From the Editor Journal of the Royal Society of Medicine; 2015, Vol. 108(11) 425 DOI: 10.1177/0141076815616300
No transformation without reconciliation Kamran Abbasi Editor, JRSM
Two months ago I asked you for advice for new medical students.1 I’m still seeking it. Are these brighteyed recruits being sold a career that has lost its magic? Is professionalism as we knew it dead, replaced by miserable clock watching? Medicine has much to be proud of in its evolving embrace of shared decision-making, acceptance of new technologies and willingness to tackle complex challenges posed by our ageing population and multimorbidity.2,3 Yet, when I speak with doctors of all ranks, from professors to junior doctors, whether in hospital specialties or primary care, there isn’t much that feels good. Reports are everywhere of low morale and disillusionment. The reports ring true with each conversation and anecdote. The NHS faces unprecedented financial challenges and spiralling demand for services, the implications of which are an impetus for spending cuts and service innovation. Following the discontent caused by the Health and Social Care Act, a restructuring that the profession largely opposed, instability has become established. People yearn stability. Financial considerations dominate minds that wish to be preoccupied with the health and welfare of patients. Until recent months, these unwelcome priorities primarily affected senior doctors. Now, with a government push for an ‘extended’ 24/7 service, junior doctors feel victimised, bullied into accepting a new contract and threatened with longer working
hours for no more pay.4 There are two central issues. First, whether or not the government is steering the NHS in a sensible direction? It is a complex debate. Is the government responding pragmatically to a crisis in service delivery? Or is there a grand design to dismantle the NHS? Whichever side you choose, the second issue is more straightforward. Any change is difficult, well-nigh impossible to introduce with an unwilling and demoralised workforce. If the government pits itself against consultants, general practitioners and junior doctors, how can the health service deliver satisfactory care to patients on a day-to-day basis, let alone contemplate fundamental reform? There can be no transformation with reconciliation. References 1. Abbasi K. Your advice to new medical students. J R Soc Med 2015; 108: 337. 2. Zarnegar R, Brown M, Henley M, Tidman V and Pathmanathan A. Patient perceptions and recall of consent for regional anaesthesia compared with consent for surgery. J R Soc Med 2015; 108: 451–456. 3. Donaldson IML. Ambroise Pare´’s accounts of new methods for treating gunshot wounds and burns. J R Soc Med 2015; 108: 457–461. 4. Potluri R. Is it time to re-appraise the weekend effect? J R Soc Med 2015; 108: 382–383.
Downloaded from jrs.sagepub.com by guest on June 4, 2016
Letter Journal of the Royal Society of Medicine; 2015, Vol. 108(12) 472 DOI: 10.1177/0141076815599781
To submit a letter in response to a JRSM article, please visit http://jrsm.sagepub.com to find the article concerned, then click on the ‘Submit a comment’ link found in the Reader Responses section. Comments will automatically be submitted for consideration to be published in print.
Postgraduate medical school of the University of Exeter Professor Baum’s review1 of Professor Ernst’s A Scientist in Wonderland2 rightly recognises an important book. However, it’s a serious mistake to call the Exeter Postgraduate Medical School (PGMS) an ‘academic backwater’. The PGMS was the first such School in the UK, and Exeter was the first British University to fund such a body. Brimblecombe’s pioneering work led to the Chairmanship of the National Children’s Committee. The first Postgraduate Department of General Practice in Europe within the PGMS produced the first three books on general practice training,3 the first multi-professional MSc in Healthcare and the first UK postgraduate Chair of General Practice. Before Ernst applied, Professor Tooke’s team had published in the New England Journal of Medicine.4 The PGMS staff were academic innovators later providing an FRS, the President of the Academy of Medical Sciences, the Chairman of the Academy of Medical Royal Colleges, a Medical School Dean, the Chairman of the Medical Schools Council, a Royal College President, and the Chairman of the Nuffield Trust. Two Directors of the PGMS were knighted. The current head of Baum’s Medical School (University College London) built his academic career in the PGMS. Baum wonders why Ernst moved from the big Medical School in Vienna to the Exeter PGMS. I saw Ernst and his wife for detailed discussions
and was on his appointment committee. He did feel constrained in Vienna. We were confident he would fulfill our brief of researching rigorously and reporting fearlessly. As Head of Department, I gave him sustained academic support.2 An established professor of Ernst’s calibre would not have moved to a ‘backwater’. In recognising the world-leading research on complementary medicine, Baum might have mentioned the vision of the Donor, Sir Maurice Laing, and of the University of Exeter in establishing the first ever Chair of Complementary Medicine. Declarations Competing interests: DPG was the second Director (Dean) of the Exeter University Postgraduate Medical School 1987–1997 and was actively involved in recruiting Professor Ernst.
References 1. Baum MA. Scientist in wonderland. J R Soc Med 2015; 108: 242–243. 2. Ernst E. A Scientist in Wonderland. Exeter: Imprint Academic, 2015. 3. Pereira Gray D. Training for General Practice. Plymouth: Mcdonald & Evans, 1982. 4. Sandeman DD, Shore AC and Tooke JE. Relation of skin capillary pressure in patients with insulin-dependent diabetes mellitus to complications and metabolic control. New Engl J Med 1992; 327: 760–764.
Denis Pereira Gray University of Exeter; St Leonard’s Research Practice, Exeter EX1 1SB, UK. Email: [email protected]
Erratum Abbasi K. No transformation without reconciliation. J R Soc Med 2015; 108: 425. DOI: 10.1177/0141076815616300 The last sentence was published incorrectly in the above Editorial. It should read: ‘There can be no transformation without reconciliation.’ DOI: 10.1177/0141076815623159
No transformation without reconciliation Kamran Abbasi Editor, JRSM
Two months ago I asked you for advice for new medical students.1 I’m still seeking it. Are these brighteyed recruits being sold a career that has lost its magic? Is professionalism as we knew it dead, replaced by miserable clock watching? Medicine has much to be proud of in its evolving embrace of shared decision-making, acceptance of new technologies and willingness to tackle complex challenges posed by our ageing population and multimorbidity.2,3 Yet, when I speak with doctors of all ranks, from professors to junior doctors, whether in hospital specialties or primary care, there isn’t much that feels good. Reports are everywhere of low morale and disillusionment. The reports ring true with each conversation and anecdote. The NHS faces unprecedented financial challenges and spiralling demand for services, the implications of which are an impetus for spending cuts and service innovation. Following the discontent caused by the Health and Social Care Act, a restructuring that the profession largely opposed, instability has become established. People yearn stability. Financial considerations dominate minds that wish to be preoccupied with the health and welfare of patients. Until recent months, these unwelcome priorities primarily affected senior doctors. Now, with a government push for an ‘extended’ 24/7 service, junior doctors feel victimised, bullied into accepting a new contract and threatened with longer working
hours for no more pay.4 There are two central issues. First, whether or not the government is steering the NHS in a sensible direction? It is a complex debate. Is the government responding pragmatically to a crisis in service delivery? Or is there a grand design to dismantle the NHS? Whichever side you choose, the second issue is more straightforward. Any change is difficult, well-nigh impossible to introduce with an unwilling and demoralised workforce. If the government pits itself against consultants, general practitioners and junior doctors, how can the health service deliver satisfactory care to patients on a day-to-day basis, let alone contemplate fundamental reform? There can be no transformation with reconciliation. References 1. Abbasi K. Your advice to new medical students. J R Soc Med 2015; 108: 337. 2. Zarnegar R, Brown M, Henley M, Tidman V and Pathmanathan A. Patient perceptions and recall of consent for regional anaesthesia compared with consent for surgery. J R Soc Med 2015; 108: 451–456. 3. Donaldson IML. Ambroise Pare´’s accounts of new methods for treating gunshot wounds and burns. J R Soc Med 2015; 108: 457–461. 4. Potluri R. Is it time to re-appraise the weekend effect? J R Soc Med 2015; 108: 382–383.
Downloaded from jrs.sagepub.com by guest on June 4, 2016
Letter Journal of the Royal Society of Medicine; 2015, Vol. 108(12) 472 DOI: 10.1177/0141076815599781
To submit a letter in response to a JRSM article, please visit http://jrsm.sagepub.com to find the article concerned, then click on the ‘Submit a comment’ link found in the Reader Responses section. Comments will automatically be submitted for consideration to be published in print.
Postgraduate medical school of the University of Exeter Professor Baum’s review1 of Professor Ernst’s A Scientist in Wonderland2 rightly recognises an important book. However, it’s a serious mistake to call the Exeter Postgraduate Medical School (PGMS) an ‘academic backwater’. The PGMS was the first such School in the UK, and Exeter was the first British University to fund such a body. Brimblecombe’s pioneering work led to the Chairmanship of the National Children’s Committee. The first Postgraduate Department of General Practice in Europe within the PGMS produced the first three books on general practice training,3 the first multi-professional MSc in Healthcare and the first UK postgraduate Chair of General Practice. Before Ernst applied, Professor Tooke’s team had published in the New England Journal of Medicine.4 The PGMS staff were academic innovators later providing an FRS, the President of the Academy of Medical Sciences, the Chairman of the Academy of Medical Royal Colleges, a Medical School Dean, the Chairman of the Medical Schools Council, a Royal College President, and the Chairman of the Nuffield Trust. Two Directors of the PGMS were knighted. The current head of Baum’s Medical School (University College London) built his academic career in the PGMS. Baum wonders why Ernst moved from the big Medical School in Vienna to the Exeter PGMS. I saw Ernst and his wife for detailed discussions
and was on his appointment committee. He did feel constrained in Vienna. We were confident he would fulfill our brief of researching rigorously and reporting fearlessly. As Head of Department, I gave him sustained academic support.2 An established professor of Ernst’s calibre would not have moved to a ‘backwater’. In recognising the world-leading research on complementary medicine, Baum might have mentioned the vision of the Donor, Sir Maurice Laing, and of the University of Exeter in establishing the first ever Chair of Complementary Medicine. Declarations Competing interests: DPG was the second Director (Dean) of the Exeter University Postgraduate Medical School 1987–1997 and was actively involved in recruiting Professor Ernst.
References 1. Baum MA. Scientist in wonderland. J R Soc Med 2015; 108: 242–243. 2. Ernst E. A Scientist in Wonderland. Exeter: Imprint Academic, 2015. 3. Pereira Gray D. Training for General Practice. Plymouth: Mcdonald & Evans, 1982. 4. Sandeman DD, Shore AC and Tooke JE. Relation of skin capillary pressure in patients with insulin-dependent diabetes mellitus to complications and metabolic control. New Engl J Med 1992; 327: 760–764.
Denis Pereira Gray University of Exeter; St Leonard’s Research Practice, Exeter EX1 1SB, UK. Email: [email protected]
Erratum Abbasi K. No transformation without reconciliation. J R Soc Med 2015; 108: 425. DOI: 10.1177/0141076815616300 The last sentence was published incorrectly in the above Editorial. It should read: ‘There can be no transformation without reconciliation.’ DOI: 10.1177/0141076815623159
