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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
A question for the primary care review
- Hendrik J Beerstecher (16 November 2007)
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Becoming a doctor
- Hugh Mann (17 November 2007)
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Role of a Doctor
- Dr A. Breck McKay (17 November 2007)
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The role of the doctor
- Michael J Tayler (17 November 2007)
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Role of a Doctor
- Shiv S Budihal (17 November 2007)
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Role of a doctor
- David I. Ben-Tovim (19 November 2007)
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A dilemma: to be or not to be a doctor
- Dr. Rajesh Chauhan (19 November 2007)
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Role of Doctors
- Ramaswamy Subramanyan, Jaikumar,S (19 November 2007)
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Pondering the role of a doctor
- Mounir E Nassar, M.D., FACP (19 November 2007)
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Role of the Doctor
- Edward M. Fitzgerald (20 November 2007)
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role of doctor
- Robert V Koepp (21 November 2007)
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The role of doctors- a view from beyond!
- Paul Thomas (21 November 2007)
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Core Value - Tough Love from Caring
- Richard D Colman (21 November 2007)
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Doctors' role
- E Hassen (21 November 2007)
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The Role Of The Doctor
- Jane.A Calne (22 November 2007)
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The Role of the Doctor - Diagnosis and treatment
- David M Bowker (23 November 2007)
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Role of the Doctor
- M J Pocha (23 November 2007)
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Redifining thr Doctor's role : The Need and Basis
- Dr.Bhalendu S. Vaishnav (26 November 2007)
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First need to know what makes a doctor to know their role
- Taiyyab Mehmood (29 November 2007)
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Hendrik J Beerstecher, GP principal 111 Canterbury Road, Sittingbourne, Kent, ME10 4JA
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Why are primary care contractors not offered equitable terms and conditions? It is good and well that alternative primary care providers are brought in, but they often receive double the funding and have no obligations to offer basic terms and conditions to employee physicians, nor do they have to offer staff access to the NHS pension scheme. Is it not time to standardise payments for services and infrastructure to create a level playing field? Competing interests: I am a GMS contractor |
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Hugh Mann, Physician Eagle Rock, MO 65641 USA
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Becoming a doctor is extremely difficult. A medical education is like an ultra-marathon. There are four years of college, four years of medical school, one year of internship, and three to six years of residency. The curriculum includes anatomy, physiology, pathology, biochemistry, and pharmacology - but excludes nutrition, hygiene, safety, and common sense. Throughout medical school, internship, and residency, young doctors are required to take night call, which means going without sleep. In addition to sleep-deprivation, young doctors must cope with cafeteria food and frequent tests. The net effect of this ordeal is that many young doctors are malnourished, overworked, exhausted, and dazed. This is why most doctors do not have fond memories of their medical education. As an intern on morning rounds, I remember an attending physician saying that if he woke up tomorrow and found that he was a second-year medical student, he would hang himself. We all laughed in pained agreement, because we understood the rigors of medical education. But young doctors do not understand that medical education is a brainwashing process, sponsored by the pharmaceutical industry. It's ironic that young doctors must sacrifice their health for the sake of an education that does not fully prepare them to cure themselves or their patients.
Competing interests: None declared |
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Dr A. Breck McKay, Physician Brisbane 4165
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The answer is simple... doctor means Teacher.. so the doctor must have all the good qualities, but above all must be able to teach the patient, but from an equal footing. What a shame so few understand, this let alone do it! Competing interests: None declared |
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Michael J Tayler, GP, full time The Surgery, Thaxted Essex. CM6 2NE
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please ask Lord Darzi, As a surgeon and politician, what do you think is "The Role of the General Practitioner?" Thank you. Michael Tayler Competing interests: None declared |
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Shiv S Budihal, consultant Basingstoke RG24 9NA
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Role of a doctor in the intensive care unit, doing,is not the same as that of a doctor sitting in the psychiatric clinic,listening. Role of doctors is not uniform and one size does not fit all. Differant specialities need differant attributes. Competing interests: None declared |
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David I. Ben-Tovim, Director, Redesigning Care Flinders Medical Centre
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Let us not get too carried away by self-aggrandisement. We work in a profession in which we seem to find it inevitable that one in twenty (being generous) of our patients suffers serious harm during a hospital stay. Why don't we set ourselves the following tasks- to provide care that is as safe as the toys produced by a run of the mill toy manufacturer, in as clean an environment as the world's bottom from last maker of electronic components for personal computers. Or are we at those levels already? If not, let us concentrate on the modest goal of providing safe care before worrying about more esoteric concerns Competing interests: None declared |
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Dr. Rajesh Chauhan, Commanding Officer & SEMO MH Baroda, INDIA _390008 (309/9 A.V. Parishad, Sikandra, AGRA. INDIA - 282007)
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Dear Editor, Down the ages, doctors always possessed a sombre and elevated place in society. This perhaps was never linked to their earning potentials. Wherever they were and with whatever meagre earnings, they still were role models for the society. Irrespective of what the future held for their children, many parents probably nourished the dream of their children becoming a doctor on growing up, for the recognition, stature and respect that would accrue from helping the sick. Albeit with the boom of market economy, the pay packages and material comforts are increasingly associated with recognition and respect. These are more of a prerequisite now for the desired push and acceleration for upward mobility, and the interconnected and interlinked recognition. Primarily, we must therefore rethink on whether the career as a doctor is lucrative anymore and sufficiently rewarding. While the medical fraternity is exploring the answers to medicine’s downslide, these intricately related factors need to be delved into by the masters and the policy and opinion makers, since alternative high-flying, high paying and less tedious career opportunities are nowadays readily available aplenty for the youth. It is painstakingly tough to become a Doctor taking 7 to 10 precious years of the prime life in this process, which is extended further with the pressing need of super specialization in the competitive atmosphere, fragmenting the medical care in the process and leaving a General Practitioner aloof when he can be the fulcrum and easily provide effective care to around 60 to 70 percent of the sick. Since alternatives careers are available offering promise of comfortable settlement in a short span with good pay packages and promotions, opting for medical profession perhaps would be relegated a last priority. Where is the necessity of becoming a doctor, when one can ‘make it in life’ with just half the efforts. Moreover, with the hefty pay packages in other careers, one can employ services and attendance of any number of doctors at any point of need, thus escaping and being relieved of becoming another sacrificial lamb for the society themselves. Under prevailing circumstances, earnings are still immaterial for most doctors, except for whatever is necessary for a decent living. Nevertheless, due recognition and respect from the society continues to be cherished and expected by doctors. In relative terms, all these expectations are faring poorly and he is increasingly being treated as a commodity. To top up, there are liability implications. So what must a doctor do now? Regards. Dr. Rajesh Chauhan Competing interests: None declared |
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Ramaswamy Subramanyan, Professor & Head Department of Pharmacology,Aarupadai Veedu medical College & hoispital,Pondicherry 607 402, Jaikumar,S
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We read with interest the article on " Role of Doctors" and associated rapid reponses. Delivering best health care not only depends on proper diagnosis and therapy. Unless communication between the treating physician and the patient is established, it will be a difficult task to render best health care. Attempts to improve communication skills should start from undegraduate curriculum and regulary practiced in the subsequent years. Such attempts is one of the approaches that Doctors should practice while delivering health care especially in developing countries Competing interests: None declared |
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Mounir E Nassar, M.D., FACP, Retired physician from clinical practice Pittsford, New York 14534
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To define the role of a doctor comes to mind a physician who is asked to write a docunentary describing his or her life's work at the patient's bed side,in the emergency department,on patients' wards, consultations in the intensive care unit/ coronary care unit, teaching aspiring young physicians, nurses, and patients or their families diseases or health care issues and prevention, and does not know where to begin. A physician in many roles, wearing many hats. He is supposed to have been taught sound medical primciples of diagnosis and treatment embracing all medical/surgical specialties and how to provide health services to the patient in a quiet unassuming compassionmate way, keeping in mind the Hippocratic Oath and to do no harm. However,contemporary medical times have changed the physicians role. Medical business,and medicallegalclaims have been imposed on the physician raising many ethical questions. Medical patient privacy has been eroded with the introduction of electronic records as well as peer reviewers or of third parties. The pressure to learn of the many medical advances. The rising influence of paramedical persons and their role. The role of the doctor has been diminished, to not so important position. The question to ask is not what is the role of the doctor nowadays, but rather can he regain his role. Competing interests: None declared |
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Edward M. Fitzgerald, Orthopaedic Surgeon, Private Practice 175 S. Union Blvd., Suite 200, Colorado Springs, CO, 80910
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There is only one role of the physician that cannot be replaced by a computer or a robot; a compassionate guide for a patient through the journey of an illness. E. Fitzgerald Competing interests: None declared |
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Robert V Koepp, research coordinator Children's Hospitals and Clinics of Minnesota, MN, USA 55404
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Perhaps it's too obvious to need stating, but the role of a doctor is to use expert knowledge of processes of health and disease to promote the former and minimize the latter. The rest of what it takes to be an effective doctor is secondary to this, the primary objective of medicine. Competing interests: None declared |
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Paul Thomas, Retired GI Surgeon Woodford IG8 0QQ
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I enjoyed reading this week's journal and it made me think of what patients might expect of their doctor- so here is a distillate of a few years experience. I suspect at the end of the day the core values of doctors will not have changed but they have been temporarily misplaced because there is so much else going on around medicine. It's a good time to bring these values to the forefront again. I regard a doctor’s clinical roles as essentially simple in their objectives- firstly to differentiate between the temporary unwell and the ill with accuracy, secondly be decisive and confident in giving advice on therapy in its broadest sense and then thirdly ensure each patient has access to the skills and facilities required. In short sort out the problem for the individual patient. Some would call this approach paternalistic – but who would accuse their plumber of being so when they respond to your call for help -so what is the difference? All of the above can be handled in terms of opinion and advice and not dictats and patients, if they choose, should be involved in the decision making. What is frequently forgotten is that a significant proportion of patients would prefer the doctor to act on their behalf and are confused by being faced with important decisions at a time when they are already stressed. As patients differ in personality and approach doctors need to develop the skill of identifying these differences and adapt their consulting manner accordingly. Always advise and never dictate, only reassure when it can be justified and mix bad news with positive advice on what can be done to help. Never overstep one’s remit- no-one knows everything so be prepared to help patients seek second opinions and don’t be surprised when they come back to you! In short- honesty with patients, a degree of humility, be supportive and give patients confidence but it has to be based on ability. My professional life was spent amidst a growing tide of political correctness and vociferous media coverage of social trends as they abut on medicine. These have been important in drawing doctors’ attention to the need to adapt and be more sensitive to patient needs. Nevertheless the simplistic advice laid out above – you would expect that from a surgeon- has determined how I think doctors should continue to manage the ‘one to one’ relationship that is the essence of all consultations- used in its broadest sense where any doctor contributes to a patient’s care. Consultations are the basis of the patient/doctor relationship - everything else follows from that – and if done well doctors will continue to make their contribution to ensuring a high standard of healthcare. External influences cannot be ignored but they should not cloud the core responsibilities in patient care. I do appreciate that it is easy to sit back and pontificate when out of the front line and importantly I do realise that time restraints and intensity of work are often the reason why doctors are not always perfect in their approach to patients. This message needs to be got across to the powers that be. Meanwhile I am enjoying my retirement where time management is equally as important! Competing interests: None declared |
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Richard D Colman, Occupational Physician York . YO62 7JW
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THE ROLE OF THE DOCTOR – TOUGH LOVE It may help to understand our core role if we first understand and accept the responsibilities that come from being a member of a “profession”. This is an old chestnut and one about which there are levels of understanding. The definition and concept I relate to is expressed in the article by John K Davies in the Journal of Applied Philosophy back in 1991. He considers a professional’s duty is not primarily to please but to do or advise the “right” thing. Usually this does please as well as alleviate the problem but at times what is said or advised is not what the patient wants to hear. The integrity of the doctor and what gives him or her professional status is the willingness and ability to take a difficult or even unpopular stance because he or she knows, in good faith and not paternalistically, that this is the best advice, informed by up to date knowledge and opinion. Doctors are in a privileged position and the concept of professionalism as described above is perhaps subconsciously recognised by society in awarding that privilege. With that privilege comes a responsibility to always act professionally by being well informed. and being able and prepared to provide “tough love” if necessary. In my opinion the reason we are prepared to do this is because we CARE. The irreducible core value of a doctor is that he or she CARES for the wellbeing of his patient/client/population. It is a sad fact that in my opinion the profession has not understood this fundamental reason why most of us become doctors. We want to learn and apply some of the ways (offered by the whole medical spectrum) by which we can play a role in caring. The soul and indeed our purpose for practising medicine is in danger of being lost if we are not allowed to undertake this role because of management and professional practices which emphasise process and productivity. If doctors become unable to satisfactorily care for their patients then their reason to remain in and maintain the standards required of the profession will be lost leading to disillusionment and perhaps the loss of moral we see at present. This perspective raises many issues regards selection, education and practice that time precludes from addressing now. Ref. John K Davies. Professions, Trades and the Obligation to Inform. J of Applied Philosophy, Vol 8 No 2 1991 p168. richardcol@doctors.org.uk Competing interests: None declared |
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E Hassen, SAS NEW NHS Trust LL13 7TD
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The role of the doctor is fourfold: -- To preserve health -- To manage disease: treat, mitigate or palliate -- To act as patient advocate -- To educate: self, colleagues, patients and the public at large The nature of medicine is changing much faster than the practice of medicine: we are human and as such the older we get, the less flexible, the less malleable. The role of the doctor cannot be tied up in specifics because life is complex, uncertain and--at the individual level--entirely probabilistic. Competing interests: None declared |
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Jane.A Calne, Honorary Senior Lecturer UEA School of Medicine health Policy and Practice,Norwich,NR4 7TJ
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The role of the Doctor is changing in the brave new world of the MMC particularly for F1 doctors . Traditional values of compassion combined with astute time consuming attention to detail, in order to make an accurate diagnosis are being replaced by new more resilient ones which are appropriate to the altered working environment they find themselves in. Working in the NHS today, is similar to working on the production line of a very large impersonal factory . The analogy being particularly vivid in hospitals. The F1 doctor’s role is like that of a shop floor factory worker. He or she must be able to look at the patient simply as a product on the conveyor belt of the NHS factory. All empathic sentiments must be left with their coats when the workers clock in at 8.30 in the morning.Any emotional feelings about the product (patient) or extra time spent talking to it would only waste valuable factory time .The product must get through the system in the specified time and the factory worker (F1 doctor) must commit all his or her energy to making sure that as many products get onto the conveyor belt as quickly as possible. The new factory worker emerging from the MMC needs to be cold and unfeeling.He or she must also be reasonably efficient, athough cutting corners is acceptable as long as the product has a label (diagnosis) on it. The supervisors (consultants and registrars) do not usually check that all the labels are correct as they are so busy themselves, usually in another part of the factory . So even the correct label is not important, the only thing that matters is that the labels are slapped on as quickly as possible and that the products look as if they are finished.Unfortunately, the products often break again after leaving the factory but that doesn’t matter as long as the managers can tick the boxes on their clip boards and count that the right number of products are delivered for the target count at the end of the day. New factory workers no longer need to adhere to the outdated Hippocratic Oath.Their new oath states that their purpose in the factory is ‘to keep to the targets set, whatever the human cost’. Workers must be exemplary at filling in forms and excel at ticking boxes. To do this really well, it is essential to become skilled at working with one hand only, as the other hand will be needed to carry their own clip boards which give evidence of the tasks they have completed.Luckily this is not a major problem, as examining the product by touching it or with a stethoscope has become virtually obsolete due to the fact that every product is put through the scanner before being despatched. Factory workers should preferably be loners who are self reliant as it is thought to be more efficient if everyone in the factory works independently since this helps the factory to keep to its European Working Hours Directive (EWHD). The factory runs on a minimum of available supervisors ( consultants and registrars) and most of whom are tied up doing specialist tasks in offices ( clinics) or repairing products in the workshops (Operating theatres).If the workers ( F1 doctors) on the shop floor need help with an especially difficult product (patient) or the conveyor belt goes wrong and starts to cause damage , they must not expect to get help from their supervisors. The old way of working in teams (or firms) which were responsible for different parts of the factory,is no longer thought to be efficient and the newest factory workers are expected to try and fix the conveyor belt themselves. One of the best survival skills for new factory workers is to be overconfident and happy to blindly guess how to deal with problems . A useful maxim for a factory worker would be ‘Que sera’. No matter what happens today, it is best not to care too much as there will be lots more products arriving tomorrow, so having a laid back attitude to what one does today is essential for one’s psychological wellbeing. A false sense of confidence is especially important when working at night as the factory workers must be sure that they can run the whole factory with only one or two other workers. Night work requires an ability to relax despite dealing with a large amount of uncertainty and often very little supervision.Finally the new factory workers must be very happy, even eager to leave exactly on time at the end of their shift and to be blasé about the many unfinished jobs on their production line.If they don’t leave on time, they will be punished by the EWHD whipping boys and will be unlikely to get a reference from their supervisors. The old style workers ( houseman) would not be effective in the new NHS factory .If they were diligent and meticulous in finishing the product carefully and worried about putting the right label (diagnosis) on each one, it would take too much time and time is money for the factories . It would take even more time if they were to try to examine the product in the old fashioned way using stethoscopes and their hands, rather than arranging the factory standard battery of tests .This would lead to a lack of ticks in the boxes which would upset the whole system and may even bring production to a halt .If God forbid, they were to try to find out more about the product (talk to the patient) they would really start to have problems in keeping to the EWHD. One solution would be to miss out on breaks for meals and drinks.However, eventually this would lead to long- term sickness and they would be no good to the factory. They might try to overcome the limitations of the hours by staying on late and finishing some of the products that they had not been able to complete properly, earlier in the day. These workers would have to be careful and sneak about the factory unseen, whispering quietly so as not to be rumbled by the EWHD spies. They would only be able to save their jobs by falsifying their time sheets. If the old style workers were to start looking closely at the products and begin to worry about the fact that they are sometimes not packaged very safely, they would not be able to sleep at night and so would be useless in the factory the next day. These types of concerns might well make the traditional style workers so unhappy, that the job would become untenable and they would vote with their feet. The role of the new F1 doctor is to assist the NHS ‘factory’ in reaching its ‘targets’ and this must be achieved whilst sticking rigidly to the European Working Hours Directive. Attention to the individual patient is not required and would indeed be a disadvantage due to the time required. We need no longer look for applicants to Medical School with altruistic tendencies who want to do Medicine because they ‘like helping people’ as these qualities are actually a disadvantage in a target led NHS.This system is rapidly squeezing out the traditional caring role of the doctor . The new science of administration and management has created a doctor who is prepared to swallow the powerful potion of reduced waiting lists and targets mixed with a good dose of EWHD so instead of Dr Finlay we will have Frankenstein’s F1. Competing interests: None declared |
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David M Bowker, Retired consultant psychiatrist Stockport SK7 2LL
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It is unfortunate but opportune when the core role of the doctor is being considered to have the recent report that inadequate care occurs in half of A & E trauma cases together with the details arising from the inquest into the death of Diana Princess of Wales. These, together with the knowledge that a major source of serious complaint against doctors relates to failures in diagnosis which in turn often arise from taking inadequate histories (it will be a foolish doctor indeed who relies on a central data bank as an alternative to taking an adequate history when possible) leads to an inevitable conclusion, that the most appropriate core skills of a doctor should be the ability make an accurate diagnosis and follow this through with the procurement of the best forms of treatment. Only a medical doctor, out of a whole plethora of health professionals, has the best greatest potential for this skill based on knowledge, training and experience.. Sadly the GMC guidelines and a trawl on the internet through the various rather banal mission statements from medical establishments show that an accurate or indeed any diagnosis is rarely seen as a priority amongst desirable goals - although there is much on interpersonal sensitivity and non-possessive warmth towards diverse conditions and and ethnicities, which is fine but surely not of greater importance than basic good medicine. Competing interests: None declared |
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M J Pocha, retired Paediatrician Bedford Hospital, Kempston Road, Bedford MK42 9DJ
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In your editorial you have laid out many of the features that make up the doctors' role. In response to the cartoon "Do you want to see 'nice but average doc?' or 'grumpy but good doc'?" the patient's answer would always be "I want to see nice and good doc"! To my mind the most important thing for a doctor to provide for patients is the confidence that they will be given attention and the best possible treatment, that they will be told the truth, however unpalatable, but in a kind and sympathetic way and that their doctor will admit when s/he doesn't know the answer, but will find out or make the appropriate referral. I went into Medicine because our family GP always made me feel better. Being an anxious child, when I was unwell I expected the worst, but his presence made me feel everything was now going to be all right. This, I think, is a key role for a doctor and probably one of the few things the robot or machine cannot replicate. Competing interests: None declared |
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Dr.Bhalendu S. Vaishnav, Addl. Professor, Department of Medicine P.S.Medical College,Karamsad, Gujarat. India 388325
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The need to redefine the role of a doctor is based on changing disease patterns and our changing perceptions of health, pre-disease and disease states .The biomechanic view of health which, at one point of time addressed most of our health needs does not do so today.Indeed, the fundamental causes and remedies of our health problems are quite outside the domains of our day to day care. The concepts and perceptions of health are undergoing constant metamorphosis. The doctor today is more than ever before required to adderess health in its totality i.e. encompassing an integral oneness of body-mind-soul. The reality of subjective dimensions of health is being increasingly acknowledged by studies of psychoneuroimmunology. A heightened intellectuality or an intuitive spirituality will provide us broad outlines as well as minutest details for redifining our fundamentals of what we understand as disease and what we want our health care and medical education system to come up to meet the demands for which an ailing patient looks up to us. We can provide health, but can we provide healing ? We need a Consciousness based approach to health to shape our health care services which will not negate the best of our science but fulfil the patient's expectations completely. Competing interests: None declared |
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Taiyyab Mehmood, Medical Doctor Trainee UK/Riga, Latvia
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To understand the role of a doctor, one must first take a step or two back and understand what is and what makes a person to be a doctor, or for the pedantic, a proper, true doctor in its outright, as the founders of medicine said. A doctor is supposed to belong to that community where there is some common cause, common feelings and mutual solidarity. The implication is the doctor is a member in a community where the same body of the individual is crucial for its survival and development. The doctor has a big say and great weight in influencing their "medical clients"/patients and in righteously guiding their orientation. This may answer one responders question partly the role of a GP. There should be good qualities and noble characteristics which should be observed in dealing with others, the foremost among people who should enjoy such good qualities must be with greater reason doctors. That is their role. In addition, of such qualities are the following: A. Mercy, tender-heartedness, gentleness and patience. Doctors should stick to such characteristics because they deal with people inflicted with illness which makes them psychologically stressed. It is indisputable that such "medical clients"/patients are the foremost among other people who should receive due care, mercy and leniency, especially from doctors to whom they are entrusted if a doctor loses such qualities, one then loses the most important characteristic in one's profession. B. Among the most important qualities which a doctor should observe is honesty in the broadest sense. Honesty to themselves will inevitably produce a clean, open, good, sincere loving heart, mind, body and soul. The doctor should guide the "medical client"/patient to that which will benefit him in absolute honesty and precision. He/she should not divulge patient's secrets unless there is a necessity. He/she should exert his utmost to make the "medical client"/patient comfortable and lead him to recovery. I concur with previous responders that education of the society is paramount, and for that practise what you preach is also a necessity for doctors to not befall the bad virtue of being a hypocrite. Doctors need to read the Hippocrates oath every morning before work and understand that their role is not just a career but their life, as is a person who is ordained to be a priest. Act with the wisdom that the ancient doctors had, that we lack and believe the knowledge today makes us infallible to any criticism or our roles today. Peace to you all! :))) Competing interests: None declared |
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