BusyMamaMD

Over the last few decades, public perception of physicians has been on the decline.  Some of this is due to factors such as rising health care costs and long appointment wait times, 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, doctors have stood silently and allowed their once great reputation to be tarnished.   Interestingly, the field of nursing has contributed to this downfall with their own public relations campaigns.  The nursing field has pursued a many successful public relations campaigns, which have resulted in an image of compassion, intelligence, and selflessness.  They have done this, however, at the expense of physicians.  Using negative rhetoric, the nursing profession has directly compared themselves to doctors, branding themselves as the superior alternative.  Physicians need to unite to create their own positive public relations campaign.

During the mid-20th century, to be a doctor was one of the most prestigious careers one could achieve.  Physicians were well respected.  Today, the tables have turned.  Survey data from 2012 revealed that only 34% of Americans have “great confidence” in physicians, compared with 73% in 1966 (Blendon 2014).  As stated in The Wall Street Journal, the profession has been in a “midlife crisis” and “American doctors have lost the status they used to enjoy” (Jauhar 2014).   The public has lost their trust in us.

United States physicians consistently are seen more negatively than physicians in other countries.  The United States ranks near the top in overall patient satisfaction with treatment, but near the bottom when it comes to trust in their physicians (Blendon 2014).  Respondents in a New England Journal of Medicine survey showed that the US ranks 22 of 29 countries studied when it comes to physician trust (Blendon 2014).  One author, in a story about physicians in the United Kingdom, recognized this poor perception.  Although physician reputations in the UK were in jeopardy, they were “nowhere near the US perception of physicians seeking a fast buck” (Neuberger 1994).  The author discussed the differences in the UK and US, explaining how the profession was held in much higher esteem in the UK in stark contrast to the US (Neuberger 1994).

This loss in social status and negative public perception has greatly affected physicians, and subsequently affected the care they provide to their patients.  In a 2008 survey, only 6% of physicians described their moral as positive (Jauhar 2014).  Furthermore, half of those surveyed stated they planned to stop practicing or greatly reduce their patient load over the next three years (Jauhar 2014).

While physician image has been on the decline, public perception of nurses has continued to grow.  As the last few years worth of Gallup polls have shown, nurses are consistently rated highest on honesty and ethical standards.  While this has gone up over the last decade, the opposite trend has been observed for physicians.  As the latest Gallup poll in 2014 revealed, over 80% of American state nurse have “very high” or “high” standards of honesty and ethics, while only 65% of Americans feel the same way about doctors (Riffkin 2014).  Using a strong rhetorical public relations campaign, nurses have successfully transformed their image into what it is today.  However, they have done so often at the expense of physicians.  Much of the campaign has focused on “choose us not them.”  This has been done well by various nursing organizations including the American College of Nurse Midwives (ACNM) and the American Association of Nurse Practitioners (AANP).

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” according to their website.  The association has performed extensive market research and based on that research, has attempted to revamp the image of midwifery.  They have been successful.  Midwives attended 3% of births in 1989 compared with 10% today (Santa Cruz 2015).  Rather than show patients the benefits of their profession, they have focused on negative rhetoric towards obstetricians.  Many midwifery websites will discuss the high Cesarean rates or “unnecessary” interventions of physicians.  Rather than give benefits of both sides, the website, www.midwife.org, is very clear on “disruptions to a normal healthy birth” which include medications and Cesarean delivery.  As midwife Breedlove states to the Atlantic, many obstetricians “over-medicalize” birth and claims childbirth is a “natural occurrence not a medical event” (Santa Cruz 2015).  Rather than seeing an obstetrician as a doctor that has their and their baby’s best interest at heart, he or she is painted as an over-bearing, controlling surgeon.

The AANP has also been busy with public relations.  Most recently, social media was overrun with promotional materials for nurse practitioners, stating “brains of a doctor and heart of a nurse,” implying that physicians are lacking in the heart department.

Besides nurse midwives and nurse practitioners, nurses in general have received positive media attention.   Social media has been overrun with rhetoric that builds up the nursing profession while tearing down physicians.  Memes stating various slogans such as “Be nice to nurses.  We keep the doctors from accidentally killing you” to “Behind every great doctor is an even greater nurse” shed physicians in a very negative light.  This humorous rhetoric paints an image of a dim-witted doctor who needs a smart nurse to help him do his job.

In order for public perceptions of physicians to change, doctors as a group need to focus on a public relations campaign.  For decades, physicians and their professional organizations have sat idly by and watched their reputations tarnished.  While the various nursing associations discussed have active public relations departments, this does not exist for doctors.  The American Medical Association (AMA), the largest physician organization in the country lacks a true public relations department.  According to their website, they do have a “press center” that focuses on “issues vital to bettering patient care and helping physicians advance and improve the practice of medicine.”  Yet, no one is responsible for bettering the image of physicians.  A similar specialty search of the professional organizations for internal medicine, pediatrics, obstetrics, and other areas reveals similar findings.  Once the decision is made to launch a public relations campaign, the physicians must take a combination of an excellence and rhetorical approach.

We as physicians can make a comeback in the public eye.

First, research needs to be done on the reasons why the public distrusts and has negative feelings toward physicians.  Once the causes are known, doctors can work to correct the problem.  If the public believes rumors that are untrue, then the public relations campaign needs to educate the public on the truth.  If the public has a problem with something physicians are currently doing, then perhaps physicians as a group need to change that behavior in order to better serve their public.

If, based on nursing rhetoric, the public believes physicians are uneducated or just as experienced and educated as a nurse, then the public needs to be informed otherwise.  The average nurse practitioner has 1.5-3 years of training in a masters’ program, or about 500-1000 clinical hours, after college (AAFP 2012).  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 (AAFP 2012).  Those numbers would be even higher for specialists such as cardiology or nephrology.   The people of the United States need to hear the facts.  This could be done by feature stories, following a person from medical school through residency and showing the sacrifices made along the way.  Tweets or Facebook posts comparing clinical hours of nurses and physicians could be shown.  News stories of physicians, discussing the hours worked and the tests taken could be done.

Perhaps, the public has a negative view of physicians because they lack in a specific area of knowledge, such as nutrition.  Maybe people do not like most doctors’ “bedside manner” or speaking styles.  If the public wants their physician to talk more about nutrition and weight loss, then that should be added to medical school curriculums and continuing education in nutrition required.  This would help physicians by improving their image and at the same time, give the public what they want.  Similarly, if it is the beside manner that is the issue, doctors can receive additional training on empathy and communication skills.

Finally, just as nursing organizations have used rhetoric to improve their public perception, physicians and physician organizations can do the same. Currently, the obstetrician is framed as an impatient surgeon.  Symbols and language can be used to re-frame that image.  Positive stories of a physician saving a baby’s life by emergency Cesarean 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 as well.  One could interview the physician and ask her why she practices the way she does and publicize that interview on various pregnancy sites.

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 of mutual understanding and discussion is needed.  Once this occurs, physicians will not only be more satisfied in their careers, but patients will be more satisfied with their care.  It is a lofty goal that sometimes appears out of reach, but it can happen with a well thought out public relations campaign.   Physicians need to fight their negative image and show the public that they are caring, compassionate, and capable individuals.

References

American Academy of Family Physicians (2012).  Patient perceptions regarding health care providers.  Retrieved from http://www.aafp.org/dam/AAFP/documents /about_us/initiatives/PatientPerceptions.pdf

Blendon, R.J.  (2014).  Public trust in physicians- U.S. medicine in international perspective. The New England Journal of Medicine, 371(17), 1570-1572.

Jauhar, S.  (2014).  Why doctors are sick of their profession.  The Wall Street Journal.  Retrieved from http://www.wsj.com/articles/the-u-s-s-ailing-medical-system-a-doctors-perspective-1409325361

Neuberger, R.J.  (1994).  The new public perception of health care and physicians.  Journal of the Royal Society of Medicine, 22 (87), 9-10.

Nurses for a Healthier Tomorrow.  (2002).  Johnson & Johnson launches campaign to address nursing shortage.  Retrieved from http://www.nursesource.org /NFHTSpring2002.pdf

Riffkin, R.  (2014).  Americans rate nurses highest on honesty, ethical standards.  Gallup.  Retrieved from http://www.gallup.com/poll/180260/americans-rate-nurses-highest-honesty-ethical-standards.aspx

Santa Cruz, J. (2015).  Call the midwife.  The Atlantic.  Retrieved from http://www.theatlantic.com/health/archive/2015/06/midwives-are-making-a-comeback/395456/