The Doctor's Tale: Professionalism and Public Trust

Tim van Zwanenberg (Professor of PostgraduateGeneral Practice,University of Newcastle,Newcastle, UK)

International Journal of Public Sector Management

ISSN: 0951-3558

Article publication date: 1 December 2004



van Zwanenberg, T. (2004), "The Doctor's Tale: Professionalism and Public Trust", International Journal of Public Sector Management, Vol. 17 No. 7, pp. 632-633.



Emerald Group Publishing Limited

Copyright © 2004, Emerald Group Publishing Limited

The theme of trust, or its absence, pervades much of modern day culture. Onora O'Neill's timely 2002 Reith Lectures caught the mood, opening up a discourse at a time when many are worried about the public's loss of trust in institutions. The medical profession is one such institution, where patients' trust in their doctors, seen by all as essential, has been brought into question.

History may show that Sir Donald Irvine has been one of the most important doctors in British medicine since the inception of the National Health Service in 1948. He was the first ever general practitioner to become president of the General Medical Council (the profession's regulator) in its 150 year existence, and presided over the Council during a period of very considerable turbulence. Indeed, it is clear from this book that he was the architect of much of that turbulence as he determined that reform was necessary, and that the bargain between the profession and society had to be re‐negotiated. His presidency, of course, coincided with a series of medical scandals ‐ Bristol, Alder Hey, Shipman ‐ and these, he argues, were the drivers for change in the professional self‐regulation of doctors.

The Doctor's Tale (is it his tale or the story of all doctors?) is an intriguing mix of autobiography, personal justification, journalism, contemporary social history, and political rhetoric. It is in four parts. The first deals with his early professional life as a general practitioner in unfashionable Ashington and then describes some of the characteristics of the medical profession and its regulation. The second covers the 1970s and 1980s when important developments took place, but, he argues, the plot was ultimately lost. The third provides a fascinating account of the Bristol case, and the fourth chronicles what happened thereafter, including the battles amongst the profession over revalidation and the impact of the conviction of the serial killer, Shipman.

This is an important book. It is also well written and highly readable. It provides an insight into Irvine's own values and into the machinations of a great profession in the throes of change. There are irritations: the repeated jibes about the British Medical Association (the doctors' union); the constant lauding of the Royal College of General Practitioners; and, the tendency to state his opinion as fact! And some of the description of the internecine warfare in the profession reads like last week's newspapers. The world has moved on. Nevertheless the final chapter does much to bring it all together, as Irvine summarises his views on the critical role of newly autonomous patients and a new professionalism among doctors. He also speculates on how patients might be better served if the NHS were more diverse and less centrally controlled.

As the debate moves on, particularly in the wake of Dame Janet Smith's inquiry into Shipman, it remains to be seen whether Irvine is right. He usually is, an unforgivable trait amongst many of his colleagues.

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