A physician's view: Medical training means learning how to be callous

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A physician's view: Medical training means learning how to be callous

"There's never been a better time to become a doctor," said a friend trying to recruit A-level students to Bristol medical school last week. His reasoning was simple. The combination of the government's expansion of medical school places and the frightening-off of many potential applicants by dodgy doctor stories means competition for places has never been lower. When I applied for medicine there were 50 applicants per place. Now we're lucky to get two. The Bristol Royal Infirmary inquiry may have skewered the profession for its club culture, but it's not a club that many people want to join any more.

Criticisms of medical culture are nothing new. Professor Kennedy, the inquiry chairman, has been making them for over some 25 years. Amid the post-war optimism, doctors were jolly good chaps, the nurses were angels and patients would happily wait for treatment until rigor mortis set in. So the NHS was allowed to develop as a cheap service staffed by overstretched and unaccountable workaholics.

When I joined St Thomas's in 1984, paternalism and patronage were so powerful that you didn't dare upset the establishment for fear of mucking up your reference. Thus club rules were deeply embedded at an early age. Never criticise your boss, have unswerving loyalty to your hospital and when the going gets tough, keep your head down and take refuge in alcohol and black humour.

This sense of fraternity has been further reinforced by initiation rites. The first patient I met was a dead man whom I chopped up into increasingly smaller pieces. I had no preparation for what lay behind the dissection room door – the God-awful smell, the sound of the saw slicing off the top of the skull or the sight of genitals swollen in the preservation process. When Ian Kennedy spoke of the tribalism and emotional indifference of doctors in his interim report on organ retention, I tried to take myself back to the dissection room. We didn't care that much about dead peoples' parts, because we never met anyone else who did. We were learning to be callous. This attitude remains prevalent. The worse thing anyone can accuse you of as a young doctor is becoming "emotionally involved". Small wonder we can view suffering with such brutal detachment.

The final step into the clubhouse is the product of the diabolical working conditions. After a 120-hour week of bodge-ups, black humour and no sleep, you may still be physically alive but your soul shrivels up. When I campaigned for junior doctors in the 1980s, I met a father speechless with rage after his exhausted junior doctor son took his life.

My own errors (and there were plenty) were never picked up – or learned from either. Junior doctors were expected to be incompetent on account of poor training and lack of supervision. Medical training has now mercifully improved, medical schools are over half full of women and the would-be students I spoke to in Bristol last week are all from inner city comprehensives.

But the Bristol inquiry has shown how far we have to go. We need solid data about success and failure rates. Six years after Messrs Wisheart and Dhasmana stopped operating on children, you still can't get access to the results of the UK's 13 child heart surgery units.The Bristol parents succeeded where every government and professional body has failed: by finally holding doctors and the NHS to account.

Dr Phil Hammond is a hospital doctor in Bristol