Values matter

Donald Irvine

He explains that the GMC today is fundamentally concerned with changing the culture of medicine

True professionals

What is the value of being a professional? If you ask a doctor what being part of a profession means, each of us will probably come back with a different set of answers. But two themes will probably carry through them all.

First, that being a doctor is about caring for patients - sometimes the well, more usually the sick. The doctor-patient relationship remains at the heart of medicine. Despite massive technological advances, amazing new drugs, and the capacity of medicine to perform undreamed of interventions, most medicine still boils down to patients.

Second, that being a professional means belonging to a corporate whole. It's not about red tape, diplomas nailed to a wall, stethoscopes swinging or indeed the accumulated knowledge that most doctors gain. It is about subscribing to a set of core values that make doctors what they are.

These core values, the principles that sustain and guide medical practice, are the fundamental starting point of medicine as a profession. And it is right that the GMC, as the professional body, should be at the forefront of agreeing these standards with doctors, making them known to doctors and patients - and seeing that they are implemented in everyday practice.

Even now too many outside the GMC see us as remote, authoritarian and bureaucratic. I can under stand why. The classic story is told of when Lord Kilpatrick arrived in London fresh off a train from the provinces: hailing a black cab, he was soon on his way to the GMC at Hallam Street. As he left the taxi at the end of his journey, the driver lent out of his window and whispered softly 'Good luck, Gov!'

Needless to say, the President of the GMC was not about to be up on a charge of serious professional misconduct!! But it remains the case that many doctors and patients alike identify the GMC with medical discipline, when our role is so much more to do with the values that guide doctors and make us what we are professionals

Starting with standards

Take standards. This is the starting point of professionally-led medical regulation, as the standards set dictate admission to - and sometimes departure from - the medical register. Back in 1858, and for too long a time thereafter, being registered with the GMC meant one thing and one thing only. That sometime, somewhere, the doctor in question had passed qualifying exams recognised for admission to the medical register. Competence simply wasn't an issue.

In the l990s, the emphasis changed. The GMC had long been tasked by government to set standards, guide medical education, maintain the register and discipline those whose conduct raised questions about their registration. But only in the early 1990s did we begin to ask ourselves, just what is a doctor? Is it, as the traditional model implied, a case of a one-time qualification, and registration for life? This seemed to some of us a deeply mechanical approach to professionalism, both perfunctory and not very meaningful. Or was it, as reformers suggested, time to consider the very standards of good medical practice, make them explicit and positive, and expect doctors as professionals to uphold these values patient on patient, day on day, year on year?

The Standards Committee of the GMC got on with the task, and a new set - and indeed form - of GMC guidance was the result. Called Good Medical Practice, it underpins a different approach to medical regulation. It is written in plain English. The attributes of good medical practice are set out in positive terms. And at the heart of it all, the assumption, that professional regulation is remote, functional, and about acting against the dubious or the dangerous, has been transformed forever. After all, good doctoring is not about bad doctors. It is about us all.

This new approach to medical regulation has been welcomed by most of the profession. It requires a more open culture and I am delighted that many doctors are working hard to secure just that kind of environment. It needs a more pro-active and regular form of regulation - not red tape, but a transformation of the register into a meaning ful record of fitness to practise. Hence revalidation, our proposals that doctors should regularly reaffirm their fitness to practise to maintain their registration with us.

Ethics have an important part to play

This conscious shift in the pattern of medical regulation means change at the GMC too. There have been major reforms of the way in which we do business, to make us more accessible, open, effective and value-driven.

One growth area has been standards. The task in the 1990s has been to turn opaque and often dusty rules into open, explicit guidance for doctors. Good Medical Practice, published in 1995, was just the beginning.

Guides also exist on confidentiality, consent, medical education, and on various other issues. We actively make sure that these booklets are drawn up by doctors and the public working in tandem. Before we agree new guidance, we take soundings from a wide variety of sources, and take responses on board. After all, many of the ethical issues that dominate medicine today arouse strong feelings.

A few of these issues may be too vexed for the profession to be able collectively to take a view. Like the public, we are the sum of the whole. But many can be resolved, through careful dialogue and an upholding of the core principles that guide medical practice today.

Most doctoring is about people. A more open and equal engagement with patients is part of the story. But doctors want to be treated like people too. We have feelings, failings and sicknesses just like most of our patients. In the past we have been less good at dealing with our own, or colleagues, problems than we have been at caring for our patients.

This is another reason why a more open, reflective and supportive medical culture offers much more to doctors in practice. All too often, horrifying stories of pent-up problems come to the surface. Bottled-up problems, unacknowledged blind-spots, and genuine mistakes left undealt with have destroyed many lives - patients and doctors alike, For a caring profession we remain curiously uncaring towards our own - this simply has to change.

Grounds for optimism

I think that there are tremendous changes underway in medicine Visiting medical schools, I come across young men and women determined to see a more open and value-driven profession flourish. And in the course of my travels around the country, I meet countless doctors who see their professionalism in quite a different way to the narrow, functional and sometimes paternalistic stereotype of the past. It s all very exciting. And most encouraging of all, it matters to me that so many doctors strongly support the professional values that they, through the GMC have defined.

Sir Donald Irvine CBE is President of the General Medical Council.

Return to CMQ Feb 2001