Tooke – The role of the doctor – past, present and future

February 23, 2009

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THE ROLE OF THE DOCTOR – PAST PRESENT AND FUTURE – FINAL CONSENSUS STATEMENT

“2007 was a watershed for the medical profession. Sir John Tooke’s Inquiry into Modernising Medical Careers called for the profession to speak with a coherent voice and to define the role of the doctor. The profession heeded that call. This is the current consensus on the ever evolving role of the doctor. It has been developed in consultation with the undersigned organisations, patient groups and those medical and lay delegates who attended the Role of the Doctor Conference in October. The statement builds on much recent work by the signatory organisations and should be seen in the context of the Duties of a Doctor as defined by the GMC in Good Medical Practice.

The Consensus Statement on the Role of the Doctor

Doctors alone amongst healthcare professionals must be capable of regularly taking ultimate responsibility for difficult decisions in situations of clinical complexity and uncertainty, drawing on their scientific knowledge and well developed clinical judgement. The doctor’s role must be defined by what is in the best interest of patients and of the population served.

Based on the definition of the role of a medical doctor proposed by the International Labour Organisation it is agreed that:

Doctors as clinical scientists apply the principles and procedures of medicine to prevent, diagnose, care for and treat patients with illness, disease and injury and to maintain physical and mental health. They supervise the implementation of care and treatment plans by others in the health care team and conduct medical education and research.

All healthcare professionals require a set of generic attributes to merit the trust of patients that underpins the therapeutic relationship. These qualities include good communication skills, the ability to work as part of a team, non judgemental behaviour, empathy and integrity. In addition to possessing these shared attributes doctors must be able to:

assess patients’ healthcare needs taking into account their personal and social circumstances

apply their knowledge and skills to synthesise information from a variety of sources in order to reach the best available diagnosis and understanding of the patient’s problem, or to know what steps need to be taken to secure such an outcome

support patients in understanding their condition and what they might expect, including in those circumstances when patients present with symptoms that could have several causes

identify and advise on appropriate treatment options or preventive measures

explain and discuss the risks, benefits and uncertainties of various tests and treatments
and where possible support patients to make decisions about their own care.

The nature of these core requirements emphasises the need to select those with the appropriate attributes for training. Medical undergraduate education must provide a strong grounding in relevant science and in clinical practice as well as providing opportunities to develop an appreciation for research. Doctors must have the ability to assimilate new knowledge critically, have strong intellectual skills and grasp of scientific principles and be capable of dealing effectively with and of managing uncertainty, ambiguity and complexity. They must have the capacity to work out solutions from first principles when the pattern does not fit. All doctors must be demonstrably committed to reflective practice, monitoring their contribution and working continually to improve their own and their team’s performance.
Doctors must all be committed to playing a part in the education and support of the next generation of medical practitioners and of facilitating the advancement of evidence based practice.

The doctor needs to be capable of assessing and managing risk; this requires high level decision making skills and the ability to work outside defined protocols when circumstances demand. Doctors must also be able to make informed decisions about when supportive care is more appropriate for the patient than intervention.

The doctor must possess the ability to work effectively as a member of a healthcare team, recognising and respecting the skills and attributes of other professions and of patients. Patients with long term and disabling conditions are particularly likely to be experts in their own condition and should be supported to keep as healthy and independent as possible.

All doctors have a role in the maintenance and promotion of population health, through evidence based practice. Some will enhance the health of the population through taking on roles in health education or research, service improvement and re-design, in public health and through health advocacy.

Notwithstanding the primacy of the individual doctor:patient relationship, the doctor must appreciate the needs of the patient in the context of the wider health needs of the population. For all doctors the patient must come first but they will achieve this in different ways and in different settings. As the critical decision maker with responsibility for significant health resources the doctor must be capable of both management and leadership and of taking ultimate responsibility for clinical decisions. Within a world where the capacity to treat is growing but financial resources are finite, doctors have a duty to use resources wisely and effectively and engage in constructive debate about such use. They should ensure that their own and others’ skills and knowledge are deployed to best possible effect.

Doctors have a key role in enhancing clinical services through their positions of responsibility. Some will move on from clinical leadership and management to leadership roles within organisations at various levels – service, institutional, national and international.

The role of the doctor is changing and will continue to change alongside the needs and expectations of patients. Patients are increasingly better informed and act as partners in their own healthcare. The doctor serves as advisor, interpreter and supporter in this endeavour.

This statement has the support of:
The Chief Medical Officers of England, Scotland, Wales and N Ireland, The Academy of Medical Royal Colleges, The Association of UK University Hospitals, The BMA, COPMeD, The GMC, The King’s Fund, The Medical Schools Council, NHS Employers and PMETB

Published December 2008

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MMC House of Commons Select Committee – Written Evidence

April 2, 2008

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MODERNISING MEDICAL CAREERS – SELECT COMMITTEE – WRITTEN EVIDENCE (HTML)

MODERNISING MEDICAL CAREERS – SELECT COMMITTEE – WRITTEN EVIDENCE (PDF)

“EXECUTIVE SUMMARY

Modernising Medical Careers is a collection of policies to improve the way in which junior doctors are trained and to modernise the Senior House Officer grade. The original principles as set out in Unfinished Business and Modernising Medical Careers aim to do just that and are still valid.

In the main, the implementation of MMC was in line with the original principles. However, the introduction of run-through training, thought by many stakeholders to be a good thing, limited the flexibility inherent in the original principles. The Department is re-introducing flexibility for 2008 and beyond. “

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MMC House of Commons Select Committee – Oral Evidence

March 31, 2008

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THE WITCH DOCTOR’S OFFERING – MMC

MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 15 NOVEMBER 2007

Sir Liam Donaldson KB, Professor Martin Marshall, Ms Clare Chapman, and Mr Nic Greenfield.

“Sir Liam Donaldson: I know that some of this is caught up in language and terminology, but might I just clarify that to begin with. The original programme was not called Modernising Medical Carers. It was, as you rightly say, a reform of the senior house officer grade, which was, in my view, an educational scandal in this country and needed to be remedied. I produced a report, advised by members of an expert committee, which suggested reforms to the SHO grade. The Modernising Medical Careers programme then was a broadening out of that.

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MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 6TH DECEMBER 2007

Professor Sir John Tooke and Sir Jonathen Michael

Dr Richard Marks, Mr Matthew Jameson Evans and Professor Steve O’Rahilly

“Professor Sir John Tooke: The Committee will be aware that the distress caused by the selection system known as MTAS in the spring generated a good deal of anxiety within the profession. That ultimately precipitated the then Secretary of State for Health having a telephone conversation with me and inviting me to consider chairing an independent panel to look into the circumstances surrounding that perceived failure.”

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MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 13TH DECEMBER 2007

Professor Alan Crockard and Professor Shelley Heard

Dr Jo Hilborne, Dr Ian Wilson and Dr Ramesh Mehta

Mr Mark Johnston

“Professor Crockard: I think the final stage was total frustration, feeling that our views as medical people, and as people with an interest and background in education, was being neglected. I felt that the whole principles of MMC, which I thought were very important, were being subsumed into an attempt to get the workforce running. We saw the situation unfold from fairly well back; I had tried very hard to make this known to the SRO to whom I was accountable in terms of MMC, and to the DCMO.”

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MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 17th JANUARY 2008

Professor Dame Carol Black, Mr Bernard Ribeiro and Dr Bill Reith

Professor Elisabeth Paice, Professor David Sowen and Professor Sarah Thomas

“Mr Bernard Ribeiro: Therefore, we supported the initial principles of MMC in Unfinished Business but not what happened subsequently; it was imposed. Many of the comments that our college made were ignored in this situation.”

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MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 24th JANUARY 2008

Professor Peter Rubin, Professor Neil Douglas and Professor Sir Nick Wright

Ms Anne Rainsberry, Dr Moira Livingston and Ms Sian Thomas

“Professor Rubin: The timing was largely coincidence. I should qualify that by saying that I was not involved in the establishment of PMETB. I came on the scene somewhat later than the establishment process, which was earlier on. Inquiries and reviews going back to 1970 recommended that postgraduate medical education should be regulated, as undergraduate medical education has been since 1858. The most recent of those reviews was the Bristol heart inquiry and in that review Ian Kennedy very clearly recommended that postgraduate education should be regulated and PMETB was a consequence. MMC was developing in parallel with all that. One of the issues that has been all too apparent to us is that, because the MMC came on the scene at much the same time, there has been a lot of confusion about what the two organisations do.”

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MMC – UNCORRECTED SCRIPT OF ORAL EVIDENCE, COMMONS SELECT COMMITTEE, 18th FEBRUARY 2008

Ms Lorraine Rogerson and Ms Judith MacGregor

Rt Hon Alan Johnson MP, Mr Hugh Taylor, Sir Liam Donaldson and Ms Clare Chapman

“Ms Rogerson: The Department of Health first approached the Home Office in 2005 about using the Immigration Rules to limit further competition for training posts from international medical graduates.”

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