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Exploring doctors' role in society

It seems to me that for as long as I have been qualified as a doctor (some 21 years) the profession has been struggling with the various facets of its role in the NHS, and its place in society.

Sometimes this manifests itself in a positive way with a television programme demonstrating the dedication and skill of a hospital team; but often beneath this gloss it emerges as discontent and a struggle to keep pace with the demands of a consumerist society and the target-driven culture of the NHS.

The area that caught my eye was that of doctors’ role in “wellness”

There have been attempts to explore this in the past – I remember well the BMA’s document Why are Doctors Unhappy? – but the Royal College of Physicians’ 2005 report Doctors in Society: medicalprofessionalism in a changing world has managed to strike a higher profile with the profession. Perhaps the pressure and need are greater and so the ground more fertile, and it is certainly important that the work continues.

Following the publication of the initial document, the RCP undertook a series of road shows to share the document with the wider profession (and public) and continued to evolve the themes it contained. Last month, I was privileged to be invited to take part in some of the latest stages of this work. A group of more than 100 doctors of mixed backgrounds and states of training, other professionals and members of the public were invited to a full day interactive workshop.

We covered a range of topics and their impact and role in relation to the future of the medical profession. The subjects included areas such as the future training of doctors - where the scope ranged from how we shoe-horn new needs like those of management and leadership training into an already challenged curriculum - through to how do you deliver effective training with the constraints of the European working time directive.

The area that caught my eye was that of doctors’ role in “wellness”. What surprised me was that the group felt they had difficulty getting to grips with the topic. Their debate focused on the role they felt that doctors should play in helping people stay healthy, and they struggled to really see how doctors should be at the heart of this. Perhaps this is understandable: we have so many things to champion already and we must not fall into the trap of medicalising what should be ordinary aspects of daily life. However, this is not a time for shyness, but leadership.

We only have to look at the important role doctors play in championing smoking cessation, and examine the potential outcomes of the epidemic of obesity to see the need is great and the time for action is now. It is also important that the profession does not lose sight of the role of “wellness” in those who already suffer with chronic disease.

A large amount of “mental unwellness” is experienced by those with illnesses such as diabetes, and in the biometrically outcomes-focused world of the quality and outcomes framework it is all too easy for us to lose sight of delivering holistic care and focus on treating blood tests, not people. Similarly, the recent rise in profile of patient reported outcome measures has demonstrated that trusted gold standard operations such as hip replacements can fall short of improving patients lives, even though the operation was clinically “successful”.

It was good to see (and be a part of) the profession striving to move forward at the pace of the modern world, but to do this we must be radical in our thinking and continue to challenge some of the concepts we hold most dear to become truly patient focused.

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