What Are Doctors For?; Do We Still Need Doctors?BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7136.1028 (Published 28 March 1998) Cite this as: BMJ 1998;316:1028
What Are Doctors For?
Ed David Hart
Community Health UK, £8.50, pp 62
Do We Still Need Doctors?
John D Lantos
Routledge, £17.99, pp 224
ISBN 0 415 91852 9
Are the wheels coming off medicine in the 1990s or has it always seemed like this? Do we really not know what we are for and where we are going? Have we reached the end of the road, or is it just a turning point or a crossroads? Doctors are uncertain as never before as to what it means to be a doctor. What has happened to the good old fashioned doctoring, when doctors and patients knew what was what and all was well with the world?
Two books with very gloomy titles cover this subject, although they are certainly not gloomy in themselves. What Are Doctors For? is a series of interviews with British general practitioners, all of whom have extra strings to their bows, like being poets and pastors and storytellers in their spare time. Do We Still Need Doctors? is a passionate bioethical treatise on where we are going wrong from an American paediatrician who teaches at the University of Chicago and looks after chronically ill children.
The general practitioners interviewed in What Are Doctors For? all turn out to be nice, gentle people who want to admit to their own vulnerabilities, not be autocratic, and be advocates for their patients. They see themselves as teachers and biographers and would like to bring an understanding of the arts into their dealings with human suffering. Some are more interesting than others, and some resort to hackneyed ideas to communicate what they do, which is reasonable enough under the circumstances.
They are all devoid of hard cynicism, are spiritual, and, consequently, would probably not be able to give a cold economic evaluation of what they are worth. To be fair, they were not asked to do this by David Hart, who prewrote the interviews and compiled and edited them. David Hart has been a university chaplain, art critic, and poet, and his questions happily reflect this diversity. He is not of the new breed and has clearly not worked as a research fellow for the Department of Health Sciences at York as there are no mentions of packages of care, performance, or skill mix.
Joseph Lantos, from La Rabida Hospital and the University of Chicago, writes very well indeed, by which I mean that you can understand what he is saying—a good thing for a bioethicist. Lantos writes beautifully about painful clinical dilemmas, and he lets us into his heart as a doctor and a parent. What he writes is not at all contrived and rings true. His poignant stories about patients are interspersed with clear ethical and philosophical observations, and his chapter headings give a clue to the strength of some of these. I was intrigued by the arguments contained in “Whyshould we care about other peoples' children” and “Onmistakes and truth telling.” He is particularly strong on what happens to doctors when they make mistakes and writes a balanced analysis on the issue of full disclosure to patients and the perils of progress.
Interestingly, the University of Chicago has an ethics consultation service, which is called to see about two cases per week. Lantos admits that the service's role is generally somewhere between arbitration, conflict resolution, and psychotherapy in cases such as when someone is dying, is incompetent, or has no power of attorney.
These are the easy ones. More tricky are the situations where doctors have access to special knowledge and claim a special privilege to withhold the truth for various reasons. Almost invariably, the lawyers argue for a rigorous standard of truth telling, while the doctors are often not so sure. The question Lantos poses is, “Do the vacillating doctors who are not so sure have a moral leg to stand on or are they just engaging in a little emotional self-protection?” The difference between the doctors and the lawyers on these occasions may be that the doctors, however misguided, have a desire to limit the suffering of their clients. In a recent case in which I was a defendant, I spoke to my defending counsel about ethics, and she replied that she thought that it was a place somewhere east of London. My case rests.