"While Rome Burns"

The latest issue of the British Medical Journal featured a number of remarkable articles on the perilous state of the UK health care system. The main points were well summarized in a lead editorial by Editor Fiona Godlee, ominously titled, "While Rome Burns."

Something strange is happening in the NHS [National Health Service].

Something important is quietly dying. I don't think it is too fanciful to call it the spirit of medical professionalism. And we, the medical profession, are watching it die.

Far from being privatised, medicine in England has become ever more a creature of the state.

All that has really changed ... is who does the kicking and who is kicked. Increasingly centralised decision making, driven by a political imperative for constant reform, has left us victim to 'a patchwork of mutually contradictory ideas struggling for dominance.'

And although medicine has embraced the need for evidence based medicine, policy making remains largely an evidence-free zone. [Richard Lehman wrote,] "the personal responsibility of our professional leadership to mark out where the evidence lies, what it says, and what it is lacking.'

But where is our leadership? And where, asks Ian Greener, are the voices raised in protest against the breakdown of Aneuran Bevan's founding concordat: that the government would fund the health service but leave its operational running to the doctors. 'The government has found ways to interfere in medical practice on a remarkable scale,' he writes. In the absence of coherent protest we might conclude that doctors have once more had their mouths stuffed with gold or that the medical profession wholeheartedly approves of the government's reforms. However, the most likely reason is more worrying still, as Greener agrees: that most doctors no longer have the will or power to stop the reforms.

I remember sitting in one committee meeting (I will not say where or when or about what) in which we were contemplating some new abuse of power by some administrator. The committee seemed unable to come up with a response. Finally, one member, a clinical psychologist, decried the learned helplessness that seemed to have infected us.

Fiona Godlee has taken on the role of Cassandra to warn us that a similar learned helplessness may have also infected British doctors.

Unless we heed her warning and conquer our learned helplessness, whether in the US, in the UK, or in other countries, we all will surely watch professionalism die at the hands of the managers, bureaucrats, and executives.