Reviews

Seven guidelines of wisdom

Doctors are expected to be wise. Nowadays people can access knowledge without our help. They want more from us than just correct decision making, and we expect wisdom of one another. The commonest complaint about doctors in trouble is that they lack insight.

Yet we receive no training in wisdom. We assume that it is randomly distributed and partly genetic, like musical ability. Over the past six years the BMJ has published only 13 papers with "wisdom" in the title or abstract. Three of them were about teeth.

Here at last are some guidelines. (1) Mix the generations: In modern Britain the only time that the generations mingle is at weddings. In hospital, consultants teach registrars, registrars teach juniors, and students teach one another. Intergenerational discourse should be reintroduced. Don't assume the flow of wisdom will be one way. (2) Take time for reflection: "Reflective practice" is a cliché in nursing journals but not in ours. If anyone passing my door sees me sitting and thinking I feel guilty. The only place where you could stare thoughtfully through the window used to be the train, but modern electronics have stopped even that. (3) Converse with lay people: This is hard. Many lay people have fixed attitudes to our profession, ranging from awe to resentment. Many doctors encourage these feelings. Concealing your calling is no help. We must converse as equals. (4) Dare to be unoriginal: Today's NHS is constantly seeking novelty. Its jargon has a six week shelf life. In this context it takes nerve to point out the obvious. Wisdom is old fashioned though it can be repackaged under a snappy title like "clinical governance." (5) Move around: This is increasingly difficult. Long ago undergraduates could move around Europe, but medical schools' seamless curricula now make this impossible. Regions are doing the same for specialist registrars. And consultants stay put. (6) Keep your sense of humour: Seriousness belongs in the consulting room. Outside, be a jester, whose job is to deflate pomposity. Good jokes depend on insight. Think of all the books called The wit and wisdom of . . . . (7) Stop reading articles with "guidelines" in the title: Whoever heard of a wise person reading numbered guidelines? Or writing them?

James Owen Drife, professor of obstetrics and gynaecology. 

Leeds