Unanimity in the profession

BMJ 1994; 309 doi: https://doi.org/10.1136/bmj.309.6969.1659 (Published 17 December 1994) Cite this as: BMJ 1994;309:1659

Don't pretend to be unanimous

  1. Richard J Lilford
  1. Chair, University of Leeds, Leeds LS2 9LN.

    EDITOR,—The first two editorials in the issue of 29 October sit strangely together. While the first, by Ian Morrison and Richard Smith, takes an imaginative view of the future,1 the second, by Tony Grabham, is a fine example of the authoritarian and corporatist attitude that has characterised “doctors' leaders” for too long.2 Morrison and Smith urge doctors to see themselves as part of a wider society, characterised by sophisticated consumers and shifts in the boundaries of health and medicine. Grabham, however, reminisces back to the days of Harold Wilson and Barbara Castle, when a display of professional unity apparently influenced government policy.

    If the profession is unanimous then there is no point arguing for unanimity. If it is not then the pretence of unanimity if a deception. I reject the notion that breaking ranks and expressing a contrary view is wrong. It is about time that medical leaders (and the public) stopped regarding medicine as a professional island, unaffected by the tides of social change. On the contrary, as doctors we reflect the range of opinion present in the society from which we are drawn. Doctors therefore have every right to express personal views publicly, even when these are at variance with those of the ruling medical cabal. When I was a medical student in Johannesburg I marched in the streets in defence of academic freedom, and I will continue to oppose any threat to this principle, whether from the government or from professional leaders.

    Policymakers are entitled not only to information on the majority view in the profession but also to the degree of unanimity and the reasons behind opposing medical viewpoints. Grabham is right that medical representatives are fragmented. An academy of medicine based on the royal colleges and elected representatives would form a useful point of contact between the government and the profession and a forum for reasoned argument, particularly in cases in which consensus is absent. Such an academy should not simply try to paper over the cracks of inevitable and healthy division of opinion.


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