Time for reflection after the Bristol case
Authors: JAD Stewart
Journal: The Lancet (1998)

Once again the reputation of the whole medical profession has been blackened by the action of two high- profile individuals, James Wisheart and Jaradan Dhasmana from Bristol, which you report on in your June 6 editioral,1Editorial.First lesson from the "Bristol case".Lancet. 1998; 351: 1669Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar Richard Morton's May 23 and June 27 commentary,2Horton R Doctors, the General Medical Council, and BristolLancet. 1998; 351: 1525-1526Summary Full Text Full Text PDF PubMed Scopus (9) Google Scholar, 3Horton R How should doctors respond to the GMC's judgment on Bristol?.Lancet. 1998; 351: 1900-1901Summary Full Text Full Text PDF PubMed Scopus (24) Google Scholar and Sarah Ramsay's news items on June 6 (p 1707)4Ramsay S Evidence against "Bristol case" doctors found proven.Lancet. 1998; 351: 1707Summary Full Text Full Text PDF PubMed Scopus (1) Google Scholar and June 27 (p 1935)5Ramsay S UK "Bristol case" doctors found guilty of misconduct.Lancet. 1998; 351: 1935Summary Full Text Full Text PDF PubMed Scopus (2) Google Scholar. The failure of senior consultants in Bristol to police the activities of their colleagues and the subsequent closing of ranks is an ugly sight in a profession that is inherently based on trust and has the historical privilege of self-regulation. It is time that the profession as a whole took stock. Medicine is a difficult job. It is not science but still very much an art, one that to be performed well requires a delicate balance of listening, examining, commonsense, compassion, knowledge, and, most importantly, the formation of a trusting relationship with the patient. Most of us achieve this balance, but some are unable to achieve this diagnostic balance and usually become the drop-outs from medical schools or the disgruntled doctors in later years. Others sadly become egotistical victims of their own success and forget the ethics of good practice. Most doctors, however, provide a first-class service to their patients and rarely enter the public domain. Good doctors do not attract attention and so, by definition, most doctors must be reasonably good. The public, however, increasingly expect more from the National Health Service (NHS) and the medical profession. The inadequacies of the NHS, seen in the waiting room and on the ward, are mostly perceived to be the fault not of goverment underfunding but of the doctors. We have to listen to complaints from patients about the long waiting-lists, and inadequate level of staff. The media also, are only too ready to vilify doctors, which erodes the faith the public place in the profession. So when a scandal such as the Bristol case erupts, the public are only too willing to condemn, not just the individuals involved but also the profession as a whole. Doctors need to decide exactly what their role is and how they wish to be perceived. First and foremost, we are medical practitioners: we diagnose, we prescribe, we operate, we treat. In doing this work we must make sure we do it well. There is no easy answer as to how we regulate our work, but we must not be seen to be an old boys network. We must be quick to condemn the poor performance of others and we must lose our veneer of silent reserve in the face of professional misconduct. We must be forthright in voicing our concerns about the state of the NHS, for if we are to provide a service in which the public have any faith, we must be allowed to work in an environment conducive to good medicine—ie, one that is well funded, is well run, and provides an equal service to all. In the wake of the Bristol scandal, the public may well question the values of our profession. Let us not passively restore our trustworthiness by hoping that in time our past mistakes will be forgotten—-rather let us actively restore the public's faith in us by being good at what we do. DEPARTMENT OF ERRORPulmonary hypertension in type 1 Gaucher's disease—In this correspondence letter by N Belmatoug and colleagues (July 18, p 240), the dose of alglucerase in the fourth sentence of the second paragraph should read, "60 IU/kg twice a month". Full-Text PDF DEPARTMENT OF ERRORHIV-1 in injecting-drug users and heterosexuals—In this correspondence letter by S Panda and colleagues (July 4, p 241), Sekhar Chakrabarti should have been included as an author. Full-Text PDF