What single change to your working life will restore your faith in medicine as a profession – and why?
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2009)

Has medicine lost its professional aura? What can be done to save the profession of medicine? We asked JRSM readers to suggest a single change to their working lives that would restore their faith in medicine as a profession. Alternatively, we asked you to suggest a single change that would allow clinicians to be considered more professional.

Here are the best responses.

Harvey Marcovitch, Medical editor and member of the research ethics police

If no clinician or researcher ever submitted a paper which was redundant, salami-sliced, plagiarized or unethical; which cited ghost or guest authors, burnished or hid data, unfairly manipulated statistics, failed to declare shareholdings, patent applications or consensual sexual relationships with suggested reviewers, or was deeply and irremediably boring.

Daniel K Sokol, Medical ethicist and a member of 10 committees

I have faith in the medical profession but this has regularly been shaken when sitting on committees in hospitals and medical institutions. Secrecy, nepotism, deception, arrogance, narrow-mindedness and other vices are rife in some committees, even prestigious ones. My suggested change is easy: every committee should ask itself this question ‘What difference do we actually make?’

Tim David, Paediatrician and honorary editor of JRSM

I don't accept the premise; my faith in medicine is undimmed, but I do have a wish. I reflect on every consultation, acutely aware that there is always room for improvement on my part. What I would welcome is written feedback from each family after each consultation – what went well, and what could have been done better.

Martin Marshall, Director of Clinical Quality

I don't have a lot of faith in the traditional model of medical professionalism. It is no longer compatible with what society wants from its doctors. I think that the low moral that we see reflects the difficulties that some individuals are experiencing with the transition to a more accountable and more patient-focused model of professionalism.

Joanne Shaw, Chair of NHS Direct

To be considered more professional, doctors and health workers need to start communicating with patients through the technologies and channels that we all use in our everyday lives. By making themselves accessible by phone and e-mail, health professionals would be taking a significant step towards real partnership with their patients.

Dr Neeraj Bhala, Specialist registrar in gastroenterology, hepatology & general medicine

Less politics (and politicians meddling in medical affairs) would be great but I can't see that happening anytime soon. Less useless paperwork, such as tick-boxing exercises, administrative forms and regulation gone crazy, would be a more achievable change. It would-allow clinicians and researchers to go back to what they do best – treat patients.

Gurprit Pannu, Specialist registrar in psychiatry

In psychiatry, as in music, there is no democracy; someone must lead. Hence all are not equal in a multidisciplinary team although all are vital to the symphony. Psychiatrists trained in a plurality of disciplines are equipped to conduct overall management and cannot be sidelined into a ‘medical model’.

Liz Wager, Chair of the Committee on Publication Ethics

I'd like to see academic institutions abandoning journal impact factors as a method of calculating research productivity – they are a spurious surrogate for the importance of individual articles and over-reliance on them encourages questionable publication practices such as salami-slicing and guest authorship.

Paul Cooper, Retired hospital manager

The medical profession would be considered more professional both by patients and by colleague professions in the NHS if it regarded it as unprofessional to treat patients privately who had been introduced either directly or indirectly through the NHS.

Adrian Crisp, Rheumatologist

My first priority will be the care of my patients undertaken to the best of my knowledge and ability and not the diktats of my employer and my employer's political and financial masters when these conflict with this priority.

Robin van der Weiden, Obstetrician and gynaecologist, The Netherlands

‘Work expands so as to fill the time available for its completion.’1 Since 1970 the percentage increase of hospital administrators in the USA has been 2753% compared with 156% for physicians.2 Doctors should realize themselves these consequences of Parkinson's Law. This will restore self-respect and faith in medicine.

M H Shiwani, General surgeon

Management of delivery of healthcare has advanced, legging behind medics, rendering non-medical personnel as leaders and doctors as blue-collar workers. Training of non-clinical management and financial aspects of patient care will bring the leadership and authority back to medics and make medical professionals fit for purpose.

Andrew Papanikitas, GP and researcher

As a profession we can be complaining and self-interested. We grumble that trade union is ineffective, but fail to support them with our membership and participation. We slander our representatives as self-serving but do not put ourselves forward – what's in it for us? If we all did something (anything) to improve each other's professional lives, we might have more faith in each other, and people might have more faith in us.

Fahmy Hanna, Physician and endocrinologist

Currently, the NHS is an over-managed hierarchical structure, with clinicians having limited say and even clinical directors having limited powers, being exploited to ‘balance the books’! It would be excellent if clinicians lead decision-making and are empowered to focus on long-term developments, embracing patients' views/needs rather than ‘artificial’ targets.

Peter C Gotzsche, Medical researcher, Denmark

New laws should ensure that drug and device companies report through a public website the payments (and other benefits) they make to doctors, researchers, hospitals, professional societies, patient advocacy groups and others involved in medicine, and that all raw data from clinical trials become publicly available for independent scrutiny.

William R Phillips, Family practitioner, USA

Each consultation ends with a ‘Goodbye’ and usually a ‘Thank you’ from the patient. Too often we regard these kind words as mere formalities. If we pause to hear – and to receive – the genuine gratitude patients give to us we can connect to the healing that we do daily.

Mike Dixon, Surgeon

For 20 years I have replaced what generations have done with evidence-based practice. I want to look smart at work but I cannot wear what I want. I now look like a porter. There is no evidence looking smart does harm to patients.

Richard Rawlins, Surgeon

Professionals profess, have opinions, exercise judgement, use discretion. Decisions are more important than incisions, opinions more important than medicines. Managers should change their practice, invert the pyramid of power, support professional decisions from the base – and manage services for the benefit of individual patients, rather than dictate from the summit.

Samiran Nundy, Surgeon, India

I would like to see the practice of medicine in India restored from being a purely commercial activity to one where doctors work to help the sick.

The advent of corporate hospitals in India and their luring of doctors away from both public and non-profit institutions have debased a once respected profession.

Richard Spicer, Retired paediatric surgeon

Returning decisions regarding clinical priorities to doctors. Currently patients with serious and urgent clinical needs are being harmed because politicians (via NHS managers) have distorted clinical priorities by insisting that patients with minor and non-urgent conditions take precedence for precious, limited resources in order to meet government-imposed targets.

David Shipway, Physician

Arrest the terminal decline in standards of dress. We need to regain our self-respect before we can expect the public to follow suit. We delude ourselves if we think that their subconscious perception of us is influenced by our appearance. Scruffy dress is linked with scruffy performance.

Maryam Alfa-Wali, Clinical research fellow

‘First do no harm’ is what doctors that boarded the medicine airplane decided to do. Being a doctor is practising medicine safely, effectively and passionately. The pressure of time damps this. If medical voices were louder when changes are implemented without ‘shop floor’ negotiations, professional faith will be restored.

David Misselbrook, Dean of the Royal Society of Medicine

None – I never lost it. I do not know what will restore the faith of the media or politicians. But for myself that faith must come from my imperfect but real commitment to act professionally. I hope my patients and colleagues see me as a professional. That will have to be enough.