Intended for healthcare professionals

Education And Debate

Rethinking Consultants: Where medical science and human behaviour meet

BMJ 1995; 310 doi: (Published 01 April 1995) Cite this as: BMJ 1995;310:850
  1. Jonathan Rees, professor of dermatologya
  1. a University Department of Dermatology, University of Newcastle upon Tyne, Newcastle upon Tyne NE1 4LP

    Although we may be wrong about the details, we should try to imagine what the future holds for hospital consultants. The days of the independent consultant in the same post for 30 years are over, and there will be a change from “the” consultant to a few tiers of senior staff. Patients will increasingly demand to see specialists, so more specialists will be needed. As patients and their advocates become better informed the traditional rationing of clinical care to patients in Britain, such as restricting access to specialists, cannot continue. There is a current trend for evidence based health care, but the idea that each element of medical practice can be dictated by systematic evidence based research will prove to be naive—such research informs practice rather than dictates it. Science will continue to act as the guide to medical practice but specialists will not be turned into a set of logical operators running programs designed by health planners.

    Humans tend to have two misconceptions about the future: firstly, that if we know the present we can predict what is going to happen and, secondly, that we understand the present. For any activity dependent on new knowledge, as medicine is on science, the future is uncertain simply because new knowledge always changes the rules of the game. But even if we could dream this problem away our guesses of the future will be in error because we continue to delude ourselves, outside the laboratory at least, that we understand the present: William Blake said that “every honest man is a prophet.” Nevertheless, millions of years of biological engineering have forced us down the path of linking the past with the present and the future, wiring us to anticipate and prepare for what has not happened—the triumph of play over mere reflex. …

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