Donald Irvine: A welcome for impatient patients

From the Royal Society of Arts/Pfizer lecture by a former president of the General Medical Council

I was thinking recently about the "assertive" patient. A senior lawyer said to me a couple of years ago, "Can you find me a new consultant?" He had quite a serious medical problem. He said, "He's hopeless, this man. Donald, find one for me."

I said, "Well no, let's just actually un-piece this; how have you got to this position, have you talked to him about it?" "Oh", he said, "I wouldn't like to do that, he's very grand you know." Very grand: imagine it. And I said to him, "But you're a judge!" And of course, I thought, that's a pretty foolish thing to say; he was a patient.

It's quite salutary to remember that the modern medical profession is only 150 years old. As I look back on half a century of being a doctor, medicine has been transformed. In that short time, we have seen the amazing rise of scientific and technological medicine, which has brought immense benefits. It has come to dominate with much less emphasis, until recently, on the so-called "soft parts" of medicine concerned with communication, with relationships with patients, ethics and attitudes.

In 1948, when the NHS was formed, we expected to stand dutifully in a queue and be grateful for what the NHS gave us. We passively accepted what doctors said. That's how it was. Doctor knew best. Today we live in a service-minded world where the public, not the providers, expect to have the ultimate say. Patients, especially young people, are becoming more questioning of doctors and less deferential.

I see this as a very positive development, from which everybody should gain, if we approach it right. But I admit there are still doctors who dislike what they perceive as their authority being questioned and feel diminished, so they still resent the assertive patient.