Doctors or activists? Who draws the line?

The Division of Paediatrics and Child Health of the Royal Australasian College of Physicians (RACP) has released a strongly worded statement about the harm caused to children in immigration detention. The statement in part asserts “as a country, we are failing the most vulnerable people in our care.” The RACP itself has been publicly opposed to the detention of child refugees since the policy was introduced.

Regardless of where one sits on the political spectrum, it is impossible to deny that feelings run high on this issue. Is it helpful for doctors to weigh in publicly? Who should decide what issues doctors have a responsibility to comment publicly on?

Medical specialty groups are represented formally by quasi-academic bodies known as Colleges. Some smaller specialty groups such as the Australasian Faculty of Rehabilitation Medicine and the Faculty of Pain Medicine are organized into Faculties of larger Colleges. To be recognized as a “specialist” in your discipline you need to be offered Fellowship of a College or Faculty.

This process has a number of archaic features and is slightly different for every specialty. At the end of the day, though, the formal leaders of medical Colleges and Faculties speak for their Fellows in public debates. When it does happen, it can be taken as a near-unanimous consensus of all the Australian and New Zealand practitioners in that specialty group.

For this reason, such statements have been fairly rare and are only released on matters in which the leadership of the College sees an immediate need to add an authoritative voice to the public debate about an issue of the day. Medical leaders are generally not keen to be seen as activists.

Their main job is to regulate and accredit the standard of medical training and practice within their specialty and they are obliged to work with Governments of all stripes for the good of the community. Political stuff can be left to the Australian Medical Association to engage with.

In recent times, though, it seems medical Colleges have been speaking out more frequently in public debate. The Royal Australian College of General Practitioners was very active in the election campaign releasing 14 statements in June alone. Mental health is frequently a topic of community discussion, and the Royal Australian and New Zealand College of Psychiatrists releases a media statement virtually every week on relevant topics including suicide among military veterans, Don Dale centre and the Nauru files.

While some of these statements are politically contentious if seen through partisan eyes, they are released because most doctors accept that advocacy on behalf of our patients is a critical part of the service we provide to society in return for the training and privileges we receive. The public trust us to act as a conscience when we become aware of threats to the health of any part of the community.

Politicians have an uneasy relationship with activist medical organisations. They love to demonise the AMA as the “doctor’s union” when it suits them, but they find it much harder to dismiss academic bodies such as the Colleges as self-interested lobby groups. Typically their points of view are based heavily on scientific evidence combined with real-world experience. Such statements can be a formidable endorsement of a policy or an insurmountable roadblock.

Doctors see ourselves as having a privileged position in society, gleaned from our years of academic training and constant exposure to dealing with the consequences of the community’s misadventures and tragedies. Our perspective is unique, and frequently uncomfortable to hear. We know and see much more than we can ever tell. No group knows so well the actual cost in money, tears and lost potential of dealing with the health consequences of preventable tragedies.

As activists, the medical profession can be irresistible. But we have to use that power wisely and sparingly, since there is only so much exposure to its own flaws society will put up with at a time. When Colleges speak out, it would pay to listen.