Trust a casualty in television show stunt
When a young man professing to be tired and stressed walked into the consulting room of Dr David Chambers on 1 October and asked for a medical certificate, the Brisbane GP took his patient at his word and began trying to delve into reasons for his condition.
During the consultation, the man – who was accompanied by a woman – said he was fatigued and, according to Dr Chambers, looked anxious and avoided eye contact.
Little did Dr Chambers know that he was being secretly filmed as part of a set-up by the Channel Nine television show A Current Affair for a story intended to show the doctors readily issued medical certificates to patients who simply wanted a day off work. The patient was in fact a producer from the program, as was the woman who accompanied him.
When the story was broadcast the following night, the 16-and-a-half minute consultation – in which Dr Chambers made a thorough examination of his patient, took a full history, organised for blood tests to be taken if the professed fatigue persisted, and discussed mental health issues – was edited down to a brief grab intended to justify the story’s premise.
Dr Chambers was among five GPs caught up in the ACA sting, and although their faces were disguised in the story that went to air, he found that both colleagues and patients quickly recognised him.
Aside from the anger he feels about being “hugely misrepresented” by the program, Dr Chambers worries about the corrosive effect this and similar programs might have on the crucial doctor-patient relationship.
“Doctors are rightly held to high moral and ethical standards, treating patients with respect and trust, and protecting their privacy,” he said. “But it is also incumbent upon the patient to be truthful with the doctor.
“Most of what we do is based on good history taking, and we rely on patients being honest with us. We are not mind readers.
“If you don’t have that trust, then everything is lost.”
Dr Chambers said programs like the ACA segment had the potential to be “quite destructive, because that devalue that relationship”.
It is a concern shared by AMA Council of General Practice Chair Dr Brian Morton, who said that trust and honesty were paramount in the relationship between doctors and their patients.
“Our profession expects honesty from our patients. Communications between the patient and the doctor involve honesty from the patient and, reciprocally, from the doctor,” Dr Morton said. “We cannot mistrust what the patient is saying.”
The importance of this was underlined, he said, by the experience of a colleague who treated a patient complaining that they were hearing a cricket in their ear. Rather than dismiss the complaint as a case of tinnitus, the doctor made an examination and found that there actually was an insect inside the man’s ear.
Commenting on the premise of the ACA report, Dr Morton said medical certificates were legal documents, and doctors did not issue them lightly.
But equally, they were not simply for physical maladies, as the television show seemed to imply.
Dr Chapman said he had treated a number of young men with depression who had presented with symptoms similar to those described by the ACA producer, and was alert to the possibility his patient was suffering mental health problems.
Dr Morton said often doctors had to use judgement and care in what they wrote on medical certificates.
He said privacy considerations and stigma surrounding conditions such as mental illness or sexually transmitted infections meant it was not unreasonable for doctors to talk with their patients about what should be included when writing a certificate.
Dr Morton admitted that he did, on occasion, come under pressure from patients to issue a certificate, either claiming to be suffering a cold or even not providing any medical reason for their absence from work.
“In this situation, it behoves me to make a medical examination, take a history, and come to my own conclusion,” he said. “Doctors are expected to take a profession and legal view.”
The egregious shortcomings of the ACA report – which included file footage of Dr Morton without indicating to viewers that it was from an interview given more than two years ago – were highlighted by ABC’s Media Watch program on 14 and 21 October.
Dr Chambers provided an account of his experience to Media Watch, and has written a formal complaint to Channel Nine.