Juliette McAleer is a former public sector leader and PhD candidate living with disability arising from the physical and psychosocial consequences of preventable healthcare harm. Based in regional Queensland, Australia, Juliette writes from her lived perspective of harm and its aftermath, focusing on post-harm responses and how they shape safety, trust, and the possibility of relational repair. Contact: juliettemcaleer@yahoo.com.au
“Unbillable”
I hesitate in the doorway
knowing
how costly hope can be
even if it isn’t itemised
on the bill
You look up
through myopic lenses
stethoscope labelled Consult 1
behind a desk
wide enough
to make conversation
feel like trespass
Your hand hovers
near the duress alarm
as if I’d brought in
a grenade
instead of a history
Where does it hurt? you ask
I point
to our shared humanity
and the aching space between us
Here, I say
— Juliette McAleer
I wrote this poem to describe a type of human encounter I know all too well. It looks like healthcare and bears all the typical hallmarks. The consulting room looks like any other, there is a stethoscope sitting on the desk for the purpose of listening deeply to the hearts of those who come here seeking healing, and there is a poster on the wall endorsed by the Occupational Violence Strategy Unit, urging patients to “Respect Our Staff”. I know the doctor sitting opposite me once took a solemn Hippocratic oath to first, do no harm. The same oath taken by a team of doctors in a regional town 200 kilometres from here, whose errors five years prior had resulted in the preventable loss of ninety percent of my small bowel, a hypoxic brain injury, and my permanent reliance on tube feeding. Distracted, my eyes keep drifting to the poster—a reminder that somewhere along the way, the space between patients and healers became a site of mutual suspicion and managed threat. I have every reason to be wary of rooms like this, and yet it is my credibility on trial here today.
Somewhere between that harm and this room, I’d asked one of my own doctors a naïve question. “What actually happened to me?” I’d asked, not understanding how profoundly the act of asking would change my relationship with the humans of healthcare, hereafter. From that point, I was no longer a fellow human to be healed. I was a source of exposure and risk to be managed. No alternative pathway to the answers I sought was offered. And so, I ended up here.
Here, with this instantly likeable man. His demeanour is wise and compassionate. I let myself imagine he is someone’s favourite uncle. I’m trying to see his humanity and hoping he’s trying just as hard to see mine. But this encounter, for all that it resembles care, is not care. It is an “independent” medical examination commissioned for the defendant in my medicolegal matter—the insurer of the health service that operates the hospital that employed the clinicians who designed and delivered the system that harmed me. Try saying that aloud, in one breath. You’ll feel how diffuse and difficult it is to pin down where accountability lies after healthcare harm.
I’ve sat through more than ten of these assessments, my words weighed against standardised impairment rating scales—instruments designed to reduce a life to a tidy number across pre defined categories. My harms don’t fit neatly in these boxes. The losses that weigh the heaviest may not even register on their pre-calibrated scales. The common law has even found a way to quantify the unknowable possibility that my life might have gone badly anyway. “The vicissitudes of life” is a glibly framed legal principle, established by the High Court of Australia in Bresatz v Przibilla (1962), allowing a discount to be applied to the calculation of my future losses on the hypothetical basis that some other misfortune might have befallen me even if the harm I actually suffered had never occurred. Put simply, the law offers an accountability ‘discount’ to those who harmed me because bad things happen to people, and I am, after all, a person to whom bad things might have happened. My post-harm life has been punctuated by dehumanising indignities like this, and yet nobody in this process has asked me what it’s been like to hear my suffering recited back to me in a language designed to serve the interests of not one, but two, honourable public institutions—medicine and law—founded to protect the common good. In spaces like these, I’m here to have my story taken apart, instead of taken to heart.
My experience of healthcare harm didn’t end with the “adverse event”. It was exacerbated by everything that came after—and perhaps especially, what didn’t. I was left to piece together what happened from clinical notes written in a language I was never taught, while the people who could have helped me understand stayed silent. The only apparent pathway to the answers I so desperately wanted was litigation, where my vital signs became evidence, my losses became categories, and the answers I needed became the property of insurers, lawyers, and institutions with interests of their own. Wailling and colleagues refer to the harm emerging from the institutional or interpersonal responses to an adverse event as “compounded harm”, a phenomenon that intensifies when relational or structural rights are violated (Wailling et al., 2022, 2025).
Healthcare systems have formal mechanisms for responding to adverse events, in the form of incident analyses, morbidity and mortality reviews, complaints processes, open disclosure, and regulatory bodies. Each serves a legitimate institutional function. But none are designed to help a harmed person heal within the relationship that caused the harm. And when they are inaccessible, or experienced as hollow, the harm compounds.
Healthcare harm is mostly unintended. It happens inside relationships of trust and vulnerability, where the harmed party remains dependent on the very system that injured them—often more so than before. There is no clean “after”. Gratitude and fear coexist. Anger is tempered by dependency. When the institution that harmed you is the same one keeping you alive, the protest that harm ordinarily demands becomes a luxury you cannot afford (Smith & Freyd, 2014). One of the hardest lessons my experience has taught me is that sometimes the most dangerous of places are those where good intentions abound.
And yet, I often also reflect upon how courageous it is for healthcare workers to walk into a consulting room or an operating theatre every day knowing that, in a system this complex, harm will sometimes still happen, despite your diligence, your skill, and your care. And then what it must feel like to shoulder this inside a culture that demands composure as the price of belonging. The culture of medicine demands superhuman stoicism from people doing deeply human work, and I know I can only imagine the toll of practising inside a system whose design makes safe care harder than it should be. It is painfully obvious to me that the system that failed to protect me also fails to protect them from the weight of it. I want the clinicians involved in what happened to me to know that while I looked hard for a villain, all I found were second victims (Wu, 2000), and that grief never exhausted my curiosity about who and how they are. I would have liked the chance to say this to them directly, in a room designed for that purpose, rather than writing it here, to strangers, in the hope it reaches no one and everyone at once. Sometimes sovereignty looks like staying human in a process designed to make this impossible. What if our responses to healthcare harm were designed to hold more than one truth at a time?
This question is what brings me to restorative practice, and to the work of scholars and practitioners who have spent decades in this space proving that a different response is possible. In Part 2, I will explore what these responses bring to healthcare, and why it must be built with the people who have lived inside its failures. Knowing the difference between being moved by someone’s story and being informed by their hard-won lived expertise is where this work begins.
References
- Bresatz v Przibilla, 108 CLR 541 (HCA 1962).
- Smith, C. P., & Freyd, J. J. (2014). Institutional betrayal. American Psychologist, 69(6), 575–587. https://doi.org/10.1037/a0037564
- Wailling, J., Cameron, G., Stolarek, I., Turner, S., Bleakley, B., O’Connor, N., Harwood, C., Power, M., Turner, K., Kooijman, A., Oelke, N. D., Gustafson, D., Robson, R., Anderson Wallace, M., Drennan, G., Hughes, J., O’Hara, J. K., Swanepoel, F., & LeMaster, C. H. (2025). Restorative initiatives: Emerging insights from design, implementation and collaboration in five countries. Frontiers in Health Services, 5, 1472738. https://doi.org/10.3389/frhs.2025.1472738
- Wailling, J., Kooijman, A., Hughes, J., & O’Hara, J. K. (2022). Humanizing harm: Using a restorative approach to heal and learn from adverse events. Health Expectations, 25(4), 1192–1199. https://doi.org/10.1111/hex.13478
- Wu, A. W. (2000). Medical error: The second victim. BMJ, 320(7237), 726–727. https://doi.org/10.1136/bmj.320.7237.726
