Doctors - Death by Degrees

Dr Alan Sandford and Glenda McLean have been working as consultants in the Greater Southern Area Health Service, NSW, Australia for over two years. One complex work effort has been the protracted employment contract negotiations with the Orthopaedic Surgeons at a regional hospital. While Doctors are recognised as tribal and various studies attest to their primeval capacity to stick together, we observed the ferocious levels of animosity and competition between Doctor groups (craft groups) at the hospital regarding status and financial remuneration. In exploring the dynamics of the Doctor groups we have tried to shine a light on the destructive implications of competition. Our analysis provides some psychodynamic and psychoanalytic theories in the use of fear of death by Doctors to leverage the influence in the public healthcare system. Examples ofinfluence are the wilful overuse of resources, organisational manipulation, inappropriate control over operating theatres, bully behaviour towards nurses and administration, and the development of cartels to reduce competition. Such behaviour leads to poor outcomes for patients, including adverse events and patient deaths. Our analysis also demonstrates the darkness of the losing side; the impact on the other clinical areas within a hospital and the betrayal, loss, suffering and dehumanisation of staff and patients.In terms of dark competition what is being played out between the various Doctor groups in the public health system? In considering that Doctors are in charge of death we explored the Doctors degree of death by group. For example how is that the Orthopaedic Surgeons exert more power than the Dermatologist? We have used the word Degree to denote the different qualifications and clinical speciality of the Doctor groups within a hospital and explore the different relationships between competition and death.We anticipate the development of a working hypothesis for the ISPSO conference 2006 that advances our understanding of psychoanalytic perspectives of the competitive Doctor relationships within hospitals.'