Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: Trust and truth telling

BMJ 2019; 366 doi: (Published 10 September 2019) Cite this as: BMJ 2019;366:l5477
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

When my patients tell me their symptoms they put their trust in me: they trust me to listen attentively, to examine carefully, and to investigate as thoroughly as necessary. They trust me to keep their confidences and to follow up as promised. Above all, when they ask me a question they trust me to tell them the truth as far as I know it. If I fall short in any of these areas I am likely to lose their trust—and then I’m not much use to anyone. I also risk losing my medical registration.

The same applies to all doctors, and we guard our reputations carefully, so it is a big deal to be accused of deliberately misleading the public—as David Nicholl, a consultant neurologist, was accused by the Tory MP Jacob Rees-Mogg last week on LBC radio.1 Nicholl had been involved in planning to mitigate the adverse effects of Brexit on pharmaceutical supplies. His well informed worries were dismissed as “scaremongering” by the politician.

Worse still, under cover of parliamentary privilege, which averts the possibility of being sued for defamation, Rees-Mogg then compared Nicholl to the disgraced ex-doctor Andrew Wakefield, who was struck off the medical register in 2010 for falsifying his research and fraudulently claiming that the measles, mumps, and rubella (MMR) vaccine caused autism.2 Rees-Mogg eventually apologised for this calumny, but not before he had been roundly rebuked by Sally Davies, the chief medical officer for England.

When members of the public are asked whether a given professional is likely to tell the truth, doctors are considered to be significantly more honest than politicians: 92% versus 19%.3). That poll by Ipsos MORI was done a year ago, and the public’s trust in politicians may now have fallen further.

In science and in medicine we assume the veracity of our colleagues—it’s difficult to see how else we could operate—and it’s still a shock when we discover fraud and lies. In politics, meanwhile, it seems that lies are so commonplace that it would be foolish or naive to believe a politician.45

The informal system of gentlemen’s agreements and codes of honour, which in previous decades led to resignations if a politician was found to have lied, no longer seems to be working. Perhaps what we need now is a register, as in medicine, with some minimum competences required for anyone to be eligible to be a member of parliament. Politicians who are dishonest or corrupt could then be struck off, becoming ineligible to stand for further elected office.

There is a long way to go, but perhaps that could start to rebuild our trust in politicians.



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