President's Oration
By Dr Ron Goodey, NZMA President (speech delivered at NZMA AGM 5 May 2009)
From early childhood I wanted to be a doctor. I never considered any alternative career. I had contact with a number of family doctors and a variety of specialists but to me they were all “doctors”.
50 years ago, as a medical student in Dunedin, I knew about the medical association. We had lectures about it. I knew that the New Zealand Medical Association had been founded in 1886 and that it was subsequently accepted as the New Zealand branch of the British Medical Association in 1896. I was taught, but forgot, that it then held its first AGM in Nelson in 1897, where it elected its first president, George Cleghorn, a Calcutta born, UK trained doctor. In contrast to your new president, Dr Cleghorn was only 46 & in very active practice. He had done much to facilitate the transition of our medical association into a well organised branch of the British Medical Association which, itself, had only been formalised in 1874 though its predecessor had started in 1832.
When I graduated from Otago Medical School, I was very proud. This was not because I had passed exams or obtained a meal ticket (as a house surgeon I was to be paid less than half the wages of a first year primary school teacher). I was proud because I had become a member of the medical profession. One of the first things I did was to join the Medical Association - we all did. We recognised that the medical association was the one organisation which unified our whole wonderful profession. It was, and is, an organisation made up exclusively of medical doctors but including doctors from every medical discipline. As a house surgeon I attended the Auckland Medical and Dental Ball for the first time. We had to book early to get tickets and we had to hire dinner suits. We filled both the Auckland Town Hall and the Concert Chamber. I recall divisional dinners with more than 300 people present. I recall one divisional meeting, to discuss a controversial issue, to which there were so many attendees that we had to walk from Auckland Hospital's largest lecture theatre in the dark to a much larger meeting hall in the War Memorial Museum in the nearby Auckland Domain. Drug firms and instrument firms regularly hosted functions at which a sponsored lecture was complemented by a social gathering with colleagues from many branches of our profession. Frequently, lecturers were prestigious colleagues from overseas and such functions were often held in a hospital or clinical school. Family doctors, specialists and house surgeons enjoyed talking with each other, discussing mutual patients and mutual interests. Such functions are no longer acceptable and if they were, it is probable that few doctors would attend, at least in the big cities.
Ethical requirements have changed. There are many new restrictions imposed upon us through various vehicles. However, we no longer prescribe how our members may announce changes in our practice or the size of our nameplate on the door. Instead of relying on the respect and satisfaction of colleagues and patients to promulgate the quality of our work, we rely on the size of the advertisements we can afford and whether we are photogenic.
In 1967 our Association formerly recognised its independence from the British Medical Association and in the following year, 1968, our Coat of Arms was granted. Gradually, the Medical Association has ceased to be a main provider of our educational, professional and social needs but has been displaced by our professional colleges and societies, IPAs and cell groups and a host of other medical organisations.
However, the NZMA remains the only organisation which covers all the disciplines within our profession and which in doing so can nurture and preserve the collegiality which makes our profession different from almost any other. Ours is a profession which puts the needs of patients ahead of our own. In recent years, a decreasing proportion of doctors belong to NZMA and only a small proportion of those who do, attend the professional and social activities which NZMA has traditionally provided through its central office or its divisions. We seem to be losing that which only NZMA can supply. We tend to share activities only with those who have the same area of expertise, the same employer the same work group or who work in the same suburb.
Our medical schools have also lost their connection (or never had one) with many of the doctors practising in New Zealand. Use of medical school libraries and seminar rooms is restricted mostly to those medical and other health professions who work or train there. Modern security requirements and restricted parking, make such facilities inhospitable in evenings and weekends. Furthermore, many New Zealand doctors were not trained in New Zealand and do not identify with the alumni of our medical schools. Some barely know that our medical schools exist. Most doctors are no longer informed about lectures or other activities within our medical schools or how to use their library facilities. Only the NZMA has the breadth of representation to bridge the gap between medical schools and our wider medical community.
The Medical Council of New Zealand is the only other organisation which relates exclusively to all New Zealand doctors but our roles are complementary. The New Zealand Medical Association has the structure to preserve our professional integrity, pride and collegiality. For most of us the expectations of our medical colleagues and ourselves are a far more powerful motivation to maintaining high professional, ethical and personal standards, than requirements imposed by other organisations and the penalties available to enforce those requirements.
Our Association needs to increase its financial membership to fund and support its many important activities. However, this need creates a risk of our association over-stressing personal benefits of membership. I believe most members belong, not to have access to discount wine, but because we believe in the Association and what it has done and continues to do for all doctors , for our whole profession and for the welfare of all New Zealanders. What we need is for all doctors once again to recognize this & to want to belong. A bigger membership could mean more affordable subscriptions and a still bigger membership.
I have known of solo mothers struggling to support their family through part-time medical practice. They cannot afford to belong to the NZMA but our profession would be stronger if they did. There are other groups similarly placed. We need to support all doctors all the time, and establish or restore their sense of belonging to a great profession rather than to a small part of it. Then, hopefully, with time many more doctors will join the NZMA because they want to support the work it does and the professional role it plays.
Our association’s old methods of professional & social interaction have stopped being effective. We have to be innovative in finding new, technological and different ways to communicate with and involve all doctors and to enhance collegiality. Through our councils and in other ways we already work with general practice and specialty groups. Should we be identifying additional organisations with complementary goals and seek to establish joint ventures with them? Medical History Societies, Medical Law Societies, Medical School and hospital departments and various special interest groups may all benefit by reaching though us to a wider medical audience. To me, facilitating professional and social interaction between doctors in differing medical disciplines is the biggest challenge NZMA has to meet. Only when all New Zealand doctors feel part of our profession and almost all choose to belong to NZMA, can NZMA meet its full potential in helping to ensure that all New Zealanders enjoy the restoration & maintenance of good health to which our profession is dedicated.
On behalf of Auckland doctors I want to thank the board for your initiative in establishing an Auckland Council to facilitate professional & social interaction throughout the Auckland region. I sincerely hope that what you have started will be a template for the provision of such activities in other regions for nurturing the sense of pride and responsibility of belonging to our great profession. The New Zealand medical profession has been very fortunate with the quality and dedication of the people who have served them through NZMA on our board, councils and in our head office. Our board has an incredible line-up of past chairpersons. We are very fortunate that the present chairman, Pete Foley, has agreed to stay on for a 2nd term so we can benefit from the rapport he has established with the new government, his enthusiasm, his experience and his ability to fill with confidence, not only his fellow general practitioners but the members of every specialty. To do all he has done, and also maintain a general practice, has required great enthusiasm and talent, the respect and generous support of his Hawkes Bay colleagues and an ability to go without sleep. Thank you Pete. Thank you all members of the board and councils and to all the staff here in Wellington.
It is an immense privilege for me to follow Dr David Kerr as President of the New Zealand Medical Association -- the only association which embraces all branches of our profession, a profession of which I feel very proud to be a member. Thank you all.