Second International Conference on Medical Registration, Melbourne, 27-30 October 1996

Stress amongst doctors is increasing, with suicide rate higher than their patients'. An important identified cause of medical suicide is the so-called "litigation explosion". Most doctors are members of medical defence orgisation (unions).

These have repeatedly issued warnings: There is a litigation crisis, never criticise a colleague nor admit liability, a successful claim of negligence would destroy doctors - and judges "use devices" to over-compensate injured patients (even if the doctors were not negligent!).

Most doctors believe every word - and pay premiums promptly; no questions asked. Accordingly, they endure chronic stress: distrust of their patients, anxiety and depression. And substance abuse follows. The standard of medical care and ethics suffers as a consequence.

There may be a costly and unhealthy reliance on: over-prescriptions, defensive medicine and unnecessary surgery to avoid litigation. Yet a dispassionate analysis of several published papers would show that the situation is not as bad as painted.

The Tito Professional Indemnity Review (PIR) has questioned all the warnings issued by unions. Unfortunately, few doctors have studied the PIR, whereas all would have read headlines of unions' publications. Believing their unions give factual information, many doctors interviewed condemn PIR (without studying it). Unions have also been known to defend doctors accused of sexual misconduct with questionable zeal; such defence poses problems for both complainants and medical boards. Boards may have a responsibility to provide registrants with accurate information to counter unfounded stress caused by misinformation.

When patients complain, doctors are happy to respond to boards' enquiries about their conduct. Yet unions may instruct them not to do so. Doctors follow this advice at their peril. While boards may let the matter go, many complainants would not. That could be the start of endless medical stress, and drug dependency. The end could well be medical suicides. The existing power imbalance between medical boards and defence unions needs urgent attention.

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