Medicine on the Brink: The Dilemma of a Learned Profession

MEDICINE ON THE BRINK: THE DILEMMA OF A LEARNED PROFESSION* SIR GEORGE PICKERINGi I believe that the profession of medicine is now facing a dilemma which may destroy it unless the nature of the choice is seen dearly and faced with insight, courage, and resolution. The dilemma is similar in Britain and in the United States. Should medicine behave as a learned profession or as a technical trades union? The issues of learned professional and technical trades union are the same on both sides of die Atlantic but have reached different phases ofdevelopmentin die United States and in the United Kingdom. This has itsadvantages sinceeach can learn from the other. Fifty years ago when I first visited this country, medicine was at its best deeply respected as a learned profession. The great doctors were learned and the less great would have Uked to be and respected those who were. Professional standards were high; service to the sick and integrity were the watchwords. Professional bodies sought to maintain and enhance standards and discourage those who erred or who sought to err. Now medicine seems to be in dangerofceasing to value or respect learning. What would have been regarded as unprofessional behaviour is not only tolerated but encouraged by the larger organisations ofboth senior andjunior doctors. This is what I mean by medicine on the brink. In my more realistic and more pessimistic moods, I suspect diat we are no longer pausingat the riverbank but that we have already crossed. Yet medicine increasingly attracts the best of our young. If they can detach themselves from the myopic selfishness of their predecessors and resist the stupidity of some of their leaders and some bureaucrats and politicians , I am sure there is still hope. The tide ofbattle may have set against the ideaUsts, but it is not yet finally lost. What I hope to do here is to draw attention to the issues, their importance for the future of excellence in *Schroeder Letture, Dartmouth College, Hanover, New Hampshire, November 22, 1976. tAddress: 5 Horwood Close, Headington, Oxford OX3 7RF, England. Address for reprints: 1161 York Avenue, New York, New York 10021.© 1978 by The University of Chicago. 0031-5982/78/2104-0022f01.00 Perspectives in Biology and Mediane ¦ Summer 1978 \ 551 medicine and in the service to the sick, and to encourage thosewho think like me not to give up the struggle. Learned Profession In the study of the Regius Professor of Medicine in Oxford hung three portraits: Linacre, Harvey, and Sydenham. Their statues once stood over the door ofdie Royal CoUege ofPhysicians in London. These portraits were entitled Litterae, Scientia, and Praxis: letters, science, and practice. These were, and are, the three components of the learned profession of medicine [1, pp. 169-196]. Linacre was a great Greek scholar who was physician to King Henry VIII, and he founded the Royal College of Physicians of London. In his time and Harvey's, learning meant a profound knowledge of Latin and perhaps Greek. Latin was the international language of scholars. It was in Latin diat Harvey wrote his great work, De motu cordis, translated into EngUsh by others. A scholar who wrote in Latin was understood by all other scholars, at least in Europe. University lectures and university business were conducted in Latin. It is not going too far to say that what distinguishes a learned man and a learned profession is the abiUty to write, speak, and interpret with precision the international languages of scholars. The goldsmiths, the mercers, and other guilds, now represented by the great city companies, might have developed expertise and an understanding and familiarity with the materials of their craft in no way inferior to those of doctors, lawyers, and priests, but they did not command the same respect or social status because they did not work in Latin. They could not communicate with learned folk, nor were they able to match the scholars in their disputations. The superficial meaning of learning has greatly changed since Linacre's day. Latin is no longer die international language of the knowledgeable and discriminating. If there is such a language, it is English . But the deeper meaning oflearning stays the same: it...