A consultant doctor in a different speciality to mine came to see me as a patient in New Zealand’s public health system. She needed an operation, and wanted me, a specialist obstetrician and gynaecologist, to do the surgery for her. “After all, there’s got to be some benefit to working here,” she said. When I told her I wouldn’t be able to honour her request, she gave me her personal doctor blacklist. The doctors on it were the subjects of repeated whisperings about their practice. She did not want those doctors, or any of the registrars we supervised, anywhere near her.
This sort of medical privilege my patient wanted to cash in on is common. We call it “playing the doctor card.” Playing this card allows doctors to escape certain harms we routinely expose our patients to. Even in the public system we can hand pick our surgeons and avoid the ones who might not meet the current threshold for being struck off. We can feign surprise if they are eventually found out. Perhaps the degree of their offending does really shock us. Nonetheless, when we and our loved ones are sick, it is as if we fly in a parallel first class system that operates outside of our patients’ view.
We doctors often like to use the aviation industry to compare safety standards against. There is one big difference between their passengers and our patients. It partly explains why the aviation industry works more effectively to keep people safe and ours does not. If a pilot is incompetent, or, if they take off in a plane they know is unsafe, they will still be found to be at fault when the plane crashes. Crucially, they are also on board. The trouble with doctors is that we are not going down with the plane.
Medical rosters may be made with unsafe levels of staff and hours of work, healthcare systems may be so poorly designed to increase the likelihood of harm, and there are incompetent practitioners among us, but chances are that we doctors will not subject ourselves or our own loved ones to the risk. We use our insider knowledge to advantage. Our secret ability to avoid much iatrogenic harm might weaken the incentive to fix these issues.
Take the most recent evolving scandal in my field of obstetrics and gynaecology. It happened in Australia, but it could easily have happened anywhere. Questions are now being asked how Emil Shawky Gayed was allowed to practise for decades while leaving a trail of harmed women behind as he moved from place to place. Lawyer Gail Furness, who authored a report into his misconduct, said that after witnessing so many episodes of bad practice “staff had become desensitised to it”. But when you don’t have your own skin in the game you are not desensitised. You weren’t feeling it in the first place.
We need to do something about this problem because, as Guardian journalist Melissa Davey notes, Gayed’s disturbing level of misconduct is not the first such case of its kind. It is not even the first case of its kind in New South Wales. In 2008, the NSW government promised the public that lessons would be learned when it was discovered that gynaecologist Graeme Reeves abused patients over a period of more than 20 years. In response to that scandal, state lawmakers passed the Medical Practice Amendment Act, providing for mandatory reporting when doctors become concerned about a colleague’s misconduct. It is possible that healthcare professionals who knew about Gayed and failed in their statutory obligations could be charged under the Act. Perhaps then we might pay more attention to the pain of iatrogenic harm.
Our family owns an elderly cat, and we have a family rule that the first one who notices a pile of cat vomit has to clean up the mess. Unsurprisingly, cat vomit can go unnoticed in our household for a very long time. As in all unpleasant situations, as long as we can avoid stepping in it, we can look the other way and pretend it was an accident that could have befallen anyone. Doctors and nurses knew about Gayed. They know things about other people too.
• Alison Barrett is a member of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (Ranzcog). She lives in Hamilton, New Zealand
