Richard Smith on questioning doctors on their future

Richard SmithI have just come back from a gathering of the “big dogs of British medicine” at Highclere Castle, home of Lord Carnarvon, who participated in the discovery of the tomb of Tutankhamun. The point of the meeting was to provide the Royal College of Physicians working party on future doctors with material for their deliberations.

It was my job to end the day in my “performing monkey” role, and I had the idea of asking the big dogs–who included a sprinkling of patients, managers, philosophers, and the like—a series of questions. Below you can read the answers. Some of the questions may seem flippant, but all had serious intent. Most of the questions were about how things will be 20 years from now, and I told the audience that they couldn’t abstain. There were about 100 people in the audience.

1 Do you think that an NHS free at the point of delivery, universal, comprehensive, and funded from taxation will still exist?

Evenly split.

2. How will we die? Will the “compression of morbidity” happen, whereby we are healthy until 84 and three quarters and then fall to bits over the next three months, or will we live to be 105 demented, Parkinsonian, blind, deaf, and with every joint replaced?

More thought we’d live to 105.

3. Well assisted suicide be legalised?

Most thought yes.

4. If I have to live in a nursing home I’d like to live in one where I can keep a python, have sex with people I’ve just met, smoke, and take illegal drugs. You might be in the next room. Would you like a nursing home like this?

Overwhelmingly yes.

5. Will our society be more individualistic or exhibit more solidarity?

Evenly split.

6. Have doctors failed in their duty in their duty to lead change in the NHS?

Most said yes.

7. Are doctors part of the problem or part of the solution?

About a third said that doctors were part of the problem, which was for me the most surprising result, although people pointed out that doctors can be both at the same time.

8. Are doctors scientists?

About three quarters said yes, but a quarter said no.

9. Will more than 50% of consultations be carried out by phone, email, video, or some other form of technology?

Most said yes.

10. Who will own patients records? Patients or doctors/the system?

Almost everybody said patients.

11. Will we in Britain accept responsibility for the health of people in the poorest countries of the world as we accept responsibility for the health of people in Liverpool and Glasgow?

About a third thought yes.

12. Will five medical schools have closed?

About a third said yes.

13. Will the financial crisis create change in the NHS in the way that new money hasn’t?

Virtually everybody said yes apart from one or two people for whom it would be politically difficult to agree.

14. Assume that you have children even if you don’t. Would you advise them to go into medicine?

A roughly even split.

Here are the questions I forgot to ask, but maybe you’d like to give an answer.

1. Will there be an epidemic that kills half the population?

2. Should doctors stick to treating patients or “get out of their box” and speak up on subjects like climate change?

Competing interest. I paid my own fare to the meeting but did get a free lunch, which was moderate, and a look at the Egyptian remains for free, which was fun.