The performance of doctors. i: professionalism and self regulation in a changing world

Introduction

The performance of doctors embraces attitudes to practice, knowledge, and skills. It is the outward and visible expression of our professionalism. In general, people think highly of the medical profession in Britain; rising expectations are a mark of our success. Nevertheless, self regulation, on which our professional independence and self respect depend, cannot be taken for granted. Sympathetic critics such as lay people, sociologists, and doctors reflect a wider public perception that we seem reluctant to assure doctors' competence and protect patients from poor practice. There are also criticisms that we are not addressing the widespread dissatisfaction with the attitude of some doctors, including their paternalism and poor communication with both patients and colleagues, and are failing to make self regulation demonstrably effective and responsive.1 2 3 4 5 6 7 8 9 10 11 12

These criticisms, if not dealt with, could seriously damage public trust. They provide ammunition for people who oppose professional self regulation on the grounds that, where doctors' and patients' interests conflict, doctors' interests will invariably come first. Greater external control of the profession is their prescription.

In this article, and another to follow, I propose a modern expression of medical professionalism, founded on sound self regulation, that should bring the public's and the profession's interests together successfully.

The changing world

Our professionalism is shaped by the context in which we work. First and foremost, medical knowledge and skill have expanded at an unprecedented rate. This, together with the revolution in information technology, has huge implications for the profession. Can we, for example, maintain medicine as a distinctive entity in the face of growing subspecialisation? Can we adapt to careers that may not last a lifetime without reorientation and retraining?

People know more about health matters because they have independent access to clinical information and because their …