognition: that the email containing a substantial clinical question requires professional thought; that reviewing a result is work even when it happens outside the consulting room; that a missed appointment leaves time that cannot necessarily be recovered; and that an unpaid account affects not an anonymous institution, but a practice employing people and trying to remain available to its community.
This is not an appeal for gratitude simply because doctors have chosen difficult work. Nor is it a request that patients silence legitimate concerns. It is an invitation to see the fuller ecology of care.
Good medicine depends not only on knowledge, technology and access. It depends on trust, reciprocity and sustainable human attention. If we value thoughtful, accessible practitioners who will walk difficult journeys with us, we must also value the time and labour that make such care possible.
Sometimes that may mean pausing before sending a long clinical question by email and booking an appointment instead. It may mean cancelling in good time, settling an account, or expressing dissatisfaction directly before taking it into the public domain. And sometimes it may simply mean acknowledging that the person caring for us is also a person; one who is trying to offer skill, presence and good judgement within the same limited hours that govern all our lives.
