Series

The role and education of doctors in the delivery of health care^**

National systems for health-care delivery in more developed countries

Even in more developed countries, there is a temptation to believe that by spending a greater proportion of the nation's wealth on health care, we would improve both health status and the longevity of the population. This is probably not the case. In fact, health-care spending is closely related to the wealth or gross domestic product (GDP) of a nation and there is, according to statistics from the organisation for Economic Cooperation and Development, a strong correlation between the GDP per

Priorities and choices

Arguments about how best to fund health-care services should not allow us to escape the simple truth that health care is funded by the citizens for whom the service is provided. Except for the few people who pay directly for their health care, most citizens pay for health care through some form of insurance, whether organised privately or through the state. Given that all societies now have to make choices about what health care is to be delivered, to whom, and under what circumstances, there

The role of doctors in management

Faced by the rising cost of the delivery of health care, and the need to determine priorities and choices, not surprisingly those responsible for funding health care have sought to regulate the activities of doctors and to restrict their autonomy. Clinicians have a choice, either to be part of the management, or to be managed. I contend that they will benefit their patients most by taking their share of the responsibility for managing the system and be better able to maintain their professional

Teamwork and clinical decisions

The delivery of health care has become complex and satisfactory delivery can only be achieved through teamwork between doctors, nurses, and other professionals. We need to learn how to work in teams to deliver efficient and effective care while ensuring that the delivery of care does not become impersonal, because all of us want a personal doctor to whom we can turn for advice when we are ill.⁹

Most patients, when they seek medical help, require the answers to six questions.

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  “What is wrong?”

The hospital and the community

The complexity of modern health care and the numbers of people involved, along with some well-publicised disasters, have led to widespread concern in the UK about quality assurance in the delivery of health care. There is a strong movement to develop clinical guidelines using the evidence base for clinical practice. Although this input is welcome, we should remember, as Marianne Rigge, the director of the College of Health has said, that perhaps half the patients do not have evidence-based

Education

The dilemmas and problems of modern health care must inform the education and training provided for doctors and other health-care professionals. The task is to develop passionate medical professionals who are dedicated to individual patients, and who have a population perspective, including a responsibility to improve public health within their practice.13 They need to understand the system in which they work and they must be able to provide leadership. The principle of a modern medical

Conclusion

There was a Victorian aphorism that a good doctor was better than a bad doctor, and almost as good as no doctor at all. That such a statement is no longer true is because of the advances in biomedical science. Medicine used to be simple, ineffective, and relatively safe. Now it is complex, effective, and potentially dangerous. The mystical authority of the doctor used to be essential for practice, now we need to be open and work in partnership with our colleagues in health care and with our