Peter Arnold: Avoid the foolish physician

THE doctor who treats himself has a fool for a physician.

Enter that phrase into Google and you’ll get about 147 000 hits.

There are variations, such as “A physician who treats himself has a fool for a patient” attributed to Sir William Osler.

Why, then, should a group of NSW doctors who are retired or nearing retirement want to write prescriptions and referral letters for themselves and their families?

For decades, responsible medical organisations have been urging doctors to have their own GP — and not to treat themselves or their families.

Doctors’ fallacious reasons for not having a GP are legion, including “Taking a health problem to another doctor lays me open to professional ridicule for not recognising, myself, that the problem is a) trivial or b) serious.”

Other reasons given can be found on various websites, including that of the Australian and New Zealand College of Anaesthetists.

But the problem now has the potential to get worse as the number of retired doctors expands exponentially with the baby boomer generation reaching retirement age.

Some doctors retire to enter other fields; others because of illness, infirmity, old age or burn-out.

Some were in clinical medicine, others were non-clinical or in administration.

Some doctors have been out of practice for two or more decades.

All were “registered to practise medicine”.

Whether clinicians, or in laboratories, or in administration, we all had the same registration privileges.

NSW instituted “non-practising registration” a few years ago for those who had retired and who charged no fees for services rendered to their families.

This curious form of registration has been deemed inappropriate by the new Medical Board of Australia:

For the purposes of this registration standard, practice is not restricted to the provision of direct clinical care. It also includes using professional knowledge in a direct non-clinical relationship with clients, working in management, administration, education, research, advisory, regulatory or policy development roles, and any other roles that impact on safe, effective delivery of services in the profession.

Medical practitioners with non-practising registration cannot undertake any practice as defined above. They are not permitted to prescribe or refer, regardless of whether they are being remunerated.

This would accord with the dictum “The doctor who treats himself has a fool for a physician”.

Doctors who wish to treat themselves or their family must now have full registration, indemnity insurance and continuing education  — as well as a higher registration fee.

Surely this approach is sensible and logical.

Alas, many do not see it like this.

Led by some current and former leaders of the AMA, NSW is opposing this commonsense approach.

They maintain that an annual 2-day seminar is sufficient for retired doctors — some of whom have never practised clinical medicine requiring prescribing and referral to specialists — to keep abreast of current practice.

Some have expressed “outrage” that doctors could go from “valued competent professionals” to “nothing but retirees”.

Some wish to maintain the “dignity [sic] of writing the occasional script or referral”.

Is this a logical, rational approach?

Or is it inflated professional pride, seeking to preserve status when, in truth, claims to that status have expired?

Can’t we be like ordinary people who, when they retire from their jobs or professions, do just that?

They retire to pursue other interests and don’t hold out to be still competent in their erstwhile field of practical expertise.

To treat oneself and one’s family when in clinical practice is foolish — to do so when no longer in clinical practice is not only foolish, but foolhardy.

Let’s hope that the Medical Board of Australia does not give in to this irrational attack from NSW.

Dr Peter Arnold is a former Deputy President of the NSW Medical Board, former chairman of the Board’s Professional Standards Committee and a former member of the Medical Tribunal of NSW.

Dr Arnold has submitted this article on the condition that anonymous comments in response are not accepted. MJA InSight has agreed to this condition.

Posted 7 February 2011