Great Expectations

I’ve been thinking about the rigorous demands society places on the medical profession, the demands doctors place on themselves, and the resulting fall-out.

A recent article in Good Practice discussed the Good Samaritan laws and the now well-known case of the radiologist who ‘failed’ to stop and render assistance by the roadside (at night on a lonely road, with no torch, no phone and no equipment, in a state of shock). She was found guilty of ‘unprofessional conduct’ though later this judgement was, thankfully, overturned. I say thankfully, as otherwise we’d have to change the meaning of ‘D’ in DRABC.

The Good Samaritan laws are not just there to protect doctors. In some states, the law mandates our response in emergencies. Common law apparently obliges no one to rescue another person who is not known to them- unless you are a doctor. In NSW, for example, a doctor may be guilty of unsatisfactory professional conduct if he or she ‘fails to attend’, in an emergency, or to make provision for another doctor to attend in their stead. To me, this amounts to all doctors always being on call, which is hardly fair. Can’t we at least make a roster?!

Does this mean a doctor should never sleep with earplugs, should never get drunk, should never retire, in case it affects our ability to respond effectively to a medical emergency?

Many would argue that this is the price you pay for becoming a doctor, that with the privileges of the profession come responsibilities. To an extent, I agree. However, shouldn’t individual autonomy and humanity come first? And are the privileges really so great?

I certainly agree that we should assist where we can. Where we can! Most doctors have a strong sense of duty without legal dictation, myself among them. Should our actions be a legal requirement, though? We should have the choice, even if the ‘right’ choice is to assist.

I’m still mulling it over and would welcome your input. There has been interesting debate about the case on the Australian Doctor and Medical Observer websites.

I have been guilty myself of expecting too much of doctors. Growing up in a medical family that regarded the rest of the town practice as extended family, GPs seemed to me like demigods, all powerful, unflappable, a noble breed. Is it any wonder I chose GP training in the end, with this upbringing? And is it any wonder that I found myself lacking when compared with this youthful ideal?

I remember, prior to medical school, expressing disappointment with someone’s actions to a friend, saying ‘I mean, she’s a doctor!’ My wise friend replied ‘I don’t like it when people assume doctors aren’t human. They are, with normal human faults,’ or words to that effect.

When I have accidentally let slip to my patients that I am a real human and not some robot automaton, the reactions have varied. To sum it up in the words of a pre-teen, when I mentioned that I see the same physio as her: ‘um, that’s weird.’

I took the hint and try to keep myself, the person, out of consults. However I do sometimes resent this. It is a bit artificial to give nothing of your personal perspective when you are seeing people for people-problems. I know we are professionals and that part of what we offer is impartiality, but there is a limit. Do our patients really want robots?

Sometimes it is a relief for me to have a patient who is also a doctor. I feel they know how much they can expect of me, understand what I cannot provide and that they come with the knowledge that I am a fellow person. Many doctors actually make fantastic patients, in part for this reason.

So, do the ‘privileges’ of our profession really make up for all the demands? With falling rebates, high patient expectations, pressure from the bureaucrats, and harsh judgements like the initial ruling on the WA radiologist, we all may wonder.

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One comment

  1. I share your sentiment Dr D. When I read that article in Good Practice my immediate thought was that this law has turned my good will into resentment. As you say, most doctors by nature would of course stop to help out unless there was a reason not to. By making this a legal requirement, its just another thing over our heads. Why does the government/legal system insist on trying to fix problems that don’t exist, only to create new ramifications that they’ll never comprehend?

    And as far as being “people” with our patients – I think its an essential art. Essential because most of our patients, as we get to know them, will demand it in their own ways; but more importantly, I believe that if we suppress our selves throughout our consultations, that’s one thing that will rapidly lead to burnout. We must be professional, impartial, and patient-focussed at the same time – we aren’t down at the bar having a drink with our patients (hopefully); but part of being a good GP is discovering how best to meet your patients needs while making your practice sustainable, and finding the right amount of You to bring to your consultations is a big part of that. Juicy topic….this should be explored in more detail…:-)

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