Tim Senior is a GP at Tharawal Aboriginal Corporation, Airds, Australia.
The thing about being swept along by cultural currents is that you don’t notice until they start to change direction. Those currents are just the way things are. As GPs we go about our daily work noticing the diagnostic challenges, the prescribing decisions, and the reassuring explanations. We rarely think about our societal role. At the times we formally perform this role, we may primarily notice because of the associated paperwork and frustrations. This is the role that allows us to write prescriptions at all, or to certify death, or to say that someone is too sick for work or jury service. While we often feel powerless and overwhelmed as individuals, as a profession we are licensed (literally) to perform functions that no other professions can.
Generally, these roles come from the powers and privileges that healers have held in all societies, but specifically, in Western societies it comes from the fact that doctors and lawmakers were drawn from the same upper-class group of men. Over time, we’ve grown to understand the harms that this power can yield, largely as a result of persuasive work from groups of our patients.
“… it’s impossible to ignore the cultural shifts away from ‘university-educated elites’, and the disparagement of expertise and knowledge.”
Why am I thinking about this? Well, moves to expand traditional social powers of doctors to other professions can be seen in this light. Interestingly, very few policymakers or doctor advocates express the argument in these terms, or seem to be even aware of it, but I think policy changes are caught up in broader cultural changes here.
On the surface it’s about breaking down access barriers to care and making getting a prescription easier — the health system based on convenience rather than quality or safety. But it’s impossible to ignore the cultural shifts away from ‘university-educated elites’, and the disparagement of expertise and knowledge.
Doctors as a profession (though often not individual doctors known by individual patients) fit right into these groups. The move towards traditional roles being taken by other health professions is a parallel to moves away from perceived ‘elites’, tertiary education, and specialised in-depth knowledge. We see it formally in models of care that move towards implementation of a linear algorithm — managing a condition looks so simple, why would we need doctors for that? We see it informally in the way patients are influenced in medication choices by the latest TikTok videos, and bypassing medical professionals entirely to access the latest talked-about peptide.
“In talking about journal articles and nuance and communication we sound like elites, and seem more distant from the patients we are serving …”
In talking about journal articles and nuance and communication we sound like elites, and seem more distant from the patients we are serving, who know they just need a convenient health professional to supply a medication, few questions asked. It’s true, health professionals should be more representative of the patients we see, but not, it seems, by doing the work to expand admission to medical school to those traditionally excluded.
In short, doctors — as a profession, not individuals — are being challenged in our social roles partly because we — as a profession, not individuals — have high status. Curiously, the functions others want to take are the barriers to practice, prescribing rights, and access to funding. I don’t often see other professions clamouring to complete long paper forms for access to social welfare or housing.
Is there any point to knowing this? Policy advocates aren’t saying this out loud, and may not even be aware of it. However, I think it’s worth understanding, because it goes some way to explaining why arguments about relative lengths of training, or cost to the health system instead of just talking about salaries, don’t get much traction. There’s something more fundamental in the culture sweeping along these changes. I’m not arguing for a maintenance of status, but it is important that we maintain an attachment to a deep understanding of the disciplines that inform our practice, and keep our patients healthy and safe, even if it’s becoming unpopular and countercultural.
Featured photo by Etactics Inc on Unsplash.
