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Modernising Medical Careers
- Nivritti G PATIL (14 May 2008)
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Modernising Medical Careers
- GEORGE Y CALDWELL, SINGAPORE 259858 (14 May 2008)
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Pre-registration - half a century on
- Morris Greenberg (14 May 2008)
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Nivritti G PATIL, Professor of Surgery Dept. of Surgery, Queen Mary Hospital, Pok Fu Lam, Hong Kong SAR
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Having spoken to many trainees and colleagues in U.K. and read lot about MMC, it would not be inappropriate to call the whole episode as "Messing of the Medical Careers". Competing interests: None declared |
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GEORGE Y CALDWELL, GENERAL PRACTITIONER 31 BALMORAL PARK #18-33,, SINGAPORE 259858
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If it ain't broke don't fix it! So said Henry Ford I. What exactly does "modernising" mean? Is it not just interfering for interference sake? Any change in Medical Careers should only be recommended by those who have practised Medicine, and for many years. The Department of Health should act only on such recommendations. There are many retired Practitioners, both General and Specialist who will readily give their opinions and experience. Those without experience of Medical Practice indeed may have their say and will be listened to since they could well bring in ideas of new systems of organisation, new useful technology etc. But the basis of all is looking after the welfare of the patient and what is in his best interest. The teaching of students has remained much the same for generations, and only recently have changes been made. These changes should be reviewed. Were they for the better? Is Anatomy indeed going to be expunged from the curriculum of teaching students? This sounds extraordinary even to the lay ear. A Surgeon who does not know his anatomy will be rather useless, never mind a doctor in General Practice. That sounds a loony idea. Let us look seriously at other loony ideas that are proposed. Too much emphasis in recent years has been on continued Hospital Practice and the general down-grading of General Practice. It is little wonder that the Hospital Practitioner in his white coat develops a toffee- nosed attitude to patients, of "knowing everything" and having a reputation of not being able "to communicate". Far better then to revert to the system of sixty years ago when once a student had completed his Finals examination, he be allowed indeed encouraged to go straight out into General Practice, with a partnership of colleagues as his peers, and get his knees browned. There he will be somewhat humbled and learn that he is not God. His patients will come to no harm. Much later he will return for a year in hospital practice as a cheap labour unit for the NHS, with a better understanding of his patients' background. In the distant past the General Practitioner was a sort of circus- ringmaster and selected which Specialist or Consultant and hospital was best for his patient. He was on first name terms with his hospital colleagues. Now he is a supplicant for access to whatever is available. That is not a good change. It has all become like a communal (Russian) supermarket. Not good for the patient. It is cold callous inconsideration. Quote: When it is not necesary to change, then it is necesary NOT to change. Lucius Cary, Viscount Falkland 1610-1643. Competing interests: None declared |
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Morris Greenberg, Retired Home NW11 7SY
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Dr R. van Winckel LMSSA waking and reading the correspondence on "Modernising Medical Careers" and the reports of his successors to up-date himself, would find the scene familiar. At the time he fell into coma there were good reasons for the reality of the Pre-Registration provisions falling well behind the planned. The economy had yet to recover from the war, but the introduction of the Welfare State and its National Health Service offered hope that things could only get better. Before our very eyes the grim workhouse was being transformed into a caring hospital by the Medical Superintendent, the Matron and the Hospital Secretary with the support of the League of Friends. Although Medical Manpower Planning had not yet become the science it is today, it managed to produce too many graduates chasing too few jobs. As for the standards of the "approved posts", in terms of supervision, training, hours of work, study facilities, and board and lodging, they were highly variable, but a generation used to the mantra "There's a war on!" merely shrugged, and accepted a period of apprenticeship that very often amounted to a source of cheap and submissive labour. I must acknowledge some responsibility for the plight that the current generation of young medical graduates are enduring. My excuse in not agitating at the time was the fear of acquiring a black spot on my cv. Probably this was misplaced as most of the consultants I had the good fortune to work to were not exploitive or abusive. My excuse for failing later to involve myself on behalf of the young graduate was the pursuit of professional excellence. My generation was guilty of neglect by abdicating to the medical politicians: the Deans of the Medical Schools, the BMA, the GMC, Presidents of Royal Colleges, the Departments of Health and their Chief Medical Officers, and various committees who have contributed to today's sorry plight. All we can do is grovel and beg foregiveness - next time round we won't leave the public good to others but will try if not to be industrious dung beetles then wise medical politicians. Competing interests: I was one of the early pre-registration medical graduates. |
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