Andrew Singer: Open engagement

ONE of the challenges for my specialty of emergency medicine, and for medical specialties generally, is how to avoid being too insular.

It’s a topic I raised late last year in a speech to a meeting of the Australasian College for Emergency Medicine (ACEM).

An organisation set up by and for Fellows with responsibility to maintain specialty standards and the training and assessment of future Fellows appropriately has a focus on its own Fellows, but it is also important to remember the role we play in the community at large.

In providing a service to the community, we need to understand what the community needs. In the past, deciding on these needs tended to be based on Fellows or members bringing their own understanding and experience to inform how the organisation responded.

Increasingly, though, this is seen as inadequate and even wrong. In particular, there is the risk of trying to align the organisation’s interpretation of what the community needs with the organisation’s (or particularly its members’) goals.

I would argue that it needs to be the other way around, whereby the organisation bases its goals on what the community needs. This requires medical organisations to be more outward-looking. One way to do that is to engage the community at large in the organisation’s decision-making processes.

All colleges now have some form of formal engagement with their trainees, and in many cases have trainees represented on almost all their committees. My challenge to ACEM, and to all specialist colleges and other medical organisations, is to have a similar level of engagement with health consumers, and the community in general.

Some organisations already do this well. I have been particularly impressed with the way the Australian Medical Council has done this for a number of years, with health consumer members on many of its committees, and even on accreditation teams for specialist colleges and medical schools.

In my experience input from consumer members is both invaluable and often a useful counter to the insularity often observed in medical organisations.  For example, we often concentrate on the technical aspects of how a skill is obtained, whereas the community’s concern is rather that the skill is available and is used appropriately.

However, there are concerns and difficulties expressed about how to make this work.

One concern regularly raised is that health consumers don’t have the expertise to understand the technical aspects of a medical specialty or the training of specialists. Yet the point is that they are being included precisely because they are not medical experts. Their role is to bring their own understanding of the community’s health needs and experience, something that we as doctors have a tendency to exaggerate based on our own expertise

Sometimes there is uncertainty as to where to find a suitable and relevant group of health consumers to engage with. This is particularly the case for specialties such as critical care which, by their nature, do not form long-term relationships patients. Nonetheless, it is worth seeking out organisations and individuals who are willing to engage.

Another concern is that the engagement will be dominated by a person’s personal experience or biases. This is a risk for health consumers and doctors alike. It can be an opportunity to resolve an issue or to bring a shared understanding on both sides, and should not be an excuse to not engage.

I hope specialist colleges and all medical organisations will make community engagement a priority, as I can only see benefits both to the organisation and the community in general.

Associate Professor Andrew Singer is the principal medical adviser to Acute Care and Health Workforce Divisions, Department of Health, Australian Government, an adjunct associate professor at the Australian National University Medical School, and a senior specialist in emergency and retrieval medicine at Canberra Hospital and Health Services.