The doctor still knows best

There has been a significant change in what it is to be a doctor in recent years. The cliché of the white coated male professional wandering around wards, working 100 hour weeks and staring forlornly into the eyes of dying patients, Dr Kildare style, has been replaced not only in the public’s perception but also within the medical profession.  

‘In a world of increasing transparency, the sanctity of the shut door of the GP clinic room seems out of date’

No longer are doctors prepared to work long hours for the sake of their patients, with the introduction of the European working time directive and working time regulations for junior doctors in 2009 limiting the amount of time on the ward to 48 hours per week. Nor are they prepared to dedicate themselves completely to the job. The increasing feminisation of medicine and the drive for part time working from both male and female doctors has made the elusive life/work balance more tangible.

Nor are they necessarily staying within medicine, with a recent report from the Medical Programme Board suggesting 23 per cent of year 2 foundation doctors have simply not applied to higher training. A survey of 3,800 doctors by the British Medical Association last year showed two fifths of doctors are considering leaving the profession, with 50 per cent saying they “would not recommend a career in medicine”.

But it is not only how long and how much doctors are prepared to do in medicine, but a more marked changed in attitude towards what medicine is. This has occurred for multiple reasons. 

Patient power

Patient expectations have changed. Patients are more internet savvy, better able to negotiate the healthcare system and almost certainly more sceptical of the doctor in front of them. The rise in patient as consumers and the well worn mantra of “no decision about me, without me” have changed patient perceptions on the healthcare system with more vocal and more “empowered” patients demanding flexible opening hours and Choose and Book hospital appointments. 

‘While one definition of a doctor, that of the expert clinician, has been on the way out, there has been a paradoxical rise in the doctor as the “health evangelist”’

In return, patients are encouraged to self-manage with personal treatment plans and personal budgets. You may argue this is not a bad thing. The catalogue of disasters from Alder Hey to the Bristol heart scandal to Mid Staffordshire all showed doctors in a bad light. Rather than being the guiding light for patient safety, doctors appeared arrogant, unlistening and − worse still − only looking out for their own needs and expectations.

In a world of increasing transparency, the sanctity of the shut door of the GP clinic room seems out of date. We run the risk of the government using the demands of an articulate minority (in a movement some have dubbed “healthism”), who may not represent the majority of patients, as a battering ram to push forward a consumerist understanding of healthcare.

Defending doctors

But with this rise in patient power there has also been a change in how doctors view themselves. The profession has been unable to stand up for itself. The highly successful campaign led by the Daily Mail against the Liverpool Care Pathway resulted in the bizarre affair of the Palliative Care Association initially calling for a review into its own guidelines, before later defending its own practice.

Likewise, the muted and confused initial response to the MMR panic showed a lack of leadership. Finally, self regulation, the hallmark of a profession, disappeared from medicine when the government made the General Medical Council answerable to one of its own bodies in 2001.

‘It is that intangible quality of professionalism that is worth defending at all costs’

While one definition of a doctor, “the expert clinician”, has been on the way out, there has been a paradoxical rise in the doctor as the “health evangelist”. There has been an expansion in the role of the doctor.

Gone are the days of curing the sick. Now the average GP is expected to take on multiple roles in the practice. These range from “QOFing” the patient, smoking cessation advice, alcohol reduction, prescribing exercise and looking at their emotional wellbeing, to being vigilant for domestic violence and promoting breast feeding; taking the focus away from the individual in front of you all in rather speedy time chunks.

Doctor privilege

So why does it matter? Why is it important to defend professionalism within medicine? It’s certainly not the only profession or institution undergoing changes, with the Leveson inquiry affecting the press, “expert learners” permeating through higher education and the Savile inquiry’s impact at the BBC. 

Why is medicine really important? I would argue it is because at its heart lies the relationship between the doctor and the patient, the intrinsic inequality between the expert and those that are sick, where the patient’s autonomy is upmost in the doctor’s mind.

It is a privilege to be a doctor; it is a privilege to become involved in someone else’s life to that extent and to be able to make a difference. It is that intangible quality of professionalism that is worth defending at all costs, because equating the job to working at a supermarket sells short those that matter most: the patients.  

Dr Frankie Anderson is a hospital medicine trainee. She is speaking at the session “From Shipman to Mid Staffs: does doctor still know best?” at the Battle of Ideas festival on 19-20 October at the Barbican, London, in partnership with HSJ