tdated citadel
ti Rowan Wilson oi) 'lac lio th ade disciplines, medicine has least affected by changing fashions III ,si.1.13n; aviour. While sociology students 'and riot, the medics stay bent over kicroscopes: beards and flowered 4,re still thin on the ground in the and even the old paternalistic 4 1.',,`15iris of discipline have shown an ir ;`Ilg viability in an age when dis..4 kii ttself has become almost a term of re i 0 . 0 te is a restiveness in the land, howeven the medical profession can!4stafIn Permanently immune to it. Over r0 itle„ ew Years, young doctors 'have be1,,` easingly to regard themselves as ssed minority, and to act accord'CrleY have demanded, and obtained, toil, t improvements in pay and work,i0 ti'flitions. They have claimed that they Zs.1.5? Under-represented in the coun"Le liMA. They have even managed e their presence felt in the oligarqathi :le halls of the Royal Colleges. In# the last entrenched stronghold of Athe very citadel of the Estab.This ,,is under attack. is is the Genquicall Council, the supreme discip`43c1Y of the profession. Increasingly re heard, both young and old, claim "t it is old fashioned, arbitrary, unde mocratic, expensive, and that something ought to be done about it. The history of the growth of opposition to the GMC is interesting and has its lessons for many another old-established institution. Until about five years ago, nobody paid any attention to it. It was there, it was presumably doing a reasonable job, and that was that. Then the Council became over-ambitious. It was dissatisfied with its limited functions and its modest income of £145,000 a year, derived from a levy of £21 on every medical student on qualifying. It wanted to extend its influence over medical education. It therefore proposed to raise its income by putting a yearly tax of £2 (soon later to be raised to E5) on all qualified doctors. At this point the doctors, touched in the most delicate part of their anatomy, woke up. A payment on qualification, almost certainly donated not by oneself but by a proud parent, was one thing; a yearly levy was quite another. They protested. What was worse, they began to look at the GMC with new eyes, not as a protector of their ancient rights and dignities, but as a collector of taxes. They asked themselves, first, why it should be worth nearly half a million pounds a year; and then by a natural extension of thought, what the hell it was there for anyway. Under such a cold and unsympathetic gaze the GMC wilted a little. For the fact is that many of its traditional functions have a distinctly old-fashioned look nowadays. It is a protector of ethics all right, oiibut they are in large part the ethics of ant her day. High on its list of offences loom e essentially Victorian crimes of sexual irregularity and self-advertisement, public attitudes in both areas have changed out of recognition since the GMC was set up.
The GMC itself has changed very little. It continues to hold to the view that any doctor who goes to bed with a woman patient is guilty of unprofessional conduct and should be deprived of his livelihood. He is supposed to be "taking advantage of his professional position." This not only assumes a passive attitude on the woman's part which is no longer valid. It also takes little account of special circumstances and the present tendency of men and women to regard sexual intercourse as a form of pleasurable entertainment rather than an apocalyptic event.
The rules about advertising are even more anachronistic. They were formulated in the days of private medicine, in an effort to prevent doctors engaging in an undignified scramble for patients. In this context, they were reasonable enough. But since the advent of the National Health Service, private practice has become relatively insignificant.
Reform of the profession's ethical standards is therefore in the air. There is increasing pressure, not only for the abandonment of the emphasis on sex and advertising, but for a more positive approach on questions of more contemporary importance such as drug addiction. Most doctors admit the need for a disciplinary body, both in their own interests and the interests of patients. What they are questioning is the relevance of the GMC in its present form and with its present preoccupations. It looks as if the Council's initial modest demand for extra funds has triggered off a process which will eventually lead to a completely new approach to medical ethics.
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