The use of the reputation of the white coat

Last year alone, the government announced the construction of several dozen clinical and hospital centers, new hospitals and a major renovation of the health infrastructure. Many media outlets, in search of comparisons with countries in the region, wrote that hospitals are being built only in Serbia and that there has never been as much investment in healthcare as in recent years. Investments in healthcare in Serbia are, of course, necessary considering the state of our hospitals, health centers and other medical institutions. In the context of the serious departure of doctors and medical personnel from the country, non-transparent public procurement and the increasingly frequent horror stories we hear from maternity hospitals, homes for the elderly and other places where, above all, we should feel safe, the government, both in the campaign and outside, boasts not only by renovating the existing ones, but by accelerating the construction of future medical space shuttles on hundreds of thousands of square meters. Why is such communication about healthcare important for politicians in power and why is healthcare necessary for politics?

photo: tara radovanović / tanjug

SUPERLATIVES, GLAMOR AND THE ABSENCE OF VISION

Reading the news and headlines of the last few months, not to mention the whole of last year, we learned that the new complex of the General Hospital in Valjevo, instead of the current 15, will have as many as 24 facilities after the reconstruction of 110 million euros. For the reconstruction of the existing and the construction of a new children's hospital in Novi Sad, which the provincial authorities announced as the "crown of the revitalization of the health system", at least nine billion dinars have been earmarked. Glamorous announcements of new hospitals, capital investments and allocation of tens of millions of euros from the state budget resonate in other cities, and are most often announced by mayors or high-ranking government officials visiting local governments. For example, in Bor, the construction of a new hospital has been announced for the end of 2024, which will be a "central diagnostic center for the whole of eastern Serbia, with the most modern equipment", as announced by local portals. 260 million euros have already been invested in the reconstruction of the Clinical Center of Serbia, with the latest equipment, beds, diagnostics according to the highest standards. Apart from this, Belgrade should soon get a new facility for the needs of the Special Prison Hospital, as well as the long-announced new University Children's Clinic "Tiršova 2", the purchase of which is estimated at slightly more than 95 million euros. In April 2023, the Minister of Health, Danica Grujičić, announced the construction of a new GAK People's Front building on Bežanijska kosa, and at the same time a plan to close the covid hospital in order to find another purpose for those facilities.

By the way, according to the "New Economy" research, the construction of covid hospitals in Batajnica, Kruševac and Novi Sad cost us around 130 million euros. The arrangement of maternity hospitals and the construction of hospitals was mentioned as one of the main priorities in almost every election campaign, and the government particularly boasted about the figures that since the beginning of 2013, more than 25.000 workers have been employed in the field of health and that in five years the state has invested as much as one billion in healthcare. Of course, investment, construction, reconstruction of the entire health system is desirable and necessary, but it is very often an instrument of populist political communication and the absence of a vision of the system, which in most political statements focuses exclusively on physical space.

photo: bojan stekić

THE AUTHORITY OF ONE PROFESSION

At the same time, politicians like to surround themselves with the support of doctors, prominent medical experts, university professors, and directors of clinical and hospital centers. Not only are doctors the holders of electoral lists, but many are also representatives in the republican and city assemblies, mayors, and ministers of health. On the political scene of Serbia, a number of doctors have always been involved in politics - some of them, as they themselves claimed, entered politics to ensure better conditions for the profession and improve the system from within. Involvement of doctors in politics is most often through their participation in the work of local or republican authorities. In contrast to Serbia, global research shows that this type of political engagement of doctors is still rare because they rarely leave medicine for a career in politics.

Unlike lawyers, political scientists, journalists, businessmen, university professors, medical sciences prepare experts for concrete problem solving, for treating people and other roles that are closely related to science and not so much to management, administration or marketing. And that, as William Glaser once wrote, leaves them with no possibility of working full-time in a non-medical job such as government. In America, numerous surveys of doctors on the topic of their connection with politics revealed that the specialized knowledge and all the skills that doctors have painstakingly acquired would actually be "wasted" on any involvement in politics, especially on the administration and bureaucratic problems that they would have to solve in his political activity.

On the other hand, doctors are very interested in voting in elections and events in pre-election campaigns, so politicians are particularly interested in hiring doctors and seeking their public support in order to improve their public image. Why are doctors so important to politicians in the campaign? First of all, the research points to this interconnected, one might even say paradoxical relationship in which, on the one hand, the doctor is an exceptional expert who relies on knowledge and skills to be able to predict and overcome complicated problems. On the other hand, a politician relies on his own knowledge and personal relationships, but, many authors of political communication agree, his solutions are rarely predictable, sustainable and successful. Because of this, from the point of view of success and the reward system, "many doctors can only condescend to politicians and other pressure groups as incompetent and inferior," says Glaser. In considering the relationship between doctors and politicians, Cunningham wrote in the fifties of the 20th century that the "doctor's dilemma" arises precisely from the fact that politics is a "business of dirty hands", while medicine has always been a profession of "clean hands" - perhaps it can be interpret today's obsessive need for politicians to surround themselves with the support and authority of doctors, surgeons, heads of hospitals and other medical personnel.

The influence that doctors can have on the political fate of healthcare or a healthcare reform advocated by a certain political party stems primarily from the enormous influence that medicine as a profession has on citizens around the world. Therefore, the vast majority of citizens in all developed democratic countries trust doctors the most, and above all, their ability to make the right decisions when it comes to health, health care or the reform of some area of ​​medicine, public health. .

photo: Tanjug

MEDIATIZATION OF HEALTHCARE

Given such a degree of public trust and the reputation of the profession itself, doctors, as well as other scientists, have always been interesting to politicians. At the same time, the speeches of distinguished surgeons, specialist doctors, biotechnologists, nanotechnologists, epidemiologists and many others are often criticized, so they are objected to as some kind of "disguised lawyers" who only care about their narrow professional field, and that by participating in in the political campaign, they fight only for their own interests, while ignoring other problems and scientific research that could be on the list of priorities of politicians who could win power and really do something concrete for health.

In these performances, the media play a key role - the greater the doctor's authority in the profession and the greater the celebrity, the greater the influence he has on public opinion, on the perception of the politics he directly or indirectly supports. It is precisely in this aspect - in the mediatization of healthcare - that some authors see the main reason why the boundaries between science and politics, healthcare and politics are blurred, and they ask the question where the doctor ends and the political official begins. At the same time, the scientists themselves from various fields and disciplines, including medicine, who work in France, Germany, Great Britain and other Western European countries, believe that it is very important for them to have an influence on the public debate and to be present in the public through good relationship with the media. In this way, comparative analysis shows, they get more space to find sponsors for their research, but also political points if they are candidates or on one of the electoral lists.

photo: Tanjug

Some authors even consider that media communication about healthcare, medicine and science is actually a part of political communication, when the influence on public debate, system reform or political advocacy of certain positions is taken into account. In this sense, appearances by doctors in political campaigns can also be seen as an instrument for reaching some audiences or groups who do not think about politics or are not interested in politics, and who otherwise have confidence in the health system or doctors as people who solve their specific problems. problems. This also applies to the trust of citizens, which is reflected from doctors to other professions: the American public is skeptical of biotechnology and likes to create conspiracy theories about it, but is inclined to believe in the medical application of biotechnology because it is about the ultimate value - their health and concrete the benefits they can get from this.

Unlike in Serbia, in the USA, doctors most often give donations during the election campaign. Thus, during the 2020 presidential elections, more than nine million dollars were collected from American surgeons alone, of which 60 percent of that amount was donated to the Republican Party. Academic research on the participation of doctors in politics shows that during the last election cycle for the US president in 2020, the largest number of donations were made by orthopedic surgeons, followed by eye surgeons, neurosurgeons, urologists, and the least by plastic surgeons and pediatricians. Measurements of the origin of donations and affiliation with Republicans and Democrats show that among doctors, ophthalmologists give the most support to the Republican Party. This kind of political engagement of medical doctors shows that it is one of the surest ways for doctors to actually ensure a safe representation of their interests in the field of health and healthcare in the next mandate of the political party they support. On the other hand, some authors, based on such research, also talk about the political polarization of doctors in relation to their narrow specialty, since similar data were valid in the 2016 US election cycle when Donald Trump won. The preference of surgeons for Republicans is interpreted on the basis of the high degree of "conscientiousness" that surgeons have in relation to other individuals, claiming that the Republican political platform at the state and local level contains exactly that "value of personal responsibility". Of course, these are free assumptions and assessments of the authors who are engaged in examining the political preference of doctors towards certain political leaders and options. Other interpretations are more certain, which rely on the ideology of influence and favor of doctors as members of the "higher class" who earn extremely well and whose environment is such that it is based on wealth, profitability and conservative views on the world.

The author is an associate professor at the Faculty of Political Sciences at the University of Belgrade