It was with great interest that I read Kate Adams' criticism of the selection processes for medical students and junior doctors (first person, pages 24-25, 12 August).

Her repeated use of the term 'firm' to describe a consultant-led team of hospital doctors caught my attention.

This is a general name for an independent organisation, in control of, or owning its assets, and established to achieve the objective of the owners. In the most common case, the objective is to maximise the value of the firm in terms of share price, capital growth or dividends - depending on the owners' preferences.

Dr Adams clearly has an independent mind and the courage of her convictions. Yet it is clear that even she is so inculcated in the culture of the medical profession that she freely uses a term which implies that hospital doctors can use their independence and effective control of the NHS's assets (owned largely by others) to pursue their own objectives.

Education and training are not the only areas in which the culture of the medical profession may need to change.

Rory Stemp


Dorset Healthcare trust/Bournemouth University