An ordinary meeting of the Society was held on Wednesday 4th March. The President was in the chair. A minutes silence was held in the memory of Dr Peter Horsey. The President introduced the speaker Dr Julian Sheather who spoke to the title: ‘Is medical professionalism a thing of the past? medical virtues and the modern world’. Dr Sheather said that he had a philosophical background and that the language of ethics had something to say to the medical profession now it is under such pressure. Professionalism is difficult to define – you know when it is not there but it is at the heart of the doctor patient relationship. Modern managerial methods of guidelines and the like cannot take it into account. The RCP definition includes ‘vocation’ which is something that cannot be judged by external rewards. There is something within a vocation that draws those involved into it. Dr Sheather said that he often hears it is dying and that people are no longer going into medicine with a sense of vocation. However, medicine is more than a technical knowledge of disease, it involves human suffering and fear; there should be a desire to ameliorate this suffering. This involves judgement. Prostate cancer is full of uncertainty around diagnosis and treatment and rules cannot guide us. Patients need help to face these uncertainties. Medical paternalism is much talked about, and by inference disapproved of, and patient autonomy is the current mode. But do patients want to make decisions themselves? They want, and need, guidance and good sense. If doctors hide behind guidelines they cannot give it. Dr Sheather discussed Virtue Ethics – a contemporary moral reflection that focuses on action-orientated questions. It involves ‘good things’, defined either as the ‘external goods’, such as status and income which are competitive or the ‘internal goods’, such as those found within medical practice – for instance a satisfied feeling of a job well done - which are not competitive. Professionalism is the exercise of those virtues necessary to the realisation of the ‘internal goods’ within it. Modern institutions undermine the independence of medical practitioners, the biggest threats being political interference and the cultural environment of health. For example, he said, guidance on management, and even financial incentives [such as the financial rewards for a diagnosis of Alzheimer’s Disease], coming onto the doctor’s computer screen cause a conflict of interest. NHS doctors have been immune to financial pressures in the past but these incentives will be a threat in the future. The internal goods are being exchanged for the external goods [money]. The growth of consumer culture in medicine involves the idea that ill health is unnatural and it is a problem for doctors as illness and death are seen as failures. Health is seen as an entitlement – a right. If you have this right then who has the duty of overseeing it? Doctors. Medicine is becoming responsible for all the ills of the world. Doctors are being asked to take on the social health problems they can do little about. The pressures on professionalism are enormous: if we cannot trust our doctors what can we do?
The President thanked the speaker for such a stimulating lecture. There being no other business the meeting was closed at 9.55pm