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It isn’t easy being good

The Good Doctor: What patients want. By Dr Ron Paterson. Auckland University Press, 208 pages, $31.00. ISBN 978-1-86940-592-2 By Dr Peter Thomas It has never been easier to become, or remain a good doctor in Australasia than at this time.

16 Sep 2012

The Good Doctor: What patients want. By Dr Ron Paterson. Auckland University Press, 208 pages, $31.00.

ISBN 978-1-86940-592-2

By Dr Peter Thomas

It has never been easier to become, or remain a good doctor in Australasia than at this time.

Rigorous selection into medical school, demanding examinations, searching registration requirements, post-graduate CME and CPD commitments, and learned College oversight are part of a larger list designed to ensure the best people end up practising medicine. It has been (more or less) ever thus.

Conversely, it has never been harder to remain a good doctor. The source of this paradox lies in the broad definition of “good” but more importantly, who applies it. “Good” is a nebulous word, (like “nice”), with The Shorter Oxford English Dictionary devoting one full A4-sized page to its many definitions.

Modern medicine is populated by a diverse group of “stakeholders” with each applying its own standards, rules, regulations, codes of conduct and legal framework. The penalties can be severe if the doctor breaches any of them. And here lies the heart of the paradox. How can one serve so many, to the full satisfaction of all? It is not easy to remain good.

Ron Paterson, a former Commissioner for Health and Disability in New Zealand, refers to this wider medical environment to help make his points, but sensibly focuses on the relationship that from time immemorial has defined medicine; the doctor-patient relationship. Appropriately, the subtitle of the book is “What Patients Want”. 

He brings a lawyer’s perspective to the problem and, not unexpectedly, finds that medical self-regulation, a freedom long embraced by the profession, has been largely unsuccessful. He argues that professionalism - itself a concept under challenge - and self-regulation must be balanced with external oversight, and that the balance has not yet been met. At the moment, there is too much reliance on medical trust without verification, when accountability should be emphasised.

The book is divided into four parts; the first explores the ideal good doctor.

The author acknowledges the difficulty, if not impossibility, of achieving and maintaining this lofty state, as the bar is high. He notes practitioners occupy the bell shape curve for competence and, consequently, there will be outliers. The gifted are at one end and the problem doctors the other. He calls the vast majority within the curve the “good-enough doctor”, one who can satisfy an assessment against standards of good medical practice. The name might be considered pejorative, but his reasoning is sound even if the terminology sounds offensive at first reading. 

The second part of the book develops the theme that problem doctors are real. A sobering case study begins the chapter, before the author leads into detailed discussion of certain medical scandals in a number of countries, and some well-known cases of medical criminality. These all resulted in inquiries that led to major reforms. Despite these, and initiatives such as informed consent and the newer capacity for patients to research medical practitioners on the internet, the author states there is still an “information abyss” for patients, particularly in the Antipodes.

Part three explores the barriers to change; why do the new systems and initiatives allow problem doctors to still exist? The final part tries to answer this with a series of practical and achievable suggestions to ensure “good doctors, safer patients”. Yet the author acknowledges change management is not easy and can be unexpectedly complicated and even painful.

This book is well researched, timely and thought provoking, written without recourse to lawyerly circumlocution. All doctors who care for their profession should read it.


Published: 16 Sep 2012