For how long will doctors get away with it?
This week they have continued to behave like a trade union for more pay and relief from laws they do not like, and more reports of poor practice have emerged.
In short, medical practitioners are like the practitioners of any other profession, trade or occupation. They want to earn a good living. They have their fair share of incompetents. They try their best to give the public a good service. Their profession contains similar portions of the venal, idealistic, selfless, greedy, brilliant, idiotic, caring and cold as other occupations.
Yet, they are consistently rated by the public in opinion polls at the top.
At the bottom are used car salespeople, real estate agents, and journalists.
The most recent Morgan Gallup poll on occupations shows the three professions most often mentioned by Australians as having high or very high standards of ethics and honesty were nursing (90 per cent, unchanged topping the poll for the eighth consecutive year). Pharmacists (89 per cent, up 6 per cent) and medical doctors (80 per cent, up 5 per cent) retained second and third place.
Journalists are on 9 per cent, real estate agents on 8 per cent and car salespeople on 3 per cent.
The What Canberra Thinks poll this month conducted by the Australian School of Government Studies showed had doctors among the three most admired professions.
I suspect Health Minister Tony Abbott is alert to the doctors’ high standing as he deals with their demands to change laws to make life easier for themselves.
Members of occupations down the list just have to put up with expensive inconvenient law. Journalists have been putting up with restrictive defamation laws for decades (though they have been reformed in the ACT). Real estate agents are copping stricter rules on auctions and tenancies. Used car salespeople have copped laws on warranties and odometers, and tighter laws are being suggested in the ACT and other states. But law-makers know that these occupations have little public support.
However, the doctors should be careful. The very nature of their profession keeps their standing up, but they should not take their high standing (and the leverage with government that comes with it) for granted. Accountants and Ministers of Religion used to rate in the 70s in the Morgan Gallup poll, but are now in the low 50s. Police (another worthy profession) sunk to the high 50s and are only now clawing back.
Publicity surrounding bad conduct lowers a profession’s reputation. This is why journalists will always be near the bottom. We publish our mistakes. On theother hand, doctors try to quietly bury theirs.
But the quiet burial and doctor-knows-best approach is changing with the information society and greater attention to health economics as the health budget swells.
For example, a report published this week shows that GPs jeopardised patients’ health and caused a blowout in the Pharmaceutical Benefits Scheme by rushing to prescribe new arthritis drugs based on hype from drug companies. Administrators of the PBS have to watch their Budget. They will happily blame doctors.
In August, the director of Monash University’s health economics unit Professor Jeff Richardson told a national health summit, “A conservative estimate is that there are around 4500 [patients] dying each year in the hospital system through mistakes and inappropriate procedures. I am staggered that this issue is not headline news every week. This is equivalent to 13 jumbo jet crashes.”
He said that the potential savings from stamping out preventable adverse events would be more than $4 billion a year.
Doctors are only partly to blame, but they will attract adverse publicity as health administrators look for savings and use computer power to analyse data.
The present campaign on medical negligence might well backfire in the long term. This week the Australian Medical Association said it would enlist patients in their campaign with information in waiting rooms to lobby MPs. That can only lower doctors’ standing. It is likely that people will political lobbying distasteful. They might share Tony Abbott’s view that they “have already had an earful”.
And threats to withdraw services usually result in blame attaching to those going on strike, not the employer (however badly the employer behaves).
Further, as examples of uncompensated medical negligence get publicity people might look back to this campaign. These things have a habit of behaving like a pendulum.
Sure, there are problems with medical negligence and funding for Medicare and public hospitals. But doctors should not assume that their high standing (so emphasised by Abbott) is inevitably indefinite. It can be eroded by the bad publicity that comes from exaggeration, petulance and exposure of poor practice.
Overall, doctors in Australia do a pretty good job in a pretty good health system, but they are not perfect — just human with all of the foibles of humans in other occupations.
The next Gallup poll on the professions should be interesting. It is usually done when the politicians are on summers hols.