Debrief: The political doctor

Objective or idiotic

Why are so many doctors idiots? I don’t mean in the modern sense of the word describing the foolish and unwise but from the original meaning, idiotes. The Greek word used in Athenian democracy described those who chose to avoid the daily politics of the square and public life. Over the years the word has taken on a pejorative meaning, though there was always a hint of Greek reproach for those too selfish to engage. I sense that doctors have been groomed to think of medicine as apolitical, maybe in part due to the Popperian principles of objectivity. A steady erosion of respect in political discourse has scarcely helped.

We’ve let studied neutrality bleed into our entire profession and doctors often seem to believe that we should be aloof, above politics. And yet, Christopher Hitchens described how, on the left at least, many middle-class doctors were drawn to socialism through their: ‘Experience of doctors in the slums: forced to confront the raw injustice and maldistribution that dominated the life and death question of healthcare.’ ¹

How did we become so supine? We are too often spectators, if we see at all, gazing passively on the slow-motion car crash of austerity.

Politics with a small p

It is hard with a general election hangover still throbbing in our temples but we need to embrace politics. I don’t mean, at least not necessarily, party politics. The party political system bundles up policies and the individual plans can’t be disaggregated. Instead, think of the dozens of smaller niche topics upon which we can exercise political pressure. As doctors we can excel at this lower-case politics, the local and the targeted. Think of it as the micro-political. It might be supporting a local foodbank, advocating for better services for a vulnerable group, or just tweaking the practice protocols to improve accessibility. By all means get involved in the big-picture politics — but it’s the community level that needs us.

And the NHS needs us to exercise our collective political will too. Unknown to many, Enoch Powell was Minister of Health from 1960 for just over 3 years and wrote a slim volume, A New Look at Medicine and Politics.² It’s a remarkable book and much of it remains eerily pertinent.

Many think the best policy for the NHS would be for it to be removed from politics altogether. Powell puts a persuasive case that it is almost impossible to disentangle the NHS from politics. In which case, if we want to support the NHS, we’ve no choice but to enter the political fray.

Shouting down the snollygosters

If we don’t do it who will? The BMA does good work but the recent damning report on sexism in the BMA from Daphne Romney, QC, recommended, inter alia, that ‘Shouting is completely unacceptable in any place of work.’ ³

They had to be told that? The Local Medical Committees are trying but they are hardly a shining political beacon, more of a raging bin fire, with their lamentable conference motion to hand back home visits and throw the most vulnerable under the bus.

We each have the tools for these micro-political battles. We know how to communicate and let’s utilise one of our best weapons: evidence. We understand evidence should always trump ideology and we should demand it, insist on it, resist when it is absent.

This month’s Debrief exists in a curious political limbo: the general election snuggles, clutching some seasonal eggnog, between writing and publication. I’ll leave you with an aside and a new political word to fill this odd lacuna: snollygoster.

A helpful editor in 1895 used this definition: ‘… a fellow who wants office, regardless of party, platform or principles, and who, whenever he wins, gets there by the sheer force of monumental talknophical assumnacy.’⁴

By now you will know if a snollygoster got in. It doesn’t matter; we can still pursue our politics. And, whatever the future holds, let’s not be the idiots.