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The Daily Rhino
Tuesday, May 13, 2008

They hate you
Originally published in Medical Student Newspaper.

BECOMING a doctor isn’t what it used to be. Communication skills, ethics, breaking bad news and familiarising oneself with the Job Centre would be foreign to medical graduands of the past.

Doctors have rapidly changed in their training and their demographic. Yet some things remain constant. We still have one aim - to cure the patient. And our roles as hospital leaders family doctors continue unchanged. Well…not so.

Within the health profession we are constantly under threat from government interference, nurses encroaching on our duties and hospital managers breathing down our necks. At work, we are no longer masters of our realm, but commodities.

So surely we can rely on a cheer that has buoyed generations of doctors, the love and respect of our thankful patients. Sorry, wrong again.

I am not referring to irate patients at the GP’s surgery nor pushy mums in A&E, but the particular section of the public that calls themselves the media.

You are, almost certainly, an avid reader of
Medical Student Newspaper (right?!) So you might well believe that all newspapers regard doctors with the same awe and overt love that we do. But, do you know, you’d be wrong?

The simple fact is that the media hates you.

Make little mistake about this, for if you have not yet noticed it then bear it in mind as you survey the national headlines for the next few weeks. Soon enough you will see that doctors are viewed as over-privileged, over-paid, greedy, incompetent simpletons who sap money from the public sector.

Five years ago an article in the BMJ, which surveyed a small group of junior doctors, found that new medical school graduates were increasingly disillusioned by media attitudes to doctors, and ‘doctor-bashing’ became a familiar term.

The phenomenon has snow-balled. The phrase ‘doctor-bashing’ was coined some twenty years ago but the seeds were planted far earlier than that. The American writer Ambrose Bierce quipped at the turn of the twentieth century, “
Physician, n. One upon whom we set our hopes when ill and our dogs when well.”

It is clear which particular breed of doctor has the roughest time at the hands of the journalist, the general practitioner.

Venerable, cardigan-wearing, bespectacled family doctor with a pot of lollipops. Dangerous, selfish, lazy fatcat. The criticisms range from mischievous generalisation based on a bad experience, to mean insults and fallacies.

Britain appears to suffer this peculiar ailment most grievously. In the US, where admittedly the whole health service is markedly different to ours, success is admired and applauded. If a doctor earns well, there is no assumption he or she has done it at the expense of patients.

Whereas here, doctors are thought to uniformly earn stellar salaries which should mean they are public servants with a job description the patients are free to adjust.

Why has the media decided to demonise the medical profession? The negative portrayal of doctors is now cited as one of the more demoralising aspects of working in medicine in the UK.

Papers and television news love a scandal. Sensational stories about dodgy doctors are understandably popular in the press. However the rest of us soon become tarred with the same brush as Harold Shipman.

Key accelerants to the growing hatred of medics were the recent consultant and GP pay deals, offered by the Department of Health. The pay rises afforded to the average NHS consultant and the average NHS GP were indeed generous and whether they were deserved is, in fact, entirely immaterial. The fact is that doctors have born the brunt of media fury at the deals. Somehow we are to blame for a deal the government put forward; we are the bad guys for negotiating a good deal.

In a nutshell, GPs agreed a few years ago to take a small pay cut in exchange for avoiding out-of-hours work. Seeing as it has been established that doctors are lazy, columnists are keen to point out that they cannot get an appointment when they want. This means after they have gone to work, picked the kids up, walked the dog and gone to pilates. So somehow, their life and their commitments outweigh those of the GP, who should make the time.

Much as it warms my cockles, even a retrograde cynic like me will acknowledge the move away from the paternalistic ‘doctor-knows-best’ attitude was healthy. And it would be churlish to suggest that doctors don’t make mistakes. We should be open in our admission of mistakes, but increasing litigation makes this difficult.

I am particularly conscious of the public’s attitude towards doctors this month, as I was asked to be a guest on the PM Programme, on BBC Radio 4.

The PM research team had been reading an old issue of
Medical Student Newspaper and came across the first piece I wrote as a doctor, which concerned ash cash, the fee paid on completion of a cremation form.

It is a very interesting topic and I wish debate ensuing the programme had been as stimulating. However it proved to be a very depressing experience. With some subtle editing I had been made to sound a little crass (mentioning ash cash is used on every day items such as food, rent and alcohol after a grieving daughter expressed her sadness at paying the fee when her mum died), but overall the experience was not too harrowing.

The BBC website and NHS Blog Doc (legendary blogger and former
Medical Student Newspaper writer) picked up the story and became hotbeds for debate. The deeper concepts of coping with death as a house officer, the unpleasantness of funerals and the legal implications of what the cremation form means were not examined. Instead the comments from members of the public morphed into one hundred and eighty two savage assaults on doctors’ salaries (I made the mistake of referring to an F1’s pay as ‘meagre’), our arrogance, our insensitivity and even allegations of gross misconduct.

When commenters expressed outrage that they should pay for a funeral, I suggested they should also be annoyed at the undertaker, who charges far more than a doctor. No. Let one thing be clear - the anger was squarely aimed at the doctor, no one else.

Some alarming misconceptions came to light (that we demand the fee from relatives, that we’re paid overtime, that cremation forms are private work done on NHS time), but if I tried to point them out I was ignored or shouted down. A few valiant doctors also attempted to calm the furore but to little avail.

The more sinister reasoning behind the increased dislike of doctors is that, coupled with MMC, there is a concerted effort to undermine and break up doctors in the UK, so that as we are replaced by nurse practitioners, we have no unified voice or public support to support us.

Like that fat kid in school, now no one likes you.

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