The Doctors' Strike and the Great Trust Deficit

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With its threat to carry forward the junior doctors’ strike indefinitely, the British Medical Association is in danger of scoring an own goal.

By pursuing ever more aggressive strike action, it may inadvertently add the medical establishment to a register it doesn’t want to join.

Since 2007, a growing number of Britain’s foundational institutions have joined something I like to call the Trust Deficit Register.

In the last few years, the public’s relationship with society’s foundational institutions has arguably taken a turn for the worse.

It began with attitudes toward the world of business – and particularly banking – at the outset of the near global recession. The political classes were soon similarly affected, in the wake of the MPs expenses scandal.

In both cases, levels of public anger grew substantially almost overnight. Bankers and MPs were perhaps never among the most trusted professional groups in the country, but quite suddenly they were being vilified to an unusual degree.

The trustworthiness of the police and the courts was also subject to question in the aftermath of the London riots of 2011. Universities lost a great deal of credibility as they introduced tuition fees – which now ensure that the average UK student graduates with a massive debt of £44,000.

The press – having made loud noises about keeping everyone else honest – then succumbed to public mistrust amidst widespread accusations of illegal phone-hacking.

In more recent times, the British electronic media and the entertainment industry have suffered a loss of public confidence too. Claim after claim has emerged about sexual abuse. At times, the public outcry has been so great that authorities have over-reacted, accusing innocent people.

Meanwhile, sections of the institutional church have been rocked by reports of child abuse going back decades.

The trust deficit continues to rear its head within the in/out referendum debate about Britain’s membership of the EU. Current polls reveal real uncertainty as to which way people will vote. At the core of the problem is the fact that people don’t know whom to trust.

Until now, the medical professions have managed to escape the worst effects of this creeping trust deficit. Indeed the NHS, a symbol of all things medical, is still considered almost sacrosanct by a great many people.

However, if junior doctors and the BMA are not careful, they may yet find themselves and the wider healthcare community add to the Trust Deficit Register.

In the trust stakes, medicos have more to lose than most other professionals. Theirs is regularly listed among society’s most admired and dependable classes.

In an Opinium study earlier this year, nurses and doctors were listed as the top two most respected professions in the UK, with 86 and 85 percent ratings respectively.

Of course, doctors have the same right to withdraw labour as do other members of society. They have the right to question government expectations of their working hours and remuneration.

However, the public expects of doctors a greater degree of selfless commitment to the common good, because of the high levels of respect – and at times deference – afforded them.

The BMA still enjoys a level of emotional support among some sections of the public. However, this will quickly seep away if doctors are seen to be self-indulgent or stubborn at the expense of their duty of care to the public.  

For many people, the role of a doctor is more of a vocation than a career. We admire the intelligence that is needed for the study of medicine. We respect the years of formal study and the long hours of hospital training that are required before a doctor can register.

The fact that young people will endure all of this to pursue a career centred on serving others is something we find worthy of high regard. Perhaps unconsciously, we see it as a sign that doctors feel some kind of higher calling to their profession.

This may be a little romantic, but the assumption is probably based on the knowledge that most of us will never feel the same level of commitment to our own work, even if we enjoy it. (We almost certainly will never face the same life-and-death stakes if we fail at it.)

Were doctors, as a class of professionals, ever to lose the public’s trust, this would almost certainly lead to a decrease in general public health. This is true on two fronts.

First, it may force clients (or patients) to become overly self-reliant when it comes to healthcare.

Medicos have already bemoaned Joe Public’s tendency to consult online health apps for the purpose of diagnoses and treatment plans.

The internet can doubtless help us find useful suggestions for managing relatively minor ailments. Google-driven searches of health sites cannot, however, replace a session with a caring and involved human professional.

These searches are, after all, conducted by algorithms which are programmed to tell us want they “think” we want to know – based on our previous search histories. They do not represent truly random searches, so they won’t always extend our existing knowledge far enough to be of use when it comes to medicine.

Besides, why should you or I spend hours or days online in the vain hope of replicating the skill of a medical professional? They’ve studied for years to achieve their level of diagnostic excellence.

Of course, if medicos don’t want us consulting screens for professional help, they should spend less time reading from screens themselves.

There is nothing wrong with a doctor, during a consultation, double-checking a diagnosis where necessary, or consulting the latest news on drug developments. The medical and pharmaceutical sciences are moving forward at a rapid rate; doctors don’t often have the time to keep track of the changes.

However, when GPs spend more time consulting screens than they do evaluating and reassuring the human beings sitting before them, they send a message which they may not have intended. That is, that people are right to trust digital apps for even the most important aspects of their healthcare.  

There is another reason why a loss of public trust in doctors might lead to a downturn in public health, at least in the short-term: it might lead to fewer training opportunities for doctors.

Already, we reportedly have fewer doctors-in-training than we need. This can only become more of a problem as the population continues to grow and to age.

We are also losing qualified medicos to other nations. This is particularly with countries like Australia, where British training is held in high regard and entry visas are relatively easy to come by if you’re in medicine. In time, some British students may seek a medical degree here with the sole intention of using it as leverage for permanent relocation.

Public health can only suffer if Britain’s capacity for training and keeping enough practitioners continues to drop. Advances in automotive technologies may, of course, offer some respite for patients – but perhaps very little comfort for doctors who’re worried about their future.

Automation may replace as many as 230 million jobs worldwide within the next twenty years. These losses, however, will not be limited to low-paying unskilled jobs. Far from it.

Already advances in automation are threatening jobs in highly-paid professional fields. Machine learning, for example, is allowing writing engines such as Quill to pen, from scratch, articles which feature in major publications, including Forbes Magazine.

Granted, these programmes are not yet anywhere near winning a Pulitzer, they can effectively “learn” from their mistakes and rewrite their own programming as they learn. Journalism is one profession that will be directly affected by machine learning.

Consider too the even greater disruptive capacities of “social bots” which read and emulate human emotions; and Cloud robotics, which will, at least in theory, allow machines to share their “knowledge” with other machines via a type of universal technical “mind”.

Big Data analytics makes it possible to track patterns of illness in a community. In the short term, this might represent huge potential benefits for doctors in terms of making diagnoses more quickly.

In the longer term, though, it might also mean that the doctor-as-knowledge-provider becomes obsolete.

Meanwhile, machine “chatbots” are now able to fool people into thinking a conversation with them is a chat with another human being. A combination of big data and chatbot technology might eventually make a trip to a human doctor little more than a luxury.

True, as things stand doctors are guaranteed an income because of NHS structures, underwritten by taxes. But would those structures remain if fewer people wanted, or felt they needed, to consult doctors?

Specialised medicine may also be affected by automation, at least to a point. A few countries already use surgical robots on an experimental basis to perform simple operations – with or without human intervention.

Given these near-future developments, doctors cannot afford to become complacent. They cannot assume that their grievances will always be met with forbearance by a largely supportive community.

If technology starts replacing some of their more specialised roles, medicine might start to look less like a vocation and more like a job.

Yes, doctors may need to spend time in picket lines now and again. But more important is their need to recognise and maximise their “unique selling points”; focusing more, not less, time and attention on the level of human care they provide.

In their present strike action, as in any other public grievance, perception is as important as fact.

In a time of rapid technological change, the perceptions we create today may be harder to break tomorrow, when even the most admired jobs are no longer guaranteed.

That change may happen more quickly than we think. In advance of it, even highly paid professionals need to focus on improving their human trust quotient.

If doctors allow their commitment to medicine to be seen as little more than another career move; if they appear to lose their sense of duty to an attitude of entitlement; if they are seen as becoming less committed to human care, people may soon trust them less and begin to wonder if a machine might not do as good a job. 

Listen to Mal Fletcher's BBC interview on this issue.

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