Punching your weight

BMJ 1995; 310 doi: (Published 08 April 1995) Cite this as: BMJ 1995;310:896

As we near the end of the century there is a fashion for institutions to re-examine their futures. This week, after we go to press, the consultants are doing it. Last week Britain itself was doing it, re-examining its role in the world in the 21st century. The note for this was struck by the remark of the foreign secretary, Douglas Hurd, that for a long time after the second world war Britain has been “punching above her weight.” Britain's problem is coming to terms gracefully with the fact that she cannot continue to do that.

The problem for the medical profession is rather the opposite. There is a feeling that during the past few years doctors have been on the ropes a bit. Now the feeling is growing that it is about time they got back on to the canvas and started making their punches count. Jim Johnson, chairman of the BMA's consultants' committee and instigator of this week's meeting on the consultant of the future, wants to see “consultants taking charge of their own destiny.” And the message from last November's core values conference was a strong one of regaining lost ground.

Indeed, Maurice Shock, a leading political scientist and one of the keynote speakers at that conference, even used Douglas Hurd's boxing metaphor. One of his arguments was that the many different organisations of doctors needed to come together in a new representative organisation headed and guided by a “cabinet” concerned with strategy and high politics. Without that, he said, the profession would be unable to punch its weight.

It is a tribute to the importance of the issues, and to the skills of the players on the steering committee, that the leading bodies in British medicine (the BMA, GMC, deans, and royal colleges) have maintained the momentum since November and are now ready for the next stage. This happens this week as copies of the report of the conference go out to British doctors (members of the BMA get their copies with this week's BMA News Review). The report has been put together by BMA staff under the guidance of the steering committee, and this committee will continue as “a forum for future action” based on the broad conclusions of the conference.

As doctors read their paper—and they should: it is short, clearly written, and affects them—they might bear in mind several other things Maurice Shock told the conference.

He pointed out that we were now in an age of regulated capitalism in which the consumer is cossetted and wooed. Public support is therefore crucial, as is the need to form alliances with other groups in society. The profession should not let itself be presented as maintaining a consipiracy against the public interest, but in order to prevent that it had to get “its hands dirty” in the hard business of priorities and resources. Shock also said that not only did more doctors need to become involved in managing the health service, they also needed to become the managers.

It was also Shock who described the profession's core values as “ancient vitures…distilled over time.” His point was that these values needed to be made relevant to today's problems and backed by an organisation fit for the purpose. The paper attempts to make them relevant by summarising the November discussions—and it makes no pretence that there was necessarily consensus over the ideas that emerged in discussion. In fact there was little disagreement about the values: commitment, caring, compassion, confidentiality, competence, spirit of inquiry, integrity, advocacy, and responsibility.

Few doctors also will disagree with the conclusions of one of the working groups that the consultation between doctor and patient remains at the heart of medical practice and that the need for caring and compassion remain even as the “technological marvels” of medicine increase. But not all might agree that some time spent in general practice would be of value to all doctors, or that doctors should not be the individual arbiters of rationing decisions; and for some upholding equity of access to health care or taking action when colleagues' practice falls below standard might be difficult in practice.

But debate starts with disagreement, and the saddest fate for this whole process would be that it never got beyond a series of statements that are too bland for anyone to disagree with.—JANE SMITH, BMJ

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