Vacation: A Break for Medicine.

I have to take a break from my snorkeling: for the future of medicine!

 © 2010 Am Ang Zhang

The teaching and practice of medicine: a fine tradition betrayed

Irrespective of the political dimension of medicine, the care of patients and the prevention of disease depend on practising clinicians; the medicine of the future relies not only on scientific advances but on the education of doctors. Since the last edition, leaders of our profession in Britain have presided over, and in some cases acquiesced to the partial dismantling of arguably one of the finest systems of medical education. The implementation of a national process for the appointment of junior doctors has disaffected many trainees and their clinical mentors, who feel that they have become pawns in a bureaucratic political game. More important, if they understood the full implications, we believe that the British public and patients would be horrified. Within Europe, matters have been compounded by implementation of the European Working Time Directive, which threatens the professional apprenticeship and mentoring relationships between junior and senior doctors that best nurture young colleagues. The frequently heard mantra of the ‘consultant-led service’ is all very well, but the ideal will be short-lived if training is put in jeopardy.

We, the editors of this textbook, learnt how to practise as clinicians from such ‘hands-on’ apprenticeships and ask: how can young doctors accumulate adequate working knowledge and acquire essential skills if their clinical work is restricted to 48 hours each week? One might pose the question: would a patient prefer to be treated by a fully rested but inexperienced doctor whom they had never seen before, or a tired doctor with immense medical experience who knew them and their illness? We know whom we would prefer, as does Christopher Booth (On being a patient—Chapter 1.1). Short hours and other radical changes in the organization of clinical teams impair the continuity of medical care, an element of key importance for the patient but also critical for clinical education through time-honoured individual experience. Many countries are seeking to improve their systems of medical education, but for those who might consider adopting the current UK training timetables, we humbly offer advice—don’t. It would be better to provide their medical students and young doctors with sufficient time and resources to acquaint themselves with the principles and practice of modern scientific medicine that are emphasized in this book.

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I am grateful to Julie and JD for alerting me to the preface in the new edition of the Oxford Textbook of Medicine.