A few months ago I was talking to a friend who is a gifted surgeon, urbane, humorous, well published, popular with staff and patients and has plenty of outside interests. With us was a similarly accomplished colleague, with stacks of quality publications and a recent presidency of one of the main surgical bodies, a man at ease with politicians, journalists, difficult clinical problems – in short, a very admirable doctor. We had just agreed, in all sincerity, that none of us would get into medical school these days.
In fact, the whole rigmarole of medical school entry in the UK is one of my pet hates. It is absurdly popular, and quite possibly for the wrong reasons. A different colleague holds the view that one reason why so many GP’s seem pissed off is that they spent the first 25 years of their existence being told – with some justification – that they were the intellectual elite of the nation. Their adult day to day tasks frequently fail to meet the expectations that this raises, made ten times worse by the now discredited GP contract rewarding all the least fun and professionally dissatisfying aspects of the job.
My sympathy with the striking junior doctors is limited, for which I tend to take some stick. One of the most bizarre aspects of it to me is that I was walking on air when I graduated as I was a doctor. I now had intrinisic special skills. I could in theory work usefully anywhere in the world. There was a certain status that came with the title – something the current juniors would be wise not to take for granted. 30 years later I still feel that way, the ‘special feeling’ has barely diminished. None of us was that bothered by, or interested in the details of the rather brutal contractual obligations. We had money in our pockets, and much of the work was its own reward.
By that way of thinking the current strike is crazy. It’s already morphing into a leftie hatefest of the worst kind, which won’t end well. The juniors’ terms and conditions are infinitely better than they were even 20 years ago. Are they really saying that after a colossal input from the rest of us – as taxpayers and willing subjects for their education – they will withhold their services for emergencies because a small part of the particular terms and conditions of their work with the monopoly employer in the UK displeases them? Do none of the strikers feel that ‘doctor vibe’ I mentioned earlier? Are they now all the serfs that the New Labour mob in cahoots with the General Medical Council of the early Noughties intended the doctors to become?
Perhaps they are.
Which brings me back to why they wanted to do medicine in the first place, as a sense of vocation is possibly dropping down the list, and to how the UK medical schools select them. The majority of juniors are indeed talented and committed individuals, but something has changed. Here is an excerpt from the great Theodore Dalrymple, writing in Spectator Health, on the decline of informal recommendations and selection in medicine:
This kind of selection by boastfulness now affects even the choice of medical students. It is not that their intellectual quality has gone down: on the contrary, it has probably gone up. But what is now required of them to gain entry to medical school is morally repellent, much worse than any possible defect that existed before. They now have to make a ‘personal statement’ about why they should be admitted, and this, of course, results in the most odious conformism; a kind of psychological cloning, as well as an invitation to untruth.
The son of a friend of mine applied to medical school and was turned down. He was told that, though he was academically qualified and admirable in many ways, his personal statement was not impressive enough. So he went a tutor who told him how to write his personal statement when he re-applied to the same medical school the following year. (In the world of spivvery that we have created, there is an allegedly private-sector opportunity in every procedural requirement.)
Having made his ‘personal statement’ more impressive with the paid help of his tutor in this dark art, he was admitted to the school that had refused him the year before. Needless to say, he had not changed in any way other than being a year older: but in a world in which the virtual is more real than the real, self-presentation has replaced theology as the queen of the sciences.
My solution would include adopting the perfectly good North American model (which includes Canada), and make all medical school entry postgraduate. Dalrymple’s precise phrase “odious conformism; a kind of psychological cloning” is part of the current problem.