Martin Van Der Weyden: The first principle of medicine

“FIRST do no harm” poignantly captures the raison d’être of our medical boards: to protect the public from the aberrant practices of the medical profession, due to a doctor’s professional or personal shortcomings.

Not so long ago, medical boards in each Australian State and Territory ensured that our citizens receive the highest possible standard of medical care through the fair and effective administration of relevant medical Acts.

The weighty power of medical boards resided in their capacity to deny or revoke registration critical to any doctor to enable him or her to practise medicine.

A committee of medical, legal and community representatives usually determined this process.

It is also important to note that their deliberations and appeals were made public. And many times, these proceedings were fraught, exploring the essential pathos of human frailty and fragility.

This is no more evident than in a recent judgment of the Supreme Court of South Australia in Taylor v The Medical Board of South Australia.

It concerned an appeal of the decision by the Medical Board of SA to not register a newly qualified doctor.

She had endured multiple attempts at suicide and self-harm, which had been attributed to an affective bipolar disorder, later relabelled as a borderline personality disorder.

Irrespective of the psychiatric diagnosis, this malady manifested itself in more than 30 attempts at suicide reaching back to her secondary school days.

Sadly and paradoxically, these days were also noteworthy for academic excellence and scholarship.

During her 6 years at medical school, the appellant presented to emergency services across the metropolitan area many times due to attempted suicide, mostly through drug overdose.

These episodes continued during internship at a major teaching hospital.

The report of the appeal proceedings is replete with legal manoeuvres, legal language and the opinions of leading psychiatrists.

But to an outside observer, such a process is problematic, driven and ultimately determined by an uneasy tension between facts and opinions.

Above all, as the players search for some grasp of truth, the process itself seemed to be insensitive, utterly oblivious to its human impact.

At the end of these deliberations, the presiding judge exhaustively outlined his black-and-white arguments and proceeded to dismiss the appeal.

And what do I make of all this?

Despite the recent moves by our medical schools to implement “fitness to practice” policies, the execution of these policies is a human process, subject to all the vagaries of human behaviour and inevitably the heat of an adversarial legal system.

But I also believe that the judgment, which underpins the judge’s reasons and details the background, should become part of the curriculum of our medical schools.

It reinforces two essential facts.

First, that students and doctors are but mere mortals; and second, that their shortcomings should not endanger medicine’s first principle:

“Primum non nocere”.

Dr Martin B Van Der Weyden is the Editor of the Medical Journal of Australia.

Posted 29 November 2010