Hippocratic oaths: medicine and its discontents.

Raymond Tallis is Professor of Geriatric Medicine at the University of Manchester, but in addition to his medical interests has contributed to philosophy. In this book, professor Tallis reviews the current state of medicine, and observes a dissociation between what medicine has achieved and the way in which it is perceived. He argues that we need to rethink the relationship of medicine to society. The book is set out in three distinct sections. In the first, the rise of medicine from the experiences of prehistoric peoples through the renaissance into the scientific age is outlined, the focus being the way in which scientific medicine has made the human body more human. Self-criticism has made an important contribution to the success of scientific medicine; doctors have adopted a sceptical stance towards received ideas and sought to question authority, thereby promoting gradual advance in the effectiveness ofmedical interventions. In the second section, the contemporary discontents are introduced. They include what Tallis regards as poorly informed expectations of doctors in relation to communication, time and waiting. The argument that doctors are unreasonably powerful when compared to their patients is erroneous, and the culture of suspicion and distrust fostered by politicians and others is leading to increasingly stringent controls on doctors and the practice of defensive medicine. In the world outsidemedicine,misunderstandingof scientificmethod and prejudice serve as enemies of progress, and fail to acknowledge that scientific medicine ‘for all its faults, is the bravest and most honest attempt to mediate between the needs of suffering humans and the ‘‘unhuman’’ body’. To add to the problems, some journalists and lawyers misrepresent doctors’ intentions. The third section looks into the future. Tallis anticipates that if the relationship between society and medicine does not change, medicine will cease to be a profession – it is in danger of losing its values, of medicine as a ‘calling’, and becoming a service industry staffed by technicians skilled in customer care, who may be too shallow to cope with the depths of serious illness. Tallis then effectively demolishes the argument that increasing life expectancy must lead to more years of dependency in old age. Good medical care de-medicalises old age. There is much still to gain, therefore, from the future of scientific medicine. Most doctors will find something to agree with in Hippocratic Oaths. The accumulating pressures on doctors from policymakers, managers, media and patients are undeniable. More control and more bureaucracy are features of every doctor’s life. But Tallis’ thesis – that the threat to medicine of being irreversibly corrupted comes not from the profession but from society at large – is more difficult to swallow. Of course society has made life more complicated for doctors, but doctors and their leaders have played their part. Tallis fails to adequately question the role of doctors’ professional organisations as they have sought to defend doctors over the last 30 years. For this reason, although many doctors will feel their cause is well served in this book, most readers outside medicine are likely to see it as another attempt to defend doctors rather than an invitation to a dialogue or guidance to doctors on what they must do to preserve professionalism into the future. I found the debate on power was the point at which Tallis’ argument lost its way. He argues that the power of doctors and the powerlessness of patients are both exaggerated, and that the policies followed in the NHS and the attitudes of society based on this exaggeration are misguided and damaging. This view does not reflect my personal experience nor the findings of relevant research. On this issue, scientific medicine is apparently, not so scientific. If Tallis’ thesis about the source of the threat to medicine is rejected, an obvious question arises – why have doctors failed to preserve their profession in the social environment of the late 20th and early 21st centuries? I suspect the answer is that doctors have failed to understand society and not that society has failed to understand doctors. However, you will enjoy reading this book and coming to your own conclusions in this vital issue.