It is public perception that counts

In reply: Grattan-Smith is obviously concerned about “Doctors behaving badly?” as an appropriate title for the editorial by Tattersall and Kerridge.1 He is also agitated by my column From the Editor’s Desk “Tilting at titles”.2

The editorial’s title was not the result of Machiavellian machinations — its creation belongs entirely with the editorialists. Grattan-Smith may not feel that accepting pharmaceutical company largesse is bad behaviour, but the public sees it otherwise, as evidenced by the unprecedented coverage of the “Roche affair” in The Australian,3,4 the Sydney Morning Herald,5 and the BMJ.6 The public comments were not flattering: “the gluttony of the whole thing was mind blowing”3 and its defence by doctors was “in poor taste and displays the supreme arrogance of the privileged”.7

The public and most doctors expect the relationships between the pharmaceutical industry and doctors to be open and transparent. We believe this to be the case with the pharmaceutical advertisements in the Journal, and the MJA/Wyeth Prize. Our advertising policy prevents pharmaceutical companies from placing advertisements within or adjacent to articles that might have relevance to the drug being advertised. Wyeth generously donates $10 000 each year to the authors of the best original research published by the Journal on the understanding that Wyeth has no input to the selection process. Research has already been independently peer reviewed for publication before being considered for the prize, and the winner is decided by the Journal staff and the members of our independent Content Review Committee.

Grattan-Smith’s concern with my column was its questioning of the title “doctor”, which apparently is now a source of confusion for patients in busy hospitals. He cites Samuel Johnson’s concept of a doctor and quite rightly so. Physicians of his time had every right to call themselves Doctors. They were graduates from Oxford and Cambridge who pursued a long, formal and inflexible course. It began with a Masters in the liberal arts, proceeding through the Licentiate and then a Doctorate in Medicine by dissertation.8 These doctors were the epitome not only of scholarship but also of elitism. Those with moderate means were barred from pursuing medicine at Oxford and Cambridge, as were non-conforming Protestants and Roman Catholics. It took the Scottish medical schools in Edinburgh and Glasgow to break down the English citadel.

In our times, the use of the title “doctor” by medical practitioners is a privilege granted by the community and the state, and has to be earned and sustained by open professional conduct. A closeted freebie of “a few glasses of Kooyong Pinot Noir and a good feed” is what most of the public perceives as doctors behaving badly, and it is perception that counts.