Introduction by Croakey: We reported last week that senior doctors have raised concerns about a Medical Board of Australia decision to impose conditions on the registration of a rural emergency doctor, Dr David Berger, because of his comments on social media about pandemic management.
Since then, more than 1,600 people have signed an open letter of support for Berger. However, not everyone sees this as a freedom of speech issue, with one doctor commenting on Twitter that it is more about professional conduct online.
The reaction to our article has been mixed; some readers have been in contact to express concerns about Berger’s conduct; others have expressed support for Berger and stressed the importance of health advocacy and of health professionals being able to criticise and question government policies.
Professor Guy Marks, Scientia Professor at UNSW Sydney and the Woolcock Institute of Medical Research, writes below that the case raises fundamental questions.
Guy Marks writes:
The decision of the Australian Health Practitioner Regulation Agency (AHPRA) to sanction Dr David Berger is shocking on many levels. For me, it raises two big questions: what is the role of the doctor (and other health professionals) in society and, a related question, what should society expect from doctors?
Indeed, whether it is research, policy, public health practice or advocacy, many of the gains in health achieved by the actions of doctors have happened beyond the confines of the individual doctor-patient relationship. In our practice and in our personal experiences, we quickly learn the power of clinical interventions but also their limitations.
Some advocacy is on a small scale, for individuals: fighting for access to medicines, advocating for shorter wait times for surgery, trying to get patients into ICU, or intervening to improve housing or disability support for patients in need.
However, much of the advocacy requires action on a larger scale, sometimes for these very same issues, but on behalf of many patients not just an individual. Not infrequently this advocacy brings us into conflict with authority figures, including those who hold the purse strings and those who set the rules.
Many doctors, including this one, see this as part of their mandate. My own experience, even in recent times, includes examples of both, advocacy for individual patients and advocacy for the many, which have brought me into conflictual situations with authority figures. This comes with the territory.
There is, of course, an important role for AHPRA (or its equivalent) in regulating the behaviour of doctors and other health professionals. This regulation should reflect the expectations of society for how health professionals should behave. In particular, we expect doctors to refrain from spreading misinformation, to “first, do no harm”, and not to exploit patients or the public purse.
Regulators have much work to do on all these fronts.
However, the role of the regulator should not be to protect the interests of those with power: in the profession, in government, in the media, or elsewhere. They are all very capable of protecting their own interests, without the assistance of AHPRA!
My concern about Dr Berger’s case is that the regulatory function has been exercised inappropriately and will actually have an adverse, chilling impact on the important role of doctors as advocates for patients.
In my view our community does not expect us to be silent and compliant on matters of importance to public health. On the contrary, they expect us to speak up for scientific and evidence-based approaches to improving health.
Clearly, in the context of the COVID crisis, there has been a great deal of uncertainty about how to proceed. Informed public debate has been an important vehicle for motivating effective public health action and for countering misinformation.
The stakes and temperatures have been high in many domains: in the political sphere, in the scientific debate, and in the health system response. We need all actors, including the regulators, to act in a cool and measured manner in this context. AHPRA has let us down.
The decision to sanction should be reversed and the system that allowed this damaging decision to be taken needs to be reviewed.
Guy B. Marks AO FAHMS GAICD, Scientia Professor, UNSW Sydney and Woolcock Institute of Medical Research
AHRPA made comment in this previous Croakey article: Questions about freedom of speech in a contested, politicised pandemic environment and will be invited to respond to this article.