In my very first month, when I started this blog I twice bemoaned the gradual erosion of our clinical autonomy, the very basis of our profession as Consultants, and it is an issue that I have visited often since then. (1) (2) Inevitably as the politicians and managers have imposed control over our clinical conduct they have seen that, if all medicine is can be governed by protocol, you don’t really need doctors to do it, and our very purpose has been degraded.
I’m not by any means the only Blogger dismayed by this and both Dr No and the Witch Doctor have written excellent posts recently on the subject. So if the situation is obvious to bloggers it must be obvious to the rest of our colleagues, and from talking to them I know that that is the case, so why are we not doing anything about it. WD blames apathy but I think it’s a little more complicated than that.
I see Consultants as being divided broadly into two groups. The older generation who remember what true clinical autonomy was. They are mostly appalled by what has been done to the profession, but under the continual onslaught of demoralisation and demotivating from above their response is to cash in their pensions and fuck off. So disgusted are they with what has been done with our pay, pensions, working conditions, and revalidation that they are simply shaking the dust from their feet and walking without a backward glance. The NHS is prematurely losing it’s most experienced and valuable Consultants, the head and backbone of the profession.
Management are perfectly happy with this as it leaves them with the second group. Those far enough from retirement to fear for their continuing job security. This group has never known true clinical autonomy, but have grown up with the increasing control. They are more malleable and controllable than their older colleagues, and this is what management want.
But a controlled profession is no profession at all. The very concept of being a Consultant is cheapened and damaged. When management dictate clinical practice instead of leaving it to the professionals the inevitable result in terms of quality of care is obvious. But nobody seems to care any more.