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ON graduation, young doctors are justly proud to join a profession whose ideals and central mission are encapsulated in the fabled Hippocratic Oath:
for the good of the patient … never do harm to anyone … to please no one prescribe a deadly drug … preserve the purity of my life and my art … keep myself far from all intentional ill-doing and seduction … All that may come to my knowledge … I will keep secret and never reveal …
Nothing but sublime idealism — an idealism that has long guided the patient–doctor relationship. In short, graduates join a profession in which the abiding principle is essentially one of service.
But somewhere along our professional journey, this inner idealism is subject to numerous external stressors that move us from being doctors with patients to providers with customers.
Medicine has become the playing field of politicians, bureaucrats and myriad associations representing doctors, nurses, scientists and other health professionals. All these bodies are actively involved in competition, driven by a different philosophy, which focuses on remuneration, work conditions and power.
The latest industrial action by nurses in Victoria in their ongoing pay dispute is a good example. It seems that withdrawing or threatening withdrawal of labour in health care, irrespective of the potential human consequences, has become accepted in the health industry.
This has to be expected, given the fragmentation of medicine into associations specifically representing doctors, nurses and health scientists — all seeking their place in the sun in pursuit of a common goal: a fair day’s pay for a fair day’s work in autonomous practice.
Indeed, we may be witnessing the industrialisation of medicine, where professional bodies are frequently pitted against each other in their struggle for supremacy and autonomy.
Ironically, unity does occasionally surface when forces are joined against a common bureaucratic enemy, such as when speculation was rife about withdrawal of medical research funding in this year’s federal Budget.
Sadly, what we generally witness is the loss of all that youthful idealism as it morphs into the worldly cynicism of the older medical professional and their professional bodies. When the welfare of the patient loses its centrality, the ideal of service has been corrupted irrevocably.
Some observers have even gone so far as to suggest that the culprit in this corrosive process ultimately rests with the movement to place the control of medicine in the hands of the state.
Such sentiments were expressed by the surgeon in the novel Atlas shrugged by Any Rand: “I quit when medicine was placed under State control … Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes … I would not let them dictate the purpose of which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward .”
It is ineffably sad to witness the corrosion of all that youthful idealism.
Dr Martin Van Der Weyden is emeritus editor of the MJA.
Posted 28 November 2011
The overall cost of healthcare has grown from 5.2% of GDP in 1970 to 9.1% in 2007/08. Based on the 2010 GDP of $1.236 trillion that percentage difference equates to a difference of ~$45.9 billion in annual health care costs in Australia. Also, back in the 70s much of the cost was borne by the consumer whereas these days the Government pays for most of it. So you can hardly be surprised that politicians have become increasingly interested. People want good health care but they also want good roads, police, schools etc and they want to pay less tax. The numbers don’t work. It is important that Doctors become engaged in a positive sense in these issues rather than bemoaning the loss of innocence. We are still very lucky to be paid much more than most people and to have a much more interesting job as well so the least we can do is take a positive approach.
Young doctors emerge from their medical schools wearing rose-coloured glasses but eventually descend to wearing Mardi Gras masks.
Indeed “Health Care” has degenerated into an industrialised and bureaucratised game played with deadly competitiveness by the stock-holders of the self-interested.
However, I would also allot the “patients” considerable responsibility for driving this move to industrialisation. To wit, the modern patient is not often a person in need of the attention of a medical professional, rather he is a consumer,who demands cheap health care services on tap(whether they really need it or not). The over-use and abuse of medical services by the modern consumer provokes the profession and promotes the emergence of the industrialists.
Dr Van Der Weyden’s usual brilliant writing. (But Any Rand must be a new South African Gold Standard.)
Why doesn’t this specific realisation (and others like Rachel Naomi Remen’s “Recapturing the soul of medicine”) shock us to our core. Have we just become day to day automatons? Maybe contrary to Dr Van Der Weyden the medical profession should “go on strike” to shock the bureaucrats and the public as to what has happened to our profession. But the media and the politicians would just recast that as self interest. With apologies to Xavier Herbert:- Poor fellow, my profession!
It’s not only the medicos:
“The bourgeoisie has stripped of its halo every occupation hitherto honored and looked up to with reverent awe. It has converted the physician, the lawyer, the poet, the man of science into its paid wage laborers” (The Communist Manifesto)
Worth a read (or re-read)!