BMJ  2007;335 (17 November), doi:10.1136/bmj.39399.659144.47

Editor's Choice

The role of the doctor

In his report into specialist training in the UK, John Tooke asks, "What is the role of the doctor?" The answer may be too various for a single coherent answer. So much depends on context—the clinical setting, the patient's preferences, the doctor's experience and seniority. But is there an irreducible core to the doctor's role, regardless of the context? Tooke calls for a debate that will redefine the doctor's role. We would like to hear your views.

Why bother to try to define the doctor's role? Isn't this an outmoded, doctorcentric waste of time? I would say not, for three reasons. Firstly, the role of the doctor will dictate what sort of people should become doctors and what attributes those who are already doctors should strive to develop in themselves and others. In a different time, William Osler recommended imperturbability and equanimity (p 1049; doi: 10.1136/bmj.39385.642315.FA), while Samuel Johnson applauded selflessness and modesty (p 1049; doi: 10.1136/bmj.39398.491250.59). As for current commentators, Des Spence calls on doctors to cultivate the skill of sometimes doing nothing (p 1048), and in his book Better:A Surgeon's Notes on Performance, Atul Gawande emphasises diligence and the will to do the right thing (BMJ 2007;334:1115 doi: 10.1136/bmj.39210.473264.59). Other commonly cited desirable attributes are the ability to deal with uncertainty, to absorb complex information quickly, to make decisions under pressure, to show empathy, to listen. Are these still the right attributes for today's health care? We can properly answer this only when we understand the doctor's role.

Why else is the doctor's role important? Because it will shape the grounds on which doctors' performance is judged. In the third article in our series on measuring quality through performance, Glyn Elwyn and colleagues explore the implications of using patient satisfaction as a measure of the quality of care (p 1021; doi: 10.1136/bmj.39339.490301.AD). If the doctor's role were simply to please the patient, and if financial incentives ensued, patients and public health would suffer. One need only think of the pressure to prescribe antibiotics for minor illness. Before we can rely on patients' experience as a measure, patients need to understand the doctor's role in delivering high quality care.

Finally, defining the doctor's role is important when developing systems of care. At the very least, getting this right would ensure proper use of an expensive commodity. At best, it could mean more innovation and leadership. Ara Darzi—a doctor himself but now also a UK government minister—is charged with reviewing the structure of England's health service. He has promised clinical engagement as well as public consultation, leading to an interim report in January and a final report in June 2008. Based on his recent review of London's health system, the vision will include improved access, care closer to home, concentrating specialist services, and establishing polyclinics, while opening up the market to "any willing provider." Some have welcomed the new emphasis on clinical care; others have questioned the need for this review, and whether it will really improve the quality of care. I'll be interviewing Lord Darzi in early December. If you've got questions you'd like me to put to him, please send them as a rapid response (doi: 10.1136/bmj.39400.594595.80). And do listen to his answers when we post the interview on bmj.com.

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