Intended for healthcare professionals


Openness is fine but deferred responsibility is not

BMJ 2000; 320 doi: (Published 22 April 2000) Cite this as: BMJ 2000;320:1147
  1. Robert J MacFadyen, consultant physician (Robert.macfadyen{at}
  1. Raigmore Hospital, Inverness IV2 3UJ

    EDITOR—In his Editor's Choice in the issue of 11 December Smith makes straightforward comments on bringing patients and the press into the process of health care.1 If they understood more of the practicalities of, say, cardiac surgery they might appreciate the difficulties a bit better. Few doctors have any problems with this.

    What is important is that we don't abrogate the professional responsibility that the general public (those without benefit of PhDs or careers in the law or media) rightly expect from a medical doctor. The government and our society invest vast sums in medical training and, increasingly, in monitoring medical activity. They have a right to expect rounded professionals with an ability to make informed judgments both right and wrong. It is important to achieve a balance with openness involving retained leadership and informed decision making on the part of a practising doctor. This need not be—but could easily be—compromised by openness unless the principle is indefensibly used as a shield to avoid making difficult clinical decisions.

    As with many things in life, it is the balance of probabilities in clinical practice that matters, not the absolutist principle of openness.


    1. 1.
    View Abstract

    Log in

    Log in through your institution


    * For online subscription