Over the last few decades, public perception of physicians has been on the decline. Many issues are to blame, but a largely overlooked contributing factor is the media. Physicians are often portrayed negatively, with stories of narcotic abuse, greed and medical mistakes dominating the news. Rather than fight back, physician organizations have stood silently and allowed their reputations to be tarnished. On the other hand, nursing organizations have been busy pursuing many successful public relations campaigns, which have resulted in an image of compassion and intelligence. They have done this, however, at the expense of physicians.
During the mid-20th century, to be a doctor was one of the most prestigious careers one could achieve. Yet, survey data from 2012 revealed that only 34 percent of Americans have “great confidence” in physicians, compared with 73% in 1966 (Blendon 2014). News, social media and magazines are filled with negative stories about doctors. Bloggers tell patients to ignore their physicians’ advice and “do that home birth” or “say no to that vaccine.” It seems that the public trusts actors and Playboy playmates more than their doctors. This loss in social status and negative public perception has greatly affected physicians, and subsequently changed the care they provide to their patients. In a 2008 survey, only 6% of physicians described their morale as positive.
While physician image has been on the decline, public perception of nurses has continued to grow. As the last few years of Gallup polls have shown, nurses are consistently rated highest on honesty and ethical standards while the opposite trend has been observed for physicians. As the latest Gallup poll in 2014 revealed, over 80% of American state nurses have “very high” or “high” standards of honesty and ethics, while only 65% of Americans feel the same way about doctors. Various nursing organizations including the American College of Nurse-Midwives (ACNM) and the American Association of Nurse Practitioners (AANP) have been active when it comes to improving the image of nursing, and it has paid off. Unfortunately, physician reputation was damaged.
The “ACNM Project,” launched by the ACNM, has focused on making nurse midwives the “norm for women’s health care service in the United States.” Their aggressive public relations campaign has been successful. Midwives attended 3% of births in 1989 compared with 10% today. Rather than show patients the benefits of their profession, however, they have focused on negative rhetoric towards obstetricians. Many midwifery websites discuss high Cesarean rates or “unnecessary” interventions of physicians. The website of the American College of Nurse-Midwives is very clear on “disruptions to a normal healthy birth” which include medications and Cesarean delivery. Rather than seeing an obstetrician as a doctor that has a woman and her baby’s best interest at heart, the doctor is painted as an overbearing, controlling surgeon.
Nursing organizations have also been active on social media. Facebook and Twitter have been overrun with rhetoric that builds up the nursing profession while tearing down physicians. The AANP promoted themselves on social media with the slogan “brains of a doctor and heart of a nurse,” implying that physicians are lacking in the heart department. Memes stating: “Be nice to nurses. We keep the doctors from accidentally killing you,” and “Behind every great doctor is an even greater nurse,” shed physicians in a negative light, painting a picture of a dim-witted doctor who needs a smart nurse to help him do his job.
For public perceptions of physicians to change, doctors as a group need to focus on a public relations campaign. The American Medical Association (AMA), the largest physician organization in the country lacks a true public relations department that represents physicians. Does anyone represent our interests? We, as physicians, can make a comeback in the public eye. We need a public relations department.
A PR department needs to research why the public distrusts and has negative feelings toward physicians. Once the causes are known, physician organizations can work to correct the problem.
If, based on nursing organization rhetoric, the public believes physicians are uneducated or just as experienced as a nurse, then the public needs to be informed otherwise. The average nurse practitioner has 1.5-3 years of training in a Master’s’ program, or about 500-1000 clinical hours, after college. A family medicine physician, on the other hand, will work 6,000 clinical hours in medical school, which lasts four years, followed by a 3-year residency, averaging an additional 9,000-10,000 clinical hours. Those numbers would be even higher for specialists.
Perhaps, the public has a negative view of physicians because they lack in a specific area of knowledge. Maybe people do not like most doctors’ “bedside manner” or speaking styles. Whatever the issue, we need to know about it and address it.
In addition, as nursing organizations have used rhetoric to improve their public perception, physician organizations can do the same. Positive stories of a physician saving lives can change the view from impatient surgeon to caring and skilled patient advocate. A social media image of an obstetrician crying with her patient after a fetal loss could go a long way. Where are the memes, Facebook posts and tweets praising doctors?
Medicine has gone from a paternalistic field in which complete decision-making power was placed in the hands of the doctor to the “customer is always right” model that is happening now. A middle ground is needed. Once this occurs, physicians will not only be more satisfied in their careers, but patients will be more satisfied with their care. Physician organizations need to fight back.
Kaci Durbin is an obstetrician-gynecologist.
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