Doctors: Automatons, technicians, or knowledge brokers?
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2007)

Do doctors have the X-factor? I'm sure many of you do individually, but as a profession, what is it that appeals to others? I was prompted to this thought as I sat through the final sing-off of last year's contest—something that is almost inevitable if you have children of a certain starryeyed age. What judgement might the expert panel—and the public—pass upon the medical profession? ‘Great talent, dear, but no real conviction about where you're going.’ ‘A change of image would work a treat.’ ‘You sound good within your comfort zone, but take you outside it and you suck.’

Well, possibly, but at the very least the medical profession isn't sending out signals of satisfaction. A medical student told me recently that despite her natural equipoise and self-confidence, the transition to becoming a doctor is not a mouth-watering prospect. The junior doctors she has come across have been glum, disaffected and full of complaints. It was ever thus, of course: siege mentality is one way of coping with a profession that you have been inadequately prepared for and that creates pressure of time and pressure of decision-making. Yet there seems to be a deeper malaise on our wards. Doctors feel undervalued and over-managed. Not much X-factor there then. Dr Kildare has much to answer for.

But the romance—in the broadest possible sense—that Dr Kildare enjoyed and portrayed is fast disappearing from medicine. Dissent is good, and it is important when it is about something that matters, like the philosophy of our health service. When doctors moan about pay, though, it has the ring of members of parliament asking for a minimum wage of £100 000 a year—privileged people stuffing their own mouths with gold, as John Main argued in last month's journal. The X-factor that attracted youngsters to a profession that was glamorous, socially valued, and happened to save lives in the process (and not necessarily in that order) is harder to identify.

Doctors don't wish to become automatons, but the health service would presumably be run more efficiently by automatons rather than led by doctors who are busy asserting their right to clinical freedom. Perhaps not automatons, but what about technicians? Will we remain all-knowing, all-doing leaders of clinical teams or will we become technicians? We do our bit and then we disappear. Two cardiothoracic surgeons put this same argument to me independently. The future of bypass surgery, they say, is popping into theatre to do the grafts and leaving the rest—anaesthetizing the patient, opening the chest, putting the patient on bypass, closing and suturing—to other members of the cardiothoracic surgery team. You might initially consider this to be heresy but it might be better for the patient and for the efficiency of the health service.

But as we strive to avoid our fate as mere cogs in the big machine of the NHS, how do we create a new X-factor that reaches out and attracts others? It might not be the magic ingredient that doctors were once familiar with: power. Indeed, there are very good reasons why this should not be the case. Medicine's midlife crisis may be more of a symptom of its own struggle to transform from a patriarchal profession into one that facilitates decision-making. Doctors in the new world would be gatherers of information relevant to individual patient care—the ultimate knowledge broker—instead of hunters preying on the ignorance of their patients to preserve their power and status. The allure of knowledge brokers will be high in a world that suffers increasingly from information overload. Knowledge, we know, is power, but brokering it is more valuable than guarding it. Could this be the X-factor that our profession seeks? ‘Yes, I'm really liking this,’ says Simon Cowell, X-factor judge and a man of blunt words. ‘I can see you getting a big hit with this one. It's a bit of a tricky concept but it's original and you've got the voice for it. More importantly, it's what the public wants.’