Intended for healthcare professionals

Rapid response to:

Reviews Personal views

Where are the medical voices raised in protest?

BMJ 2006; 333 doi: (Published 21 September 2006) Cite this as: BMJ 2006;333:660

Rapid Response:

Cost of protest

One of the reasons why protests gradually die down is because of the
realization that it may be futile and harmful for your future prospects.
The medical hierarchy has as many powers of patronage as the political
hierarchy and are not loath to use them. They are also entrenched and often
deprive those who raise issues of quality from membership in interview
panels, discretionary points, and budgets to improve their departments.
Many would feel it is not worth the trouble to damage your prospects for
career enhancement by standing up for what is right and those who talk
about merit, quality and clinical autonomy are considered quixotic.

I feel
that there should be constant replenishments of the entrenched medical
hierarchy so that fresh ideas can blossom. Many have been in positions
longer than the prime minister and, as one chairman in the USA memorably
said, "You have the freedom of speech but I have the freedom to fire".

Competing interests:
Supporter of clinical autonomy and pure merit in the NHS

Competing interests: No competing interests

23 September 2006
Jayaprakash Ayillath Gosalakkal
Consultant Paediatric neurologist
University hospitals of Leicester LE1 5WW