Issue 10 / 19 March 2012

AS MJA deputy editor, one of my duties was to attend the recent inaugural Dr Eric Dark Memorial Dinner and Doctors Writing/Righting the World Q&A Panel.

Despite a few qualms that this could turn into a talkfest about the unique and superior qualities of doctors, I came away from this wonderful event with renewed optimism about the potential for medical practitioners to have a real influence on health.

The night was part of a larger initiative, “Doctors Who …”, recently announced by the management of Varuna, the Writers’ House, in Katoomba, NSW. According to the Doctors Who … website, the organisation exists to nurture creativity, innovation, advocacy and collaboration among doctors, with a view to improving the health of the nation.

Quite an objective!

How can encouraging doctors to write stories, paint paintings, sing and dance and get involved in good causes improve the health of a nation?

Doctors Who … was established in memory of Dr Eric Dark, whose home, Varuna, was donated by his family to become a haven for emerging writers. Eric Dark was married to the celebrated Australian novelist Eleanor Dark and, besides being a GP, was a strong advocate for addressing the social determinants of health — mostly based on his observations of his own patients’ sufferings.

Writing in the MJA in 1937 (Medicine and the social order. Med J Aust 1937; April 3: 507-509), Dark said: “A man’s health demands that he have enough food, air, light, exercise, rest, useful work, hope for the future, something upon which he can expend all his energies to the full. He must have personal dignity, the assurance of a useful place in society, a feeling of economic security. He needs a congenial mate, and the knowledge that his children can enjoy freedom and safety. And, there must be joy.”

The keynote speaker at the Doctors Who … event was Dr Grant Blashki, also a GP and also working in public health — at the Nossal Institute for Global Health in Melbourne.

His talk started off rather depressingly with a description of a patient we have all seen — the antithesis of Dark’s prescription of health: a young man with a poor education, no job, a drug problem and a developing mental illness. With all the will in the world, this patient’s problems will not be solved in the consulting room.

Blashki explained that, although as doctors we know our patients’ context is vital, we are generally powerless to change it and end up doing the only thing we are trained to do — take a narrow clinical focus.

Using the analogy of the stethoscope, he contested that as doctors, we hone our skills to listen to and focus on individual disease states and often effectively “block out” the wider world of influence on our patients’ health.

Clearly, the stethoscope is more than an expensive set of earplugs! Turning the analogy around, it could be seen as a symbol of one of the core competencies of clinical medicine — giving full attention to, and seeking the very best for, the individual patient who has entrusted himself to our care.

But, throughout the evening, as a lively panel of six doctors took the floor to discuss their use of creativity, innovation, advocacy and collaboration in practice and beyond, I reflected on the danger of having the majority of our most knowledgeable and skilled health professionals absorbed in the minutiae of their own practice.

One of the panelists was Dr Arthur Chesterfield-Evans, whose many non-clinical hats have included that of anti-tobacco activist, state MP and president of the Doctors Reform Society. He was reminded of the tension between the stethoscope and the wider world when, on his return to hospital work as an administrator, he was told by a helpful colleague that he should try to narrow his view again in order to do his job.

While Chesterfield- Evans’ work defacing smoking advertising billboards with BUGA UP in the 1980s and ’90s has to be one of the more appealing forms of creative activism, he told the group that the next frontier was the battle against the corporate purveyors of obesity.

Others might name climate change, displaced people, food security, war or socioeconomic disparities. In the end, these, and many other forces that threaten health, are inextricably connected.

Initiatives like Doctors Who … remind us that, for our own, our patients’ and our world’s sake, we cannot afford to limit our perception of health to what we can hear through a stethoscope.

The best doctors are those who can listen closely to the intimate sounds of patient care while keeping one ear open to the world around them.

Dr Ruth Armstrong is deputy editor of the MJA and medical editor of MJA InSight.

Posted 19 March 2012

One thought on “Ruth Armstrong: The art of listening

  1. Gary says:

    Thank you for sharing the inaugural Dr Eric Dark Memorial Dinner with your readership Ruth. It is wonderful to hear the many discussion points about lost capacity for doctors to influence better health and well being in our community. There is potential for a stronger role for practitioners to translate the information they receive from their patients than is given, but it will mean a radical change for consideration doctors might offer. It will require greater and more seriousness consideration of issues affecting public health that are currently ignored.
    The complexity of issues that generate greater stress and fatigue in our community is a reason why they are often avoided by authorities. Simpler risks that have been in our face for a long time, smoking, picked up by Dr Arthur Chesterfield-Evans, underlines the very direct connection to economics as a significant part of reluctance in driving any change. It was a hard and long battle for Arthur and his colleagues to make a difference. Our community is indebted to them for sticking at it.
    I am a long time community campaigner for recognition of the stress and harm caused by unwanted noise, but have also been caught up with other environmental threats that people work and live with. Arthur has contributed assistance in this campaign. Access Economics published a report on the cost of hearing loss in 2006. About 37% identified as associated with noise. Including reference to health, it amounts to $23 billion annually. Still we struggle to get any willingness of any government to engage the community or health professionals on the matter. In recent times we have had planners introduce wind turbines to rural residential environments. A strong message relating the despair of associated low frequency noise has been set aside for the environmental benefits associated with renewable energy. A critical precautionary principle encouraged by UN representatives has not driven any priority research.
    Practitioner’s frustration at not seeing change to social and environmental risk factors is the same frustration for many in our community. There is just nowhere to go in our democratic society to bring review of imposing risk to public health. The potential of doctors getting closer to the philosophical, social and physical forms of risk to individuals well being is better than any public administrator or minister, but it is the latter that make the diverse decisions influencing community well being. One item on the community agenda is to have some reference to a doctor’s health evaluation cause mandatory investigation. By who is a troubling question.

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