British doctors failed to notice that the world around them had changed utterly and so were unprepared for the “blitzkrieg from the right” that overwhelmed them at the end of the 1980s. This was the diagnosis from Sir Maurice Shock, former rector of Lincoln College, Oxford, when he opened last week's meeting of doctors' leaders to discuss the core values of medicine. This was the first “summit” meeting of the profession since 1961 and was prompted by falling morale and influence and a request from the chief medical officer for the profession to look beyond present circumstances to consider its future.1 It occurred the day after the General Medical Council discussed proposals to change its guidance to doctors from a list of what must not be done to a description of what is required of a good doctor (p 1251).

Doctors seemed to imagine, said Sir Maurice, that they were living in Gladstone's world of minimal government, benign self regulation, and a self effacing state. In fact, “instead of the rights of man we have the rights of the consumer, the social contract has given way to the sales contract, and, above all, the electorate has been fed with political promises… about rising standards of living and levels of public service.” The appearance of the consumer society together with medical advances on an unprecedented scale and “the rise and rise of the geriatrics” has meant that “the doctor is different, the patient is different, and the medicine is different.” In short, warned Sir Maurice, “everything is different except the way you organise yourselves.”

The clergy may have escaped to what Sir Maurice called “a niche market,” but there can be no escape for doctors: “medicine is right at the centre of our affairs.” Doctors cannot swim against the …