Intended for healthcare professionals

Observations Life and Death

Conflict between clinicians and politicians—and what to do about it

BMJ 2010; 340 doi: (Published 28 April 2010) Cite this as: BMJ 2010;340:c2214
  1. Iona Heath, general practitioner, London
  1. iona.heath22{at}

    Both sides, clinicians and politicians, must not only accept but embrace the fact that they are bound to have different attitudes to healthcare challenges

    As the general election approaches, it seems timely to ponder the apparently endemic state of conflict that exists between clinicians and politicians. Is such a situation inevitable and even necessary?

    The most immediate explanation of the conflict concerns the relationship between demography and democracy. Politicians, reliant on re-election, must always put the needs of the population above those of the individual; clinicians, if they are to retain the trust of patients, must necessarily do the reverse. There is an irreconcilable and enduring tension between societal fairness and sensitivity to individual need. Democratic accountability mediated by the election process means that politicians are obliged to pay most attention to the demands of the well majority, whereas clinicians are inevitably most concerned by the sick minority. Politicians need to realise their objectives within the short term of the electoral cycle, whereas clinicians are often engaged in trying to provide continuity of care for patients over many years. …

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