Big Brother or New Professionalism?
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2006)

`A good idea ruined', is how George Orwell described Nineteen Eighty-Four, `I ballsed it up rather, partly owing to being so ill while I was writing it'. Orwell was dead within months from complications of tuberculosis but he lived long enough to savour some of the success and controversy of `that bloody book'.

Hilda Bastian relates Orwell's struggle with tuberculosis and his attempt to get a new drug called Streptomycin (p 95), which was initially a prescription drug in the USA and an experimental and unaffordable one in post-war Britain. In a glimpse of future controversies, `the government was “besieged” by patients and doctors requesting streptomycin, the BBC started broadcasting emergency appeals for it, and soon there was a black market for the drug'. Orwell was too old to meet the entry criteria for Austin Bradford Hill's randomized trial and finally obtained streptomycin from the USA, bought by dollars earned from sales of Animal Farm. Initial improvement was followed by a severe allergic reaction and he stopped treatment. The leftover drug was donated to the hospital and used by two doctors' wives whose tuberculosis was cured.

`War is peace. Freedom is slavery. Ignorance is strength', Orwell's parody of political doublespeak, encourages the conclusion that he championed, in Bastian's words, `the need for community access to unbiased information'. Doctors, as gatekeepers to that information for patients, play a vital role in the battle against doublespeak or `keeping the truth from people'. But the nature of the medical profession has changed since Orwell's time.

Where Orwell might have expected—although not necessarily desired—his doctors to be exemplars of `mastery, autonomy, privilege, and self regulation', today's doctors might be expected to place responsiveness to patients central to medical professionalism and modern healthcare. Or so concludes a working party of the good and the great gathered together behind the banner of the Royal College of Physicians. Why we should respond to the trumpeting of unelected, unrepresentative experts is not immediately clear, but Richard Smith concludes that some quibbles aside the Royal College of Physicians' initiative on defining a new professionalism has produced recommendations that are worth endorsing (p 48). Liam Donaldson's much awaited report on revalidation offers a great opportunity, argues Smith, for promoting patient-centred medical professionalism and not just talking about it.

The Royal College of Physicians, and its fellow colleges, fare less well under the critical gaze of Jonathan Osborne, who denounces their acquiescence to the government and the postgraduate medical education and training board, which you will all grow to love as PMETB (p 56). The modernizing medical careers strategy, he writes in an open letter to royal college presidents, `is a manpower planning disaster from which neither government nor colleges emerge with distinction'. So much so that doctors allude `to the colleges as irrelevant drinking clubs, whose officers only seek baubles of state, occasionally bestowed for keeping the profession quiet'. Prove them wrong, pleads Osborne, and block the current reforms to postgraduate training.