Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Why are we here?
- Neville W Goodman (13 July 2007)
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Hear hear!
- Douglas A Holden (16 July 2007)
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Is the BMA fit for purpose?
- Jayaprakash Ayillath Gosalakkal (17 July 2007)
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Professionalism is alive and well
- Ian T Gilmore, Niall Dickson, Chief Executive, King's Fund (30 July 2007)
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Brown’s Bonds - the new approach.
- Anton E Joseph (30 July 2007)
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Is the BMJ [fit for purpose} ?
- Oliver R Dearlove (7 August 2007)
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Neville W Goodman, Consultant Anaesthetist Southmead Hospital, Bristol, BS10 5NB
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Roger Jones has written an important editorial in measured tones, but I think there is an aspect of cause and effect that he has skirted over, perhaps inevitably in a word-limited editorial. He writes, "The Shipman, Bristol, and Alder Hey enquiries, and a litany of errors, shook the foundations of public trust and professional confidence." I think this is simplistic if not actually misrepresenting what happened. These events gave the politicians, enthusiastically helped by a compliant media, the chance to control the medical profession. It was not the events in themselves, but the political responses to them, that led us to where we are now. Competing interests: None declared |
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Douglas A Holden, Consultant Anaesthetist Sherwood Forest NHS Trust NG17 4JL
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As ever, Neville Goodman makes a fine but crucial distinction. Competing interests: I am a doctor in the NHS |
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Jayaprakash Ayillath Gosalakkal, Consultant Paediatric Neurologist UHL Leicester
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The reason the BMA has lost most of its allure is because of the perception by many in the front line that it had become too close to the politicians. In the midst of all its altruistic functions in limiting tobacco and pontificating on medical migration it forgot it s primary reason for existence-To represent and defend its members. Many feel that its polite engagement has in many cases been craven submission to the political masters. In many cases it opposed its own or was lukewarm in its support eg: the legal fight by remedy uk, the international medical graduates fight against draconian visa laws etc. If it truly wants to represent and unite the profession it will have to hold a mirror to its own actions, consult the grass roots, introduce a one man one vote and be an organization for all. I think if it continues the way it is currently the profession will look elsewhere for advocates. Many have already voted with their feet! Competing interests: Continously exasperated by the lukewarm support for the frontline |
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Ian T Gilmore, President Royal College of Physicians, Niall Dickson, Chief Executive, King's Fund
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In 2004 and 2005 the King’s Fund and the Royal College of Physicians published important reports on medical professionalism1,2. Since then our two organisations have collaborated to take the messages from the reports round the country in a series of medical professionalism ‘road shows’, entitled ‘Do doctors have a future?’3. Messages from these events have been loud and clear. Professionalism is not dead – it is alive and well and flourishing in our health care institutions and amongst our health care staff – albeit inevitably a little bruised and battered by some of the events listed in Professor Jones’ editorial4. In addition it is clear that simply blaming politicians or changes in the NHS for all the profession’s current anxieties is neither accurate nor productive – there are wider forces which have challenged traditional practice and the role of doctors in society. A major part of our road shows has been gathering views on a range of topics relating to medical professionalism - leadership, values, education and training, appraisal and assessment, and health care systems. Although audiences have been mostly medical, a key feature has been the passion and remarkable consistency with which our 800 plus multi-professional and lay participants, spread over ten venues, have expressed their views. Do doctors have a future? Fifty-eight percent of those attending believed they do, although a large majority of doctors and non-doctors believed that trust in the medical profession is declining, with 53% believing that the ‘new contracts’ have been damaging to professionalism. However, with respect to the European Working Time Directive, concerns focussed not on the conditions of the directive itself, but on how it is being implemented – something that effective team working and professional collaboration can help to overcome. There was also widespread criticism of the quality of medical leadership – with around 65% of doctors describing it as ‘poor’ or ‘very poor’. Road show voting results can be found at www.rcplondon.ac.uk Participants saw core professional values as essentially unchanging although it was recognised in discussion that new ways of manifesting fundamental values and new skills will be needed for new circumstances. The key to maintaining professionalism is to adapt to changing times. Altruism was seen as still very important to medical professionalism, with strong leadership, professional support, and team working conducive factors, and control over work load and priorities conditions leading to altruistic behaviour. We hope that our work on medical professionalism will make a major contribution to what Professor Jones describes as reasserting medicine’s enduring roles and values. We do not intend to rest here. A report capturing the findings of the events – ‘Understanding doctors: harnessing professionalism’ - will be published jointly later in the year. The King’s Fund and the Royal College of Physicians are combining with the General Medical Council to put on a series of similar events with medical students, beginning early in 2008. As Professor Jones and others have argued, if the profession is to move forward there will need to be a new compact – that will require less interference from the centre and real clinical involvement in local decision making, but it will also require courageous leadership and more support for that leadership from the profession itself. For more information about the road show report or the medical student road shows, contact sue.shepherd@rcplondon.ac.uk or s.dewar@kingsfund.org.uk References 1 Rosen R, Dewar s. On being a doctor: redefining medical professionalism for better patient care. London. King’s Fund. 2004. 2 Royal College of Physicians. Doctors in society: medical professionalism in a changing world. London. Royal College of Physicians, 2005. 3 Do doctors have a future? Lancet. Vol 369 April 28, 2007 4 The future of the medical profession. BMJ 2007; 335:53 (14 July). Competing interests: None declared |
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Anton E Joseph, Consultant Radiologist Mayday University Hospital, Croydon CR7 7YE
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The sub title to Professor Jones’ editorial drawing attention to professional unity and respectful dialogue between government and profession is very timely. The new prime minister has set an example by inviting experts, setting aside politics to help him in governing the country. The BMA has a very specific role in this respect. Unfortunately Professor Jones does not take this need for cooperation much further. Sometimes in the past cooperation has led to unacceptable compromises. I wish to illustrate it with one example. The BMA was firmly opposed to the introduction of performance related pay (PRP). The BMA compromised by letting the government have its way with the introduction of local awards, the discretionary points, and the national awards. However following this the BMA, so as not to rock the boat, turned a blind eye to the criteria set for national awards by the DoH. These were the need for national or international recognition for the higher awards and that ‘outstanding and sustained service to the NHS in an exceptionally pressed post would not normally be the sole grounds for an award, and would not apply above B award level’. When it was brought to the attention of the then chairman of the CCSC that these criteria were detrimental to the interests of the smaller DGH consultants it was maintained that these criteria did not particularly ‘swing the balance in favour of academics’. Also admitting ‘that these changes had to be seen in the political context; crudely put, if we were to avoid the imposition of locally determined pay, we had to accept certain changes to the merit award system’. It needed the intervention of the CRE and following their verdict that these criteria also amounted to indirect discrimination of the ethnic minorities the criteria were dropped. Recognition of service to the NHS received its rightful place in the more recently introduced Clinical Excellence Awards. It would have been the expectation of every member of the BMA that the rights of the consultants in smaller DGHs’ would have been protected during the horse trading also meant to be in the interests of BMA members. It is therefore essential to strike the right balance between cooperation and compromise. One unfortunate approach that often interferes with sensible cooperation with the government is that adopted by the Mother of Parliaments in the name of democracy. Whatever the government proposes the opposition feels it should oppose and vice versa. This attitude trickles all the way down to the behaviour of management and trade unions. I sincerely hope that the example set out by the new prime minister will create greater bonds between management and trade unions and underplay the differences. Competing interests: No related interests |
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Oliver R Dearlove, Consultant Anaesthetist Royal Manchester Children's Hospital M27 4HA
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I had emailed Prof Jones asking where the evidence was for the statement “The Shipman, Bristol and Alder Hey enquiries and a litany of errors shook the foundations of public trust and professional confidence" and then commented that I was aware of a MORI poll that suggested that confidence in the medical profession had not been dented (1). It was possible that I was not an intellectual, unschooled in the best evidence based practice and so I had missed evidence more visible to others, cogent and applicable. [For those readers who want a short story, I hadn’t, by the way] The email reply that I had from Prof Jones was that I should look at Dr Goodman’s comment which the reader can also look at, above. Prof Jones thought the view rather complacent. In other words, the evidence as we know it, is lacking. If the premises are false then the conclusions from those premisses must be unreliable. I think in this evidence based age, the Editor of the BMJ should ensure that intellectuals great and good all of them, when they write their editorials should have some evidence for their assertions. Contrary evidence will not do. One basis for stating that Shipman has dented patient confidence is that the govt want it to be so, because this serves to promote the wasteful non-starter called revalidation. – on which reams has been written and a little by me. Dr Godlee should write out a hundred times: “I must not peddle government propaganda as science fact even though it may get me a knighthood: Richard Smith didn’t.” Oliver Dearlove Note: the reader may wonder if there has been any work on how doctors view their regulator. Considering how jaundiced the average doctor in the surgery’s view of the regulator is, the surprising answer is ‘yes’ and the unsurprising result is not very well. I refer to Hospital Doctor 26 May 2006 : “[the doctors polled] believed the GMC was biased, over burdensome and did not know what was going on at a local level. [The result were described as] rather worrying.” Why don’t people write more about this? I am sure the answer is there is no mileage in it for them. COI: Warning from GMC so by their own surprising definition I am fit to practise. Councillor of the RCA –these are not their views. These are not the views of my employer. I have been critical of MTAS, critical of MMC, critical of our leaders not leading and that of course includes the Editor of the BMJ. Ref, 1Medical scandalls leave trust in doctors unshaken. http://society.guardian.co.uk/nhsperformance/story/0,,487612,00.html Competing interests: as script |
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