Doctors: still disorganised but still trusted

Last week I received a letter from a 9 year old boy who said he'd always wanted to be a doctor but now wasn't sure because he read so many bad stories about doctors. What did I advise? I answered that to become a doctor was still one of life's greatest privileges, and I tried to explain why. But to read this week's BMJ is to read about a great profession struggling to find its way in the modern world.

Not that it's new. “One thing is certain,” wrote Centurion to the BMJ 100 years ago, “that Conservatives, Liberals, Radicals, anti-Boers and pro-Boers, millionaires and working men … are all agreed on one point, namely to exploit the medical profession to the utmost … and to laugh in their sleeves when referring to ‘the noble profession’ … which … receives a beggarly pittance” (p 715). Regaining his breath after his 113 word sentence, Centurion regrets that the profession is “an unorganised mob” and calls for effective reform. One of the great secretaries of the BMA, Derek Stevenson, whose obituary appears on p 738, lived through umpteen such battles, “including an uprising against the reform of the General Medical Council.”

Forty years on that battle is continuing, and Steve Dewar and Belinda Finlayson examine the council's current proposals for reform (p 689). They find them confused and regret that the council has been timid when boldness is required. “We need,” they write, “answers to the fundamental question of why the medical profession has such difficulty overcoming a tendency to internal disagreement and stasis.”

But the battles over structural reform may be nothing to the battles over revalidation. The council's leaders want something that will work. The profession wants something that will not involve intolerable bureaucracy. A group from Leicester suggests building revalidation round not proxies for competence but around the “single most important event in clinical practice”—the consultation (p 712).

High clinical and ethical standards must, of course, be instilled into medical students at the beginning of their careers, but three articles examine how the opposite may be happening (p 685, p 709, and p 743). Students find that their education may sometimes be put before patient care, that they may be asked to do things beyond their capabilities, and that they may become involved in substandard care.

In contrast, a junior doctor describes how his confidence was greatly lifted by an 11 year old boy saying to him: “I trust you, you're a doctor” (p 711). The cynical might imagine that it would be impossible to use such a phrase without irony, but yet again a national survey finds that doctors are trusted more than any other profession (p 694).