Medicine and the media: A profession on probation
Authors: Colin Douglas
Journal: BMJ (1998)

Medicine is a rough old trade. From doubtful origins in botany and violence, it has grown over the ages to biomedical respectability and considerable political clout. Now there are about 100 000 of us at it in the United Kingdom—saints and scientists, sinners and soaks, together, of course, with the overwhelming nondescript residuum who qualify as “None of the above.” 

We live off the state, spend about £45bn of its money each year, and in return practise the trade, trying to do as much good and as little harm as possible. Mostly. We work alone and in groups, in centres of excellence and of notoriety, under close supervision or none. We vary greatly. Very few of us have any clear idea of how we are doing professionally. We are not good at handling the failures of colleagues, far less our own. And traditionally we have tried to deal with the inevitable quota of misfortunes, scandals, and rascals in ways well meaningly devised to minimise professional embarrassment and public disquiet. 

But all that seems to be changing now, and those who seek to lead and represent the profession face new challenges, the difficulties of which were teasingly explored by Richard Horton in an iconoclast’s guide to the upper reaches of the British medical establishment. The Citadel, slotted in the decent obscurity of Channel 4 at 11 pm on a Thursday, nevertheless attracted both reviews and public interest. 

The Horton style owes something to that of Paxman (“Come off it, Helmut.... You can’t seriously expect us to believe...”) and makes for good television. The chosen worthies smiled, sweated, and wriggled. Reasonable men found themselves backed into unreasonable positions, and, like the fat boy in Dickens, Horton succeeded in making the flesh creep. Even the architecture looked menacing. The costly pretentious BMA building in Tavistock Square acquired a sinister mystery—something to do with camera angles and the soundtrack—and Lasdun’s Royal College of Physicians in Regent’s Park was similarly transformed into leafy London’s own Lubyanka. 

Tieless and in flickering candlelight, Horton rooted round the catacombs of Kensal Green in search of the bones of his radical role model, Thomas Wakley, who founded the Lancet “to expose the quacks and charlatans in medicine and to report on the bungled operations of famous surgeons.” Duly inspired, and by now wearing a tie, he set off on his round of visits. Surgeons, we were reminded, “began life as barbers, and at times since they’ve been likened to actors performing in comic opera, blundering around in the operating theatre without much evidence to prove the worth of what they’re doing.” 

A hapless president found himself discussing charges that surgeons sometimes deliberately damaged organs as part of surgical teaching. Wisely, he asked for an example, but then, unwisely and without waiting for one, said: “It is simply not true.” Horton pounced. As a student he had witnessed a surgeon (“a senior member of your own college”) cutting a ureter in order to show a junior colleague how to stitch it back together again. 

“Really? When? First offence or one of a series? Did you think of reporting it? I know it might have been difficult but surely, for the sake of patients...?” Forget about Paxman; the counter questions must have sprung to the minds of at least half the people watching. Suddenly the interview looked as if it might be about to come alive. Instead, the president chose to stumble on: “I frankly don’t believe it, I’m sorry.... I cannot accept that.” So there we are. Or more likely aren’t. Quite avoidably, British surgery was left with a presidential credibility problem of Nixonian proportions. 

The physicians did little better. Horton described how he had been offered and accepted a fellowship without examination as a result of his being rude about their college in the Lancet, and how such privileges might be used to socialise and moderate the profession’s dissidents. Prodded eventually by a question about how the physicians might be losing their influence in a scrap between the various colleges, their president pronounced: “I think that’s a gross overstatement. I mean, we have always been the best. We will remain so.” 

Next please. Viewers learned about the BMA. “They’re the largest doctors’ organisation, and have a powerful and, many would say, malign influence over government... a multi-million pound business dressed up as a fancy London club.” Its chairman, lulled by a naive sounding question (“Do you ever meet the minister, for example?”) duly went overboard on the business of influence. “Good heavens, yes, um, constantly, both informally and of course at dinners, receptions....” 

So it went on. “Port and cigars?” “Port’s a bit old fashioned, and cigars are out. And we actually have an agenda.” A curious dialogue developed, in which the interviewer, with the smell of the zealot Wakley’s bones still in his nostrils, sought in every nuance of the routine workings of the London policy village a conspiracy against the people, while the interviewee kindly described things in a way that allowed just that possibility. 

Once or twice the BMA pussycat bared its trade union claws. On pay the chairman confessed to feeling a bit cheated. Formerly on a par with barristers and actuaries, now “we’re to be compared with personnel directors, with computer operators, and so on.” But as trade unionism goes it was more petulant than militant. A powerful influence on government? Really? 

Even the man from the GMC, who has done more than his predecessors to try to get things right, was given the full Paxman treatment and made to sound as though it was high time he pulled his socks up. And, as an incidental cruelty intrinsic to the medium of television, we were left wondering whether, for a man in whom the public are asked to put so much trust, a Cecil Parkinson hairstyle might not be a serious error of judgment. 

By the time Sir Richard Horton is president of the GMC—and British medicine has a commendable record in absorbing its rebels for the common good—no doubt it will all be much better. But today as a profession we are on probation. A public that traditionally just paid and trusted us wants a little more for both its money and its trust. Now people are restless, and government is active. 

I watched this programme from Scotland, where it is possible these things are managed a little less badly. Two quotes sprang to mind, and I commend them to the trade at large. The late John Smith once said that he sought only the opportunity to serve. Simple. That’s why we’re here, folks. And one Robert Burns wrote: “O wad some pow’r the giftie gie us, tae see oursel’s as ithers see us.” Particularly in these troubled times, our leaders might care to bear that one in mind too.