I’m not surprised by the DomPost front page on hospital cynicism and chaotic management. I’ve had recent exposure to some professionally glum medics.

I gave the after-dinner speech to the Auckland Medico-Legal Association last Friday. I obliged the President by being deliberately provocative, urging the medics to assert some bottom line behaviour standards against patients who are needlessly dirty, insulting, ungrateful, aggressive, queue jumping etc. I suggested that they make examples of some of the worst of such people (of course excluding emergencies, psychiatric cases and others who can not help themselves) by sending them to the back of any queue, or refusing to treat until they fulfil their side of the social responsibility contract.

This was prompted by accounts of ACC claim figures and Aus statistics showing that caregivers, who should be revered for their willingness to put their lives into helping others, have among the highest rates of injury from assault.

I’d taken some trouble to check the various formal ethical statements, and swotted up on Hippocrates’ position. Last month I visited an Institute on the Greek island of Kos which promotes his philosophy in medicine.

The problem might be recent or Anglo-Saxon or Western culture specific. The Kos Institute representative found it hard to grasp the issue. I think to her only mad people would repay good with evil, even in an A & E department.

My Friday audience response, overall, was resistance. Sure, it might have been my poor delivery, but no one spoke up, or came up afterwards, to explore the ideas, or to think of variants that might address the problem. All the comments that did not minimise the specific problem, raised obstacles to any change. Most of the doctors felt they can control such behaviours. It is probably nurses who are more powerless.

What struck me was general air of discouragement. It must be wearing to work in a spiritless atmosphere – hating management but being cynical about all solutions.

Over some very pleasant drinks afterwards I was told that hospital productivity had probably dropped 20% as many medical professionals had given up going the extra mile to cover for system deficiencies.

They told me that older practitioners still did it, because that was how they were trained, but it was a value that was dying as the generations turned over.

 What a contrast with the can-do optimism at the Hi-Tech awards dinner I attended as Jenny Morel’s guest the next evening. The technology people are having fun. They’re risk-takers, and they’re fun to be around.

Bill English’s speech to them was short and sweet, telling them that the rest of the community had to recapture their delight in welcoming risk.