Adultery: A Guide for Managing Ministers of the Crown

Policy Circular: 2011/969	Date: 19 December 2011
Issued By:	Department of the Cabinet
Distribution:	All Portfolios
Access:	Ministers’ Chiefs of Staff and Principal Media Advisors Chief Executives and Agency Senior Executives (upper tier)
Status:	Strictly Confidential – Not for wider distribution or citation
Effective:	Immediately

(NB This Circular replaces Policy Directive 2005/696: Handling Media Inquiries Regarding Ministers’ Private Lives.)

Senior public officers will be aware of some regrettable incidents that have in recent times come to light involving the personal conduct of now former Government Ministers. While these sorts of matters have historically been handled discretely and with minimal fuss, there has been a worrying trend in recent years for the media, doubtless spurred on by competition from new digital services and ready access to social networks, to focus anew on the more tawdry nether regions of public life.

Yet it is concerning to see so many of those in the public eye in their forties or even fifties who, in spite of these developments, persistently indulge in questionable behaviour in their ‘private’ lives with little care, thought or planning. If executives of more mature bearing can help in any way, it is to guide those who follow on the merits of Ministers behaving badly not just with a touch of style and saviour faire, but also with a modicum of caution.

For these reasons, the Acting Secretary-General of Cabinet has authorised preparation of this Confidential Policy Circular for the most senior levels of Government to address the important topic of philandering by Ministers of the Crown.

First, however, a cautionary note: In no way should this Circular be interpreted as recommending that criminal or corrupt conduct be condoned or covered up, particularly where those deeds allegedly involve young people of pre-consensual age. Those are matters for the appropriate legal authorities. The Government, after all, is not the Catholic Church.

This Policy deals only with issues of public morality involving consenting adults – not solely with adultery, but with all philandering in which there is either a spouse or partner potentially affected or where some form of secretiveness or duplicity is involved, and which may have deleterious political consequences for the Government were it to be exposed.

To that end a handy set of three case studies has been prepared to help illustrate the relevant points. In considering them, the reader should of course be mindful of there being many Ministers these days who are women, and more than a few who are gay or bisexual.

The examples given should therefore be seen as far as practicable as ‘gender neutral’, notwithstanding the fact that married male Ministers will unquestionably continue to pose the chief management challenge for those public officials concerned.

NB A warning – Ministers must at all costs be dissuaded from ‘screwing with the crew’. Neither public service nor ministerial staff are permitted to have sexual relations of any kind (not even the Clintonian kind) with the Minister to whom they report.

Should any such activity be detected, the staff member concerned will be transferred immediately to a far less attractive portfolio (and Minister).

Case Studies:

The inevitable affair with the younger woman

Husbands are chiefly good lovers when they are betraying their wives.

Marilyn Monroe

As Ms Monroe knew famously and too well, it is a truth universally acknowledged that a middle-aged husband in possession of a powerful job must be in want of a mistress...or at least an attractive young woman on the side. ‘Twas ever thus and ‘twill ever be.

Tell-tale signs of sexual distraction are legion and are similar to those signifying the pursuit of higher office: unusually careful attention to the ministerial appearance; smart contemporary attire; significant weight loss; and a hitherto unobserved interest in the gym, cycling and exercise generally. All that being so, how does a dedicated and responsible senior executive or staffer deal with the entirely foreseeable ministerial peccadillo?

Well, with careful management and planning, of course.

As with all senior appointments, identifying and weeding out unsuitable candidates for ministerial amore is an effort that will repay the careful bureaucrat or political staffer over and over again. Crucially, the Minister must be persuaded of the ground-rules for the affair. They are these:

• Never pursue a woman who is closer to your children’s age than to your own, or who is chronologically capable of being your daughter. This effectively means a maximum of about 14 years younger than the Minister – certainly, 15 years plus is dangerous territory
• Carefully vet the woman’s personality – vulnerable or psychologically unstable types can be alluring to an older man, but loopy babes are a media minefield – the time-honoured tradition of selecting an experienced (and, preferably, divorced) woman should be actively encouraged
• Be fully informed. Explore all you (lawfully) can about the Minister’s partner and their current relationship – is it open? Is she the jealous and vengeful type? Might she be playing away from home herself? (All the better if she is!); and finally
• The Minister should be strongly discouraged from choosing someone who is just a younger and more attractive version of his spouse, especially if their names are similar. There will inevitably be tears and potentially restraining orders as the girlfriend attempts to displace the wife entire, and not just her affections.

The notionally religious family man with a penchant for trade

Love is a game in which one always cheats.

Honore de Balzac

Here one dwells upon unhappy and troubling ground that necessitates a light tread but a firm hand. It is this example that throws into starkest relief the prevalent attitude of the media to personal privacy; about which, it is fair to say, tabloid journalists and editors take a view akin to sex workers’ position on celibacy. For the socially conservative married man with a taste for younger men, cheating is lamentable but unavoidable, and so is gristle for the media grinder.

Assuming as one must that a Minister’s off-duty sexual practices, coupled with his religious affiliation and marital status, will excite the most prurient of interest from anyone armed with a smart-phone and built-in camera, how does one protect the Government from unwanted and unwarranted denigration? Secrecy and deception is how: fight a smear with a smear of the lens.

The Minister must never visit young men at their haunts: no gay bars; no steam rooms; no ‘dance’ clubs; certainly no beats. His assignations will befit his station, to be conducted in quiet comfort away from the public gaze. And never let the Minister drive his own Government car alone after hours. That’s when real damage can be done.

It is an unwelcome liberalisation that Government drivers have been dispensed with in the small hours. Incorrigible gossips they may be, but they rarely go on the public record (unless they themselves are involved in the sexual shenanigans – but see the edict about staff above).

The engagement and use of sex-workers

My sexual preference is often.

Author Unknown

The advantages of employing prostitutes to satisfy the baser needs of public figures are well-known and need no great elaboration here. They are flexible, responsive, usually prompt and available on a fee-for-service basis – female, male or transsexual for clients straight, gay or bi. Thus services can be conveniently tailored to meet the needs of the busy and stressed Minister of the Crown.

Yet, even in these days of successful public health initiatives, there are traps of which every senior public officer supervising ministerial conduct should make him or herself aware. Much of the risk is down not to the sex-workers, but to others typically involved in the transaction, notably the Ministers themselves. This is especially the case where the Minister in question is a boorish, pompous or otherwise unattractive specimen – unfortunately, an all too common state of affairs.

Attentive observers will be aware of the unedifying spectacle of a call-girl recently being interviewed in the press about an alleged liaison with an erstwhile Government Minister. While one has a degree of sympathy for attractive and stylish young women being asked to engage (even when handsomely rewarded) in some form of sexual congress with particularly unappealing examples of Homo politicus, our principal concern here is the reputational risk to the Minister, not to his loins.

Where were the then Minister’s staffers? Why was a Minister of the Crown having a long ‘lunch’ without a senior staff member present?

Ministers need to be tightly-tracked and time-managed. They cannot be allowed, after an afternoon’s boozy lunch with prominent party donors, to have themselves quietly whisked off by mysterious third parties for a ‘neck massage’, no matter its putative therapeutic benefit.

If a Minister requires attention to any part of his or her anatomy, with or without a happy ending, it is crucial for senior staff to ensure that the right source is deployed to provide the service. Reliability and discretion are paramount. Payment methods need to be resolved that do not reflect ill on the Government: cash is good. In any event, arrangements of this kind need to be taken out of the hands of the Minister, let alone the clutches of lobbyists or their entourages.

It is with this advice that the care of good government is entrusted to all Chief Executives and Chiefs of Staff, now and in the future.

Dr Enrico Brik

A/Secretary-General

Department of the Cabinet

DEREGULATING MATRIMONY: FOR GAYS, STRAIGHTS, WHOMEVER...

Marriage is a great institution, but who wants to live in an institution?

Variations attributed to Groucho Marx and Mae West

Having myself been institutionalised twice – first, religiously, in my twenties and again, secularly, in my thirties – and also being somewhat bisexual, I feel uncommonly well-placed to comment on the current absorption with the topic of gay marriage.

Now, it is I think fair at once to stake out my default position – gay men and lesbians (and, for that matter, transsexuals et alia) should enjoy the same benefits as do heterosexual couples when it comes to matrimony: legitimate children; adultery; and ultimately, divorce.

Scholars of matrimony will know that the term originated circa 1300 from the Old French, matremoine, and before that from the Latin, matrimonium, meaning ‘wedlock, marriage’, which comes from the nominative matrem, meaning ‘mother’ + -monium, a suffix signifying ‘action, state, condition’. Thus the origin of ‘matrimony’ is the action, state or condition of, or bringing about, mothering. (In fact the Catholic Church, a trifle oddly, defines matrimony as ‘the office of motherhood’.)

Clearly then, the link between marriage and begetting of (legitimate) children is etymologically intimate.

While adultery and divorce are long-revered states and themselves need no defence, the motivation for legitimate children these days is so thin as to barely amount to a rationale at all: there must be many thousands of schools across the western world where the challenge would be to find a pupil born in wedlock whose parents were still co-habiting.

So, the deep desire for matrimony now is surely due to something far beyond the legitimising of children. But what might that be? Not being a lawyer, I thought hard about it and, in search of a deeper understanding of the status of matrimony, resorted to an incontrovertible source – Wikipedia. There I learnt that:

Marriage (or wedlock) is a social union or legal contract between people that creates kinship. It is an institution in which interpersonal relationships, usually intimate and sexual, are acknowledged in a variety of ways, depending on the culture or subculture in which it is found. Such a union...may also be called matrimony. Marriage usually creates normative or legal obligations between the individuals involved.

Well, that’s pretty broad. Nothing excluding queers there. But I’m still not clear on why so many people want to say ‘we do’ to gay marriage. After all, it’s scarcely paradise on earth for straights.

While it’s hard to explain the continuing attraction of matrimony in the modern world, the risks are easier to identify: At the advent of one’s first marriage, it would do well beforehand to hear the American proverb: The most dangerous food is wedding cake. Beyond that, why not consult Samuel Johnson on second marriages: they are the triumph of hope over experience. (And so a third or subsequent betrothal is surely the surrender of hope to delusion.)

Thus, one of the great advantages of being homosexual is, in my view, the avoidance of any general expectation of matrimony. Being gay, why would one want to marry at all? It is rather like, having been told one has a natural immunity to a particularly nasty and long-lasting disease (say, hepatitis C), electing nevertheless to go through the onerous and unpleasant treatment regime.

* * *

The Commonwealth Marriage Act, 1961 defines ‘marriage’ as, the union of a man and a woman to the exclusion of all others, voluntarily entered into for life. This definition, incidentally, was added by the Parliament not in the previous millennium but in 2004, explicitly to exclude those you-know-whos...

But leaving aside the whole a-man-and-a-woman thing, have you ever in all your days heard or read anything so preposterous? To the exclusion of all others? Entered into for life? What nonsense this is.

Haven’t these parliamentarians experienced any adultery and divorce? Don’t they watch TV or the movies or read blogs and books? Can’t they Google like the rest of us?

They need to get out more. Much, much more. And soon: well before they get to vote on any proposed amendment to the Commonwealth Marriage Act.

Indeed all this debate raises an important prior question: Why is there a Commonwealth Marriage Act at all?

The historical answer is constitutional. Here I am indebted to the Australian Parliamentary Library – the Commonwealth's power regarding marriage comes from section 51(xxi) of the Australian Constitution, which states:

The Parliament shall...have power to make laws for the peace, order, and good government of the Commonwealth with respect to: Marriage.

The effect of the Marriage Act 1961 and the Constitution is that the Commonwealth has exclusive jurisdiction over the formation of marriages in Australia – there is no room for States to legislate (although State laws may govern civil unions and de facto relationships). This however does not mean there must be a Marriage Act. There is no reason that section 51(xxi) of the Australian Constitution could not lie fallow, as do some other sections of the Constitution.

Tangentially, the Family Court in a 2001 case (Re Kevin) found that a post-operative female-to-male transsexual had validly married; but that this does not affect the current orthodoxy that a marriage has to be between members of the opposite sex.

Hold on. Does this mean the case-law applies only to post-operative transsexuals?

Hell, maybe then a pre-operative transsexual man-to-woman can’t marry her boyfriend unless she goes through gender re-assignment surgery. Gee, that seems a bit harsh. It’s expensive, painful and potentially dangerous, you know. And the guy might love her precisely because she’s a chick-with-a-dick. (Addendum - See comment below on recent High Court case).

But who honestly cares? In reality, the contemporary social edifice of matrimony is hypocritical tripe – just contemplate if you dare the nowadays routine occurrence of multiply-divorced parents happily escorting their adult children for the first time down the sorry old aisle. In my experience gay men and lesbians are on the whole far too sensible to be seduced by such drivel.

Yet, having said that, why should we accept and expect the lives of innocent heterosexuals to be traduced by such tradition?

What’s the point? Legally, it could all be done through de facto relationship/civil union legislation, with default provisions for couples over 20 and co-habiting for more than two years, or for less time if they have children from the relationship, and a sunset/re-negotiation clause that could come into effect after, say, 10 years, but would not be triggered as long as (mutual) love shall last: what in effect we have today with the legal architecture of marriage and divorce.

This wouldn’t preclude the important business of weddings, by the way. It would just make them legally otiose. Love-struck couples no doubt continuing to be so inclined, they would still be able to indulge in their religious, secular or simply bizarre ceremonies on land, at sea or in the air. Women (and indeed men) could still play princess for a day at the inordinate expense of their families.

Yep, the solution to the ‘problem’ of gay marriage is self-evident: repeal the Commonwealth Marriage Act, 1961 and replace it with...nothing.

Now, If only there were a (pre-operative) transsexual parliamentarian I could interest in my proposal.

An edited version of this piece appears on the online journal New Matilda at http://newmatilda.com/2011/12/09/repeal-marriage-act

KYLIE, MARY AND ME: AMONG THE DESERVING MANY

It is better to deserve honours and not have them than to have them and not deserve them.

Mark Twain

Obviously Mr Twain did not work in the health system; an industry many readers will know is replete with honours and the honoured, merited or otherwise. Indeed I find myself writing today having recently returned from Boggabri – one of the lesser known gems of inland northern NSW – as the proud recipient of an honorary doctorate in Health Politics.

The polyester bonnet now hangs in my office next to the plastic stethoscope given me by grateful staff to mark my departure from a senior health consulting role in NSW in 2009.
But why Boggabri, you ask? Because, interested reader, this little town hosts the southern hemisphere’s sole outreach campus for that citadel of Slovak tertiary education and research – the Scientific University of Bratislava. Like the universe, globalisation may be bounded, but it is infinite in its reach.

Having a few hours to mull over the import of this elevation while wheeling my azure 1987 Maserati Biturbo back home down the New England Highway, my mind turned to those other worthies I know of connected in some way to the health system who have been similarly honoured for their selfless dedication and years of quiet achievement. And to why there appear to be so many people in health in particular with doctorates or the like.

Much of this can of course be attributed to the title, Doctor: it holds a long-esteemed place in the western (and not only western) socio-cultural landscape. Those with a penchant for etymology will know that the term can be traced back to the middle English of about 1300, when the noun meant ‘church father’, coming from the old French, doctour, and before that from the medieval Latin, doctor, meaning ‘religious teacher, advisor, scholar’. That use came in turn from the classical Latin verb, docere, meaning ‘to show, teach’ and, originally, ‘make to appear right’.

Later in the 14^th century the term acquired the meaning, ‘holder of the highest degree in (a) university’, the sense in which we are interested today. About the same time, it also began to be used as a title for medical professionals; eventually deposing in the late 16^th century the previous epithet, leech. I wonder why such a change occurred? Along the way, the verb ‘to doctor’ acquired in the early 18^th century the meaning ‘to treat medically’, and from the late 18^th century the sense of ‘to alter, disguise, falsify’.

So there we have a potted history of the term, doctor. But what has this to do with Kylie, Mary and me?

Well, many of you would have been overjoyed, as I was, to hear in October 2011 of the award made to the then Ms Kylie Minogue of an honorary Doctor of Health Sciences by Anglia Ruskin University in Chelmsford, Essex (in southern England), for her work in raising awareness of breast cancer – a hitherto little-understood condition experienced by thirty-something pop singers and other female celebrities.

The singer, who was diagnosed with the disease in 2005, underwent chemotherapy and surgery before resuming the career that has made her a star in Britain, Australia and elsewhere. The university noted that her well-publicised diagnosis has been credited with encouraging young women to undergo breast screening: the so-called ‘Kylie Effect’.

So, she received her honorary doctorate for being famous, ill and prepared to self-publicise in the interests of others.

By contrast, Mary Foley is one of the nation's pre-eminent professionals with a distinguished career in Australian health care in both the public and private sectors. She is now the Director-General of the NSW Ministry of Health. Immediately before taking up that appointment, she was the National Health Practice Leader for Pricewaterhouse Coopers. She is I understand also the longest serving member of the Board of Trustees of the University of Western Sydney (UWS).

UWS tells us that the then Ms Foley was the Telstra Business Woman of the Year in 1998 and received a Centenary Medal in 2003 for service to Australian society in business leadership. She has also served as director on a number of prestigious boards, including the Garvan Institute of Medical Research, the Victor Chang Cardiac Research Institute, and the St Vincent’s Research and Biotechnology Precinct. She was awarded an Honorary Doctorate of Letters honoris causa by UWS in 2010.

Thus, each of us is now a proper doctor – that is, have had conferred upon us an (admittedly honorary) doctorate. We are not to be confused with those doctor doctors, who hold just a couple of bachelor degrees (typically MB,BS – no better really than BA,LLB; or BEc,BBus; or BSc,BEng).

While I do not know if the popette is yet referring to herself as Dr Minogue, I have been aware for a while that Dr Foley has decided, as I have, to embrace the title (no matter how modest she may otherwise be).

Imagine then my consternation when I found out only a day or so ago that a certain Matthew Knott, writing in some scarcely-known web journal called The Power Index*, had produced a piece in October 2011 chiding the aforementioned Dr Foley for employing the honorific as her preferred title.

Really! Doesn’t he understand how important it is to be able to face the doctor doctors on equal terms?

Mr Knott – who evidently grasps little of the highly competitive, status-driven environment and the atmosphere of pomposity that pervades the health landscape – quotes the churlish views of an anonymous informant that there is ‘increasing discomfort among senior clinicians and public servants about her use of the honorific’.

Well, Mary, I can tell you we policy consultants are absolutely fine about it. Especially those of us who hold honorary doctorates from obscure Eastern European universities.

The petulant health system gossip adds that ‘there is also a view that Foley’s ego trip could lead people to wrongly assume that the country’s biggest public health service actually has a qualified medical practitioner at the helm’.

Hell no! NSW couldn’t be that silly, could it?

Well, no and yes. Dr Foley isn’t a medical practitioner (thankfully); but she has been mistaken for one – by her own organisation, no less, which continues to cite her thus in the list of members of the NSW Mental Health Taskforce. (Indeed, here is a link: http://www.health.nsw.gov.au/news/2011/20110602_03.html.)

But, apart from this bureaucratic misstep, how could Dr Foley’s use of the title be possibly considered an ego trip, when it clearly reveals a deep insecurity about one’s status and doubts about one’s intellectual credentials. Oh. Hold on...

Look, OK. There could be something in that. But be fair. We in the health industry have to put up with some people who don’t have just one actual, wrote-the-thesis-and-got-the-hat doctorate, but occasionally two or more. And a few of them are even medical practitioners as well! While one real PhD is meritorious, having two doctorates is a bit obsessive; and three is just plain showing off.

Little wonder Mary and I (and maybe Kylie, too) are determined to use the honorific, Doctor.

At least we are in good company. Just look at all those clinicians with a couple of bachelor degrees who are doctors qua medical practitioners, but insist on the title ‘Doctor’. And, infamously, these days not only medical practitioners, but also vets, dentists, and even osteopaths (quelle horreur!) call themselves ‘Doctor’. Where will it end? Podiatrists? Speech pathologists? Surely not nurses...!?

There are very few professions these days whose name also confers a title. Once, in medieval England, a commonplace – Farmer Smith, Goodwife Jones – it is a quirk now limited principally to the military and the church. We do not, for example, call solicitors, Lawyer Pellegrini. Nor do we abbreviate an architect’s title as At Seidler. Yet doctors are called ‘Doctor’ as captains are called ‘Captain’. (Interestingly, however, the obverse is not the case: Holders of a doctorate are given the title ‘Doctor’ even though they usually are not, and are not called, doctors as a professional description.)

So, being a doctor (qua medical practitioner) does not itself entail or justify use of the title ‘Doctor’: that use is an honorific. And, as noted above, it is an honorific no more merited than the use of the same honorific when one has received (only) an honorary doctorate. With such abundant and deserving company, Mary and I should be feeling much more comfortable about calling ourselves ‘Doctor’.

Now, I wonder how the Scientific University of Bratislava is about the use of the title, 'Professor’?

* ‘Let the doctor debate begin’, by Matthew Knott in The Power Index, Friday 21 October 2011 http://www.thepowerindex.com.au/power-move/let-the-doctor-debate-begin/20111020594

THE ROLE OF DOCTORS* IN HEALTH SERVICES PLANNING AND MANAGEMENT: ALTRUISM, EXPERTISE AND LACK OF ENGAGEMENT AS PERCEPTUAL DISORDERS

The name and pretence of virtue is as serviceable to self-interest as are real vices.

Francois de La Rochefoucauld

On 20 July 2011 Dr Steve Hambleton, a Brisbane general practitioner and President of the Australian Medical Association (AMA), gave a speech to the National Press Club in Canberra on Fixing Health.

In that speech he said, ‘Evidence shows that where doctors run the management of hospitals, results improve and morale is better’, and added that, ‘if (deeds and actions) are bad for doctors, then they will be bad for patients and bad for our health system’.

In a speech to the AMA Parliamentary Dinner on 17 August 2011, Dr Hambleton reiterated his views and added that, ‘You cannot improve the health system by ignoring the opinions and advice of doctors’...‘(doctors) have the knowledge and experience to make the system work better’, and ‘they are (the) best possible health policy advisers.’

So, what is an intelligent impartial person, concerned about health policy and public administration, to make of these views? Having had some years’ experience dealing with medical practitioners in health services policy and planning and, to a lesser extent, hospital management, I thought I could assist a wider understanding by offering something in the way of explanatory analysis and comment.

But first, a thought experiment.

Imagine if you will a very smart eighteen-year-old, freshly out of high school and off to university. This kid has been told for years they are among the brightest and the best. Academically, they have performed in the top 0.5% of their state. They decide to study medicine. Why? The usual reasons – status, calling, intellectual interest, psychological suitability, family pressure, future wealth, or maybe a combination of some or most of these drivers.

What they are taught and learn, above all, is how to be a highly-skilled technician. As they progress and specialise, their status, wealth, intellectual satisfaction and sense of purpose and achievement rise accordingly. Of all the technical careers one can choose, medicine and surgery rank among the best-regarded. These are demanding careers of great human worth and social value, and their practitioners are rewarded handsomely, in both financial and non-financial terms.

But how do medical practitioners perform at all the other things we require of senior policy thinkers, health executives and leaders? Well, in my experience, and in the experience of just about everyone I have talked to in this business (including some doctors), no better than the rest of the population. And, on average, not as well as other intelligent, well-rounded people who have studied and worked in the wide range of areas that comprise a complex modern health system.

Not surprisingly, what most doctors are good at is doctoring. Intelligence comprises a complex set of qualities. It is passing rare for most aspects of intelligence to be optimised in any one individual; even in those who as teenagers ranked in the top academic 0.5% of their peers.

The qualities of medical practitioners we value are these: diagnosis, rectification and prevention of problems associated with complex psycho-physiological entities, AKA us. Most are employees, or self-employed, or partners or directors of small to medium enterprises. A few have entrepreneurial or high-level management skills, and some show fine leadership qualities – but many of them would struggle to run a school tuck shop without ‘support’. As health managers, they make great doctors.

Yet the problem here is not only about the qualities that most doctors lack – it’s about the ones they have. And what they have, as we all do, is baggage.

The encumbrance in this case is an egregious confirmation bias toward their group.

What evidence, for example, does Dr Hambleton allude to in support of his claim that, ‘where doctors run the management of hospitals, results improve and morale is better’? None, of which I am aware. Of what would such evidence comprise? A survey of doctors?

And what of the claim that (doctors) ‘have the knowledge and experience to make the (health) system work better’. What is Dr Hambleton’s evidence for that? Feedback from AMA members?

But most revealing is his statement that, ‘you cannot improve the health system by ignoring the opinions and advice of doctors’. This at a parliamentary dinner at which Federal Ministers from the Prime Minister down were seated at tables of AMA members...access not ordinarily enjoyed by any other part of the health system.

To pretend that the opinions and advice of doctors’ is ignored by health service executives and planners is risible in the extreme. Numerically one of the smallest parts of the public health system, no other group comes remotely close to exercising as much professional influence and economic coercion on health service systems and delivery. Doctors are, as a rule, engaged to standstill.

So, how could Dr Hambleton seriously arrive at his conclusions? Is it just advocacy of group interests? No. It is that, of course, but it is more. Because many doctors actually believe they should be running all health services. (Indeed I have had one senior VMO surgeon tell me during a surgery planning session – when he wasn’t entirely getting his way – that doctors will just have to run the hospital.)

The AMA’s only plausible complaint could be that doctors are not in complete control.

Being told over and over again for years that one is brilliant, outstanding, or exceptional; it must be very seductive. Only those with the most robust sense of equanimity would fail to be flattered. Being surrounded by and accepted into a revered clique of similar standing, awash with arcane practices and near insuperable barriers to entry, only serves to reinforce a sense of meritocratic hierarchy. Little wonder some doctors – particularly senior specialists – behave as if they’re God’s gift...

Doctors who move into senior health management and policy leadership ultimately must go through a moment like Charles Erwin Wilson, the General Motors (GM) President appointed in 1953 as US Secretary of Defense. When asked in a hearing if he could make a decision adverse to the interests of GM, Wilson answered yes, but added that he could not conceive of such a situation, ‘because for years I thought what was good for the country was good for General Motors and vice versa.’

Yet it appears that Dr Hambleton would, at least at present, fall short of even Mr Wilson’s meagre threshold. Other than demonstrating that the AMA President is, perhaps ex officio, unfit for senior health system management or service planning leadership, what do his statements tell us about doctors compared, say, to other technicians?

Plumbers, on the whole, are unlikely to think that town planning is a complex bureaucratic system developed solely or mainly to provide plumbing services to households, businesses and institutions. Whatever their intellectual limitations (as a group) may be, plumbers are neither so silly nor arrogant enough to think that their function is the only or principal purpose in planning new developments. Important, yes. Indeed, essential for a safe and clean environment. But not the main game.

If only doctors were as sensible and proportionate in their expectations. But alas, they are not and most cannot be, because for them medicine is health and vice versa. And so, mutatis mutandis, they cannot conceive of a heath system other than as a grand structure to support and deliver medical practices. But most of us know that health is way, way more than this. Just as defence is not just about who builds and supplies jeeps, trucks and other vehicles. Not even in 1953.

What’s good for medicine, and for doctors, is not necessarily what’s good for the health system. What’s good for patients is not necessarily what’s good for doctors. Even leaving aside the obvious financial considerations and matters of malice or incompetence, interests sometimes coincide and sometimes conflict. Whatever their merits, health complaint systems are full of such cases.

It is a fact now quite widely known and well-evidenced too that many doctors, when confronted with the option to undergo the same procedures they typically recommend to their patients, choose to forego them. Any doctor who fails to understand this point about divergent interests is frankly unworthy of a senior role in a public health service.

Confusing the part for the whole is known in analytic philosophy as a mereological mistake.

Smart people avoid being tripped up by such altruistic illusions, unless their baggage is blocking the view. The best way to get over your baggage and take the trip that wisdom asks of us – the journey to abstraction – is to leave the old suitcases where they are and move on without them.

Abstraction is a crucial quality for those in senior management, planning and leadership of services for the public good. It is the capacity not just of looking beyond self-interest and putting oneself in the shoes of others (the altruistic position), but of moving to an impartial point of view that considers the overall public interest and prepares one to take a position that may be detrimental to oneself or one’s group.

Only doctors who no longer especially care about the interests of doctors are capable of abstraction. There are some; but they are few.

And Dr Hambleton and those who think like him do not count among them.

* By ‘Doctors’ it is of course meant, doctor doctors (ie medical practitioners), not real doctors (ie people with a doctorate), apart from those who are also medical practitioners. In this article, vets, dentists and other clinicians are not included in the category of Doctors.