“THE science of medicine alone [among the professions] is kept so carefully concealed from the world, and the art must necessarily be practiced in so private a manner, as renders it difficult for the public to form a just estimate of a physician’s knowledge from the success of his practice”, Scottish physician John Gregory wrote towards the end of the 18th century.
“Accordingly, in no other profession is the reward of merit so uncertain”, he continued in Lectures on the duties and qualifications of a physician.
The confidentiality of the doctor-patient encounter has been a cornerstone of medical ethics since the days of Hippocrates, and here’s hoping it remains so in the face of widespread erosion of traditional ideas about privacy.
Patients must be able to trust their doctor if they are to reveal the personal information that could be key to successful treatment.
But what happens when a doctor can’t trust the patient?
The paragons of ethical journalism at A Current Affair recently sent one of their producers under cover to five medical practices so they could secretly film doctors who were allegedly handing out medical certificates without good reason.
“They’re the doctors who are happy to make every weekend a long one”, the program trumpeted next to a banner reading “DOCTOR’S CERTIFICATE SCANDAL”, with the word “scandal” in red letters in case you’d missed the point.
This tawdry exercise became the subject of a two-part Media Watch investigation and some of the doctors who had been secretly filmed outed themselves to complain about selective editing of the surreptitious footage.
With good reason, it would appear.
ACA has since released a longer version of two of the filmed consultations, accompanied by a whole lot of justification of the program’s actions.
Based on what has been released, I’d say the doctors involved were treated shamefully.
There are issues here around deception and filming without consent, but even more troubling to me is the misleading way the footage was used.
A few flippant remarks by the doctors were highlighted, but their attempts to question the supposed patient about his “tiredness and lethargy” and discussion of potential approaches to dealing with stress were pretty much edited out.
Viewers were left with the quite unwarranted impression that these doctors thought the issuing of medical certificates was nothing more than a big joke. And the doctors, of course, didn’t have the option of releasing their own footage to cast a different light on the encounters, leaving them vulnerable to misrepresentation and loss of reputation (although the program attempted to conceal the doctors’ identities, at least one said he had been recognised by patients).
The “reward of merit” may be uncertain when doctors are required to keep consultations private, as Gregory wrote, but that doesn’t mean the profession is protected from this kind of public shaming.
The fact that medical consultations take place behind closed doors exposes both parties to potential risks.
Patients can be deeply vulnerable when faced with a doctor who behaves unethically, but they do at least have access to formal mechanisms of redress.
It’s not always clear what avenues might be available to doctors when the boot is on the other foot.
Potential damage to reputation as seen in the ACA case is one issue, but the private nature of consultations can also raise questions of physical safety.
The MJA reported recently that almost 55% of female GPs responding to a survey had experienced sexual harassment by a patient.
The late Dr Raymond Seidler experienced more challenging encounters than most over his decades practising in Sydney’s Kings Cross. He told me once about the strategies he had come up with for averting potentially violent situations, particularly with drug-seeking patients. He would sometimes conduct a consultation on the street to avoid being alone in a confined space with a patient he thought could become threatening.
An extreme example, perhaps, but it’s worth considering how we can best preserve that vital one-on-one encounter between doctor and patient while also protecting all involved from harm.
Jane McCredie is a Sydney-based science and medicine writer.