Focus: the wrong doctors: selection or training at fault?

Mrs Munro, Chairman of a London Teaching Area Health Authority, argues vigorously that current medical training needs improvement. While investigative diagnosis, acute medicine and medical research are well served, the caring and preventative specialties are inadequately encouraged as is a sense of responsibility both to patients and to the health service as a whole. Surgeons, she adds, seem particularly prone to develop inconsiderate and irresponsible practices. She finds the present separation of decision-making (by doctors) from resource management (by administrators) 'frightening' and the present management machinery 'hopelessly cumbersome'. Doctors should be trained to 'take a massive responsibility for the totality of the service, to evaluate the use of resources, to manage, and to allocate'. In his commentary Dr MacGillivray, Dean of a London Medical School, agrees that medical education is 'inefficient' and needs reassessment. However, it is, he asserts, centrally concerned with students' attitudes and sense of responsibility, as is the underlying milieu of medical practice. There are some 'rogues', and he suggests that disciplinary procedures need improvement. However, he hopes that Mrs Munro's jaundiced view of the profession is biased by 'her position at the apex of the complaints funnel'. He agrees with her in deprecating the separation of power and responsibility and blanes in part the reorganisation of the National Health Service in 1974. He agrees too with Mrs Munro's approach to a solution. Her paper was originally given to a London Medical Group meeting chaired by Dr MacGillivray.