Graham Row: Ex-doctor underclass

A DOCTOR’S decision to retire from practice once simply meant a process of winding down.

Doctors in the latter stages of their careers could elect not to take on new patients and reduce their hours of consulting. They would limit their scope of practice to patients and problems appropriate to their diminishing energy and skills.

The retiring doctor was generally supported by a network of colleagues who were ready and willing to take on challenging patients, guaranteeing that this winding down process proceeded safely and humanely.

Doctors develop strong and mutually supportive relationships with patients, and are a trusted and reliable source of good advice — people you could trust absolutely with the custody of embarrassing secrets.

The retiring doctor could take time to gently disengage from these relationships, to introduce a successor and facilitate trust in the new doctor. This might take many months.

Doctors in full retirement were able to maintain registration. They were still “doctors”. They thought and acted as doctors with boundaries of practice and prescribing determined by self-awareness and ethical obligations. They had the leisure time to read journals and keep up to date and share the condensed information with busy colleagues.

They were respected elders of the tribe, a trustworthy source of advice based on a life of experience. This advice and support was given and received freely between colleagues. It was also available to previous patients — “Doc, my doctor has diagnosed this thing and recommended this specialist or treatment. We go back a long way and I trust you. What do you think?”

We are now in an era of “high quality” medicine mandated and monitored by politicians. The new Medical Board of Australia is subservient to the Australian Health Practitioner Regulation Agency (AHPRA) and takes refuge behind a palisade of rigid and unwavering definitions, prescriptions, guidelines and “the national law”.

Long established ethical principles governing much of medicine have been replaced by these bodies. To be an acceptably competent practitioner now requires large sums of money and the ticking of lots of boxes. There is an unhealthy obsession with credentials while experience is devalued.

The doctor contemplating retirement has stark choices — either commit fully to the onerous and very costly treadmill of box ticking or surrender registration completely.

The law regards any offender failing to meet its requirements a risk to public safety and unworthy of registration. At the stroke of midnight on the appointed day all professional activity is disallowed on pain of a very large fine.

Why the need for these laws? There must have been the most terrible damage wrought by incompetent retired doctors continuing to practise and prescribe. Obviously, to preserve confidence in the health industry in Australia this evidence has been suppressed by our political guardians and remains a dark and closely guarded secret.

The hairy-chested politicians have thus created a new underclass of “ex-doctor”. I and my ex-patients have been among the first to experience “retirement” in this brave new world. The experience, for all parties has, at times, been distressing, frustrating and expensive, or on occasion, potentially dangerous.

There is a conflict between black letter law and ethical and humanitarian obligations. Advice on managing this conflict sought from the Medical Board, AHPRA and my medical indemnity organisation has been rigidly bureaucratic, irrelevant and mostly worse than useless.

I am unable to access online content of some medical publications reserved for registered practitioners as I may not view advertisements for Schedule 4 drugs. I am still a member of the AMA and can view such advertisements in the print version of the MJA and contribute to MJA InSight, and I have been made an emeritus member of my US-based specialist association.

But the teaching hospital where I worked for more than 30 years has severed all contact, presumably as I no longer meet their accreditation standards.

To those doctors on the verge of retirement, who will join the ranks of ex-doctors, my message is “come on in, the water’s freezing”.

The pain of suddenly becoming an ex-doctor of course diminishes with time. And hardly a day goes by that I am not reminded by something in the media, of how glad I am to be out of the political dog’s breakfast that medicine has become.

Dr Graham Row practised as a nephrologist in Brisbane before he retired on 30 June 2011.

Posted 8 April 2013