Rising cannabis use in indigenous communities.

Richard Cruess, of the Centre of Medical Education at McGill University, recently observed that “Lots of people are terribly worried about what is happening in medicine and what it is forcing physicians to do”, adding that it’s time that doctors assert “This is who we are and this is what we do.” This call to reaffirm our professional identity is prompted by the many challenges confronting modern medicine, which, according to Professionalism in medicine, a discussion paper of the Canadian Medical Association, include a pervasive market mentality in healthcare where consumerism has transformed patients into customers; the suffocation of practice by bureaucratic and regulatory requirements; and the threats to clinical autonomy posed by medical industrialisation. “By breaking medical care into distinct tasks, managers can assign each task to a health professional — usually the lowest skilled and lowest paid who is able to perform the task adequately. This practice can result in physicians losing ownership and control of the process and being reduced to cogs in the assembly line care of patients with multiple needs.” These challenges — commercialism, consumerism, bureaucratisation and industrialisation — require a clear response from doctors wishing to take control of their work once more by declaring unambiguously that “this is who we are and this is what we do”. But, more importantly perhaps, doctors must resolve the issue of “this is what we stand for”. Medicine now abounds with guidelines, protocols, regulations and inspections. Of late, professional independence has been eroded by the presence of bureaucratic “ghosts” in clinical practice, postgraduate education, accreditation and recertification. Is it not time to reassert control over our professional lives?