R.E.S.P.E.C.T.—why doctors are still getting enough of it

BMJ 2002; 324 doi: (Published 05 January 2002) Cite this as: BMJ 2002;324:11
  1. Zosia Kmietovicz
  1. London

    It seems to be something of a hobby for newspapers around the world to hammer the medical profession. You can almost guarantee that wherever you are in the world and whatever newspaper you happen to unfold there will be something inside it about doctors' mistakes, misdemeanours, and mendacity.

    Negative publicity

    So how has this negative publicity affected the public's opinion of the profession? If the media are as powerful as many people believe, the drip, drip of bad news should have resulted in a dive in patients' trust in doctors.

    Yet an inquiry by the BMJ covering seven countries shows that, in most places, respect for doctors is extremely high and has not altered noticeably over the past 10 years. The only exception seems to be Germany, where the pedestal on which doctors have been put remains high—though it is now slightly beneath, rather than above, the clouds.

    Doctors beat priests

    There, doctors are losing some status, although they are still by far the most prestigious profession. In a recent poll they beat their nearest rivals—priests—by nearly 30% with 74% of the public claiming they have the highest regard for medics. However, this figure is down 7% on 1995, when 81% of those questioned ranked doctors as the top dogs in the league of professions.

    After a dip in the ratings in Australia last year, things have now taken a turn for the better. The latest poll, issued in December, shows that, at 75% doctors have retained the third most respected position, after nurses and pharmacists (90% and 83% respectively). This is 1% above schoolteachers and a 3% increase on last year. The 2000 ratings dropped to 72% a 3% fall on 1999.

    In most other countries, where there are regular opinion polls on professional standing, doctors continue to be held in high esteem. Even in the United Kingdom, which has been hit by an unprecedented number of medical scandals and transgressions in recent years, doctors top the polls as the most trustworthy and hardworking of all professionals. In 2000, trust in doctors had risen by two percentage points on the previous year (to 89%), and overall satisfaction had dropped just one percentage point, to 89% The biggest complaint among the British public was that doctors tended to take too little account of patients' feelings.

    Quality of care

    Likewise in France the public seems more than content with their doctors' performance. In a recent survey 77% of a representative sample of French men and women declared they were satisfied with the quality of medical care they were getting, and 87% could not fault their doctor's competence. If they're not happy with their doctor's performance the French tend to shop around for one they like. The survey shows that 40% of people questioned had done just that—mostly for reasons of incompetence or the doctors' “general attitude.”

    In other countries the public's opinion of doctors is climbing. In the United States this has been the trend for 15 years, and in 2000 more than half of 13000 patients surveyed rated their doctor as “excellent” in terms of willingness to listen, taking time to answer questions, and explaining treatment options and follow up care. What the US public was unhappy about were holdups in the system. They complained about finding it difficult to get an appointment, being delayed in the waiting room, and being put on a waiting list for treatment.

    Most trusted

    In Israel, too, the public's perception of doctors is unfaltering. In 1999, 89% of people questioned said they were either very satisfied or satisfied with the professional abilities of their family doctor—an 8% increase on the 1995 figure. Overall, doctors are the most trusted group of professionals in Israel—way ahead of lawyers, teachers, and the clergy. Professor Avinom Reches, a senior neurologist at Hadassah University Hospital in Jerusalem's Ein Kerem and head of the Israel Medical Association's ethics committee, was “very pleased and a bit surprised” by the trend. “It's very complimentary, considering the serious financial straits of the public health system and the chronic shortage of funds. But maybe patients blame ‘the system’ and not the doctors,” he said.

    Popularity stakes

    But out of all the countries we found surveys for, it was Dutch patients who found it hardest to fault their doctors, especially GPs, who beat their hospital colleagues in the popularity stakes. One study showed that 97% of patients felt confident in their GP, and overall satisfaction with health care was as high as 90% Again it was more the administrative and emotional side of medicine rather than trust in the profession that disappointed patients. Patients wanted to be taken seriously and provided with proper information as well as to have rapid access to doctors. It was not doctors who were blamed for not providing these aspects of medical care, but the institutions they worked in.

    Changing attitudes

    Our straw poll would never receive awards for being scientifically robust, but it provides an overview of public opinion of doctors—and that certainly seems to shine in the face of adverse publicity. What it suggests too is that patients' perception of doctors has changed. They are no longer regarded as the paternalistic figures they once were, but rather as a technician or a gatekeeper to health services. Patients are better informed, more critical, and more demanding than ever—and surely that will serve to keep doctors on their toes.

    Research was carried out by Christopher Zinn (Australia), Fred Charatan (United States), Annette Tuffs (Germany), Alexandre Dorozynski (France), Judy Siegel-Itzkovich (Israel), and Tony Sheldon (Netherlands).

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