Dr Sue Ieraci: Public expectations of doctors need a reality check

WHAT does the world expect from doctors? Are the expectations of others the same expectations we have of ourselves? Has our training and experience so far equipped us for the world in which we now practice?

These issues cause tension for many of us. We live and practice in a risk-averse and failure-intolerant society – not just in medicine, but generally, and this leads to many paradoxes.

Although the life expectancy and health status of the population are better than ever before, our community seems more scared and dissatisfied with health care than ever.

Deaths from infectious diseases in childhood are now rare – and yet we are more scared of missing a diagnosis of meningitis than ever before. And when a bad outcome does happen, the community rushes to blame, and insists on yet more tests and more processes in a desperate bid to prevent a recurrence.

Part of the problem involves the media. They show the community two extremes – medical miracles and bitter complaints. We are driven to do more, provide more, check more – and then criticised for delivering increasingly expensive health care.

What is even more frustrating is the loss of community trust in our professionalism. Despite decades of working on our communication skills, reducing paternalism and increasing feminisation of the workforce, being a doctor is just not PC.

Ironically, the unquestioning acceptance and respect previously held for doctors has now been transferred to alternative health care practitioners – many of whom provide unproven and expensive therapies to patients who suspend the disbelief they now apply to orthodox medicine.

And yet, it is doctors who are held ultimately responsible for overall health outcomes. We can’t make all the rules, but we are held responsible for their results. Doing your best doesn’t always cut it any more. Ultimately, we are blamed for not being perfect.

Society is pulling us in two different directions. On the one hand, our community wants holistic medicine, delivered with care and time, and with a focus on prevention, chronic care and general wellbeing. When acute symptoms arise, we are expected to swing into instantly accessible acute care, no holds barred and no expenses spared. Risk, people believe, should not just be managed – it should be eliminated.

So what are we to do? There are two areas where we can find our rewards. At the societal level, we can join the growing campaign to cut the complexity of health care – to return to the basic principles, deliver good outcomes with value for money and recognise that the end of life is inevitable.

At a personal level, we can deliver individual care, showing respect for our patients, and emphasising comfort and quality of life.

Posted: 5 July, 2010

Dr Sue Ieraci is a specialist Emergency Physician with 25 years experience in the public hospital system. Her particular interests include policy development and health system design, and she has held roles in medical regulation and management. In addition to her emergency department  work, Sue runs the health system consultancy SI-napse.