Doctors of The Future

Winning essays by doctors
of the future on what

medicine could be like in
50 years' time
Doctors of the future
Contents
Foreword
16- to 18-year-olds category:

What will the role of doctors be in 2050?
Winner:
Myura Nagendran
Runners-up
Rosanne Ching
10
Alexa Dean
12
Tiffany Kemp
14
William Phung
16
Sophia Stephanides
18
Medical students category:

What will be expected of doctors in the future?
Winner:
Gary Cooney
20
Runners-up
Christopher Hands
24
Ashish Marwaha
28
Kieran Mullan
34
Laura Spence
38
Jennifer Strawson
42
Nathalie Turpin
46
Foreword

We set two titles this year - one for sixth formers, and one for medical students. Why? Well, we wanted to get
the views of young people who are the scientists of the future, as well as those who have already just started
training in medicine. At the GMC we are trying to encourage reflection on what we see as a profound change in
societys relationship with the medical profession. A change from the doctor being the source of all knowledge
and authority in matters relating to illness, to a society where patients are being encouraged to take more
responsibility for their health, calling on professional assistance only when they want it.
Professor Christopher
Bulstrode
Education Committee
One of the General Medical Councils core duties is to oversee the training of medical students, these doctors
of the future. It is relatively easy to define the knowledge and skills needed by a doctor who is starting out in
the Foundation Years. Much more difficult, yet equally important in the long term, is the need for medical
education to lay the foundations for a professional flexibility that will be needed if doctors are to be fit to
serve their patients and the public in a rapidly changing society for the next half century. We cannot predict
the future, but through projects like this, we may catch glimpses of what that future might hold. By collecting
together as many of these ideas as possible, we may be able to prepare them for as many of these exciting
possibilities as we can.
16- to 18-year-olds category

This essay is based on the following ideas:
Increased ethical issues.
Philosophy of prevention rather than cure: educare.
Global centralisation of all medical information (CMID).
Evolution of super-specialisation.
Radical changes in surgical training and operations.
Myura Nagendran
First prize winner
16- to 18-year-old
category
An article published on 12 February

2050 in the Global Journal of Medicine:
Medical advances of the last 50 years and their
effects on the role of doctors
Professor M Valhalla, Senior ANI Consultant,

Royal London Hospital
Medicine is both an area of knowledge a science of
body systems, their diseases and treatment and the
applied practice of that knowledge1. With the
exponential growth of technology, the field has
undergone radical changes, from the days of
prescribing heroin for headaches, to the telesurgery
and advanced diagnostics of today. In terms of both
knowledge and application, it is fair to say we have
come a long way. The question is essentially, what
exactly has changed? What would surprise a doctor of
the year 2000 if he were able to see the health care
system of 2050? And most importantly how have
advances changed the role of doctors themselves?
With the vast array of new technologies, treatments
and procedures available to us at present, medical
ethics has become a huge field and indeed a speciality
in its own right (since 2035). Gene therapy,
nanotechnology, embryonic stem cell usage; all have
hugely complex ethical issues. Presently, a large
proportion of my day-to-day time is spent informing
the patient about which types of treatment would
suit them best and whether they have conflicting
social or religious beliefs2. Even though stem cell
therapy has become a hugely successful treatment
option, recent studies show that 30% of the
population would refuse treatment on ethical
grounds.
Being a member of the HEC (Hospital Ethics
Committee), I often spend at least 5 hours a week
with my peers in the committee discussing ethical
issues that the hospital faces3. Since the introduction

of the Medical Ethics Law in 2012, all hospitals are
required to create ethics committees that deal with
ethical issues the hospital faces on a case-by-case
basis. Politicians have finally realised that there is no
one rule fits all when it comes to ethics4. On 5 March
this year, the National Neural Interface Ethics
meeting will take place. Neural Interface is a new
experimental technology that will allow the brain to
be directly interfaced with a quantum computer5.
There are significant benefits to society but the
ethical ramifications are profound. Could human
thoughts be downloaded? Would this be an invasion
of privacy? It promises to be an interesting meeting
to say the least and highlights the increased
importance of ethics on clinical practice.
The National Screening programme became law in
20196 and it states that all patients requesting free
health care must submit to yearly screening
procedures and wear health sensors7. Using advanced
scanning procedures has meant that many diseases
and infections are caught early enough to be treated,
raising the life expectancy to an average of 104 years8.
The health sensors truly are a technological miracle.
At birth, every child in the country is now implanted
with a small computer (measuring only a few
nanometres in size)9,10 that constantly scans their body
and reports the condition of their health to the CMID
system. Heart attacks and pulmonary arrests are now
only fatal in 0.004% of cases as the health sensors
mean that a hover ambulance is usually with the
person before they even start to feel any symptoms11.
Many such conditions can now be nipped in the bud,
so to speak, reducing the workload of doctors.
The Health-Education law known as educare was
passed in 2012 following an obesity epidemic12,13.It has
been one of the pivotal factors in improving health
care and further reducing the workload of doctors.
The law introduced compulsory teaching about
healthy diets, keeping fit and other key health issues14.
By law, all schools must devote at least 30% of
Myura Nagendran First prize winner
curriculum time to exercise and fitness. Obesity is

extremely rare now and these reforms gave the
overcrowded NHS of the time, with all its financial
issues, plenty of room to breathe.
Since the early 21st century, where research was for
many, purely a method to gain a registrar post15, the
MMC streamlining of training16 meant that research
was increasingly carried out by academic doctors.
However, with increased efficiency in the health
system, much of the regular diagnosing and
administrative work of a doctor has vanished. This
vacuum of duties has led to almost all doctors now
spending at least half of their working time on
research. There are very few non-academic doctors
left. Research is also a much quicker process now.
With the CMID system, information can very quickly
be gathered and research takes only a fraction of the
time it used to. I myself currently have 19 projects on
the go and a further 79 awaiting publication and
thats only this year!
The progress in diagnostic procedures is astounding
when you step back and think about it. Only 50 years
ago, doctors were still relying primarily on CT, MRI,
ECG, etc. A huge amount of time used to be taken
booking people in for different tests and waiting lists
were considerably large17. Now, all of these scanning
procedures and more are built into one device known
as a Bio-scanner, in which a complete scan takes only
5 minutes. Vast amounts of information on the
patient can be obtained and diagnoses can be quickly
made (especially when used in conjunction with
CMID).
The CMID system, (Centralised Medical Information
Database) has revolutionised the practice of health
care throughout the world since its introduction in
2037. Every single patient in the world now has their
records, history, and other information stored in a
single database18. In addition to this, all discovered
illnesses, their aetiology, symptoms and treatment
have also been logged in. My peers and I need only
spend less than a minute diagnosing. The database
automatically scans and records all patient symptoms
and cross checks them against every patient record in
existence for the last 40 years. Considering the
population of earth, is now 9.1 billion19, the chances of
the database not finding a person who has previously
had the illness is 5 billion to one.
Once the database has correctly produced a diagnosis
and recommended a treatment based on the previous
cases it has found, I review the diagnosis and inform
the patient. In the event that a diagnosis does not

show, an MDT meeting is held to discuss possible
treatments and aetiology, after which the illness is
added to the database for future generations of
doctors and patients.
It is a shame that the implementation of this system
was delayed for 12 years as it has truly reduced the
amount of time I have to spend on research.
Searching on the old PubMed system for articles was
very time-consuming even though almost all journals
eventually came under its system20. The advent of unhackable quantum computers21 ultimately put
security fears to rest and the system was
implemented on a global scale.
The role of doctors has been radically affected by
super-specialisation and this in turn has had a
profound effect on medicine itself. From the humble
beginnings of the early 21st century where subspecialisation was just starting to become
commonplace22, to 2050 where super-specialisation is
the quintessential foundation of the health care
structure. Super-specialisation means that my talents
are focused on a single small area of expertise and as
a result23, I am one of the leading world experts in my
field of Artificial Neurone Implantation (ANI) surgery.
After completing my FRCS in general neurosurgery, I
went on to take the SFRCS (Speciality Fellowship of
the Royal College of Surgeons) in Artificial Neurone
Implantation. Super-specialisation has drastically
changed my role as I no longer have to focus on all
aspects of neurosurgery. Whilst I am trained to
respond to emergency cases24 such as intra and extra
dural haematomas and other head traumas, I am no
longer qualified to carry out procedures from any
other super-speciality other than my own. This has
meant that during my training, I was able to hone in
all my skills on ANI and have become a leading expert
as a result.
I now deal with all ANI referrals from the South
England area and I am therefore able to offer my
patients the most advanced care possible. Thankfully
though, there are still quite a few generalists left in
the profession25. Unlike in the early part of the century
though, doctors now are either very specialised or
very generalised; there is no in-between. This twofold system has been very successful and has
streamlined services for the patient (especially when
you consider that there are now an extra 74
specialities since 2010 ANI for example).
The field of surgery has undergone significant changes

in the last 50 years. Surgeons in the UK now work
relatively long hours during training (70 hours and
above)26 after the Ribeiro clause became law in the
winter of 2006. The then president of the Royal
College of Surgeons, Mr Bernard Ribeiro, successfully
managed to secure an opt-out from the European
Working Directive for surgeons-in-training after
lobbying the Prime Minister27,28. However, consultant
hours have reduced even further to only 40 hours a
week29. This is due to the eradication of administrative
duties for all doctors and working time restrictions (as
consultants are obviously not surgeons-in-training).
Surgical training programmes are now fully global.
The successful introduction of the Mark IX da Vinci
Surgical System30 to all UK operating theatres in 2024,
has resulted in telesurgery on a large scale31. All
trainees now apply for their chosen speciality and an
international matching scheme allocates them to a
training programme. I myself am now a senior
consultant in ANI surgery. However, unlike the
primitive dare I say it, training of the early 21st
century, I can teach people wherever they are31,35. I
currently have one junior trainee in Canada.
Whenever I need to teach him a new procedure or
help him out during surgery, I simply walk to my
console and carry out the procedure31. My finger
movements are replicated exactly30 and the robot
carries out the required procedure. Some operations
can even be carried out through natural orifices using
worm-like robots31 and this has given new meaning to
the term minimally invasive surgery32.
Surgical consoles have now become so cheap that
many surgeons (myself included) have one in their
house. Consequently, we no longer have to be
resident in hospitals for emergency operating. This is
another factor that has led to the decrease in
consultant working hours. In actual fact, I often still
work at least 50 hours a week its just that 10 of
those hours are spent operating at home!
So what would a doctor from the year 2000 say? I
think hed be completely and utterly lost for words.
Aside from the eradication of bureaucracy, and the
efficiency of the health care system, the technological
advances themselves scream out for recognition.
Diagnostics, screening and implanted scanners have
reduced patient numbers and waiting lists are
virtually non-existent. Prevention rather than cure has
finally become a recognised philosophy. New
treatments have increased the importance and
consideration given to ethics. Surgery has become
about as technological as it seems possible without

the robot doing the actual operating itself! It seems
indisputably conclusive that medicine has advanced
to great heights in the last 50 years.
However, we are also forced to ask ourselves how the
role of doctors has changed. It would appear that
time is probably the crucial factor in assessing this
change. A large amount of time has been freed up by
increased efficiency and advanced procedures. The
extra time has been devoted primarily to research
which is in turn creating exponentially more
advances. But in essence, all this amounts to is a
timetable change. So has the role of a doctor actually
changed?
Since the days of Hippocrates, doctors have been
respected as honourable citizens, whose sole mission
is the welfare and health of society. I do not believe
my role is any different to that of my predecessors
and I for one feel proud to continue the same noble
endeavour that began so many centuries ago.
References
1 Website - Definition of Medicine
www.en.wikipedia.org/wiki/Medicine
2 Conscientious Objection in Medicine
Julian Savulescu - BMJ 2006;332:294-297 (4 February)
3 Development of clinical ethics committees. Anne
Slowther, Carolyn Johnston, Jane Goodall, Tony Hope BMJ 2004;328;950-952
4 Medical Ethics should not be politicised. Johann
Malawana - student BMJ 2005;13:177-220 May ISSN
0966-6494
5 Website - The Brain-Computer Interface Project
www.ece.ubc.ca/~garyb/BCI.htm
6 Educated Guesses: Making Policy about Medical
Screening Tests. Louise B Russell - BMJ 1994;309:679 (10
September)
7 Sensors to Monitor Health. The Future of Health, The
Daily Telegraph, p10
8 Website - Will Life Expectancy Continue To Increase?
www.overpopulation.com/faq/health/mortality/life_expe
ctancy/future.html
9 Building nanomachines out of living bacteria. Will Knight Issue 2493 of New Scientist magazine, 02 April 2005, pg 25
10 Nanotechnology: Small science, big deal. Tony

Delamothe, studentBMJ 2005;13:133-176 April ISSN
0966-6494
26 UK surgeons report that EU directive has cut training time

Susan Mayor News roundup BMJ 2005;330:499 (5
March)
11 Effect of reducing ambulance response times on deaths

from out of hospital cardiac arrest: cohort study. Jill P
Pell, Jane M Sirel, Andrew K Marsden, Ian Ford, Stuart M
Cobbe - BMJ 2001;322;1385-1388
27 Surgeons in England lobby Prime minister on working

hours, Susan Mayor News roundup, BMJ 2005;331:1228
(26 November)
12 The obesity epidemic in young children. William H Dietz BMJ 2001;322:313-314 (10 February)
28 Website Transcript of Presidents of RCSEngs Letter to

Prime Minister.
rcs.niss.ac.uk/public/pns/pnattach/20050015/1.pdf
13 Teenagers face health timebomb. Danny Penman

NewScientist.com News Service, 08 December 2003
29 Website New Consultant Contract as a result of EWTD

www.rcseng.ac.uk/service_delivery/ewtd/consandewtd
14 Development of a collaborative model to improve school

health promotion in the Netherlands. Mariken T. W. Leurs,
Herman P. Schaalma, Maria W. J. Jansen, Ingrid M. MurVeeman, Lawrence H. St. Leger and Nanne de Vries Health Promot. Int., September 1, 2005; 20(3): 296 - 305
30Website Frequently Asked Questions on the da Vinci

Surgical System. www.intuitivesurgical.com/products/faq/
15 Brain surgery not rocket science Ramesh Chelvarajah BMJ Career Focus 2004;328:95
32 Minimally Invasive Surgery: Future developments. J E A

Wickham - BMJ 1994;308:193-195 (15 January)
16 Website Modernising Medical Careers The Next Steps

www.mmc.nhs.uk/pages/resources/keydocuments#10
33 Recent advances in minimal access surgery. Ara Darzi,

Sean Mackay - BMJ 2002;324:31-34 (5 January)
17 Waiting times for breast cancer tests have risen in past

two years. Caroline White - BMJ 2003;326:1233 (7 June)
34 Science, medicine, and the future: Virtual reality in

surgery. Rory McCloy, Robert Stone - BMJ 2001;323:912915 (20 October)
18 Website Electronic Patient Records Project

www.uclh.nhs.uk/New+developments/Electronic+Patient
+Records/home.htm
19 Website Forecast of world population
www.en.wikipedia.org/wiki/World_population
20 PubMed Central increases its appeal. Tony Delamothe
News extra BMJ 2001;322:818 (7 April)
21 The Secret is out Quantum Cryptography. Mark Kendall
Anderson Issue 2423 of New Scientist Magazine, 29
November 2003
22 Recent advances: Neurosurgery. Michael Powell - BMJ
1999;318:35-38 (2 January)
23 Will modernised medical careers produce a better
surgeon? Luke Devey - BMJ, Dec 2005; 331: 1346
24 Website Proposed Curriculum for Specialist Training
(Intercollegiate Surgical Curriculum Project)
www.iscp.ac.uk/syllabus/stage_overview_
25 Are generalists still needed in a specialised world?.
I J P Loefler - BMJ 2000;320:436-440 (12 February)
31 Robotics in surgery. Ara Darzi, Simon Bann, Iain MckayDavies student BMJ 2002;10:215-258 July
35 Website Worlds First Telesurgery from New York to

France (7th September 2001)
www.mos.org/cst/article/1623/2

The prevention and early diagnosis of diseases campaign is carried out among the world population.
Doctors play a more important role in the diseases preventive defence with a combination of traditional
herbalism and advanced modern technology other than diagnosing and treating illnesses and infections.
To heal the sick.
To relieve suffering.
Doctors as the communicators.
Doctors as the population controllers.
Rosanne Ching
Runner-up
Good morning and congratulations, our doctors-tobe. You have all earned my respect for choosing
medicine as your life-long career and completed the
fundamental training successfully. Yet, Im afraid
before you can collect your parchment, you may want
to listen to an old mans word. Fifty years ago, I was
sitting down there, just like you and trying my very
best not to fall asleep in the middle of the speech by
another old man. However, later on I found his speech
as my motto of my career which was the role of a
doctor. Over the last 50 years, the practice of
medicine has been changed and improved in many
fields. New skills and discoveries appear almost from
day-to-day which bring new hopes to the patients
and their families. The only thing that remains
unchanged seems to be our endless working hours.
What about our job? Has it changed in its nature?
Today, in 2050, I would like to share my thoughts of a
doctors role with you.
Its said that the job role of doctors has been shifted
from the position of curers to the defence of diseases
when The prevention and early diagnosis of diseases
campaign was carried out among the world
population. However, I believe thats only part of the
truth. Doctors are now much more involved in the
diseases preventive defence with a combination of
traditional herbalism and advanced modern
technology other than diagnosing and treating
illnesses and infections. With the help of the simple
blood test scanner, over 1000 inherited diseases can
be recognised once the infant is born. The
introduction of life-prolonging exercise, eg taiji and
good, balanced eating habits based on the foundation
of chinese medicine, increased the average lifespan of
human beings and also improved the general health
of people. The early diagnosis of chronic and inherited
diseases and the prevention of infectious diseases is
also one of the measures to minimise the financial
pressure on most national health care systems since
the budget of NHS doubled from 23.5 billion in 1988
10
to 45 billion in 1998 - an increase of 21.5 billion.

Overpopulation has brought many problems to the
vast majority of countries in the world including
ageing population, unbalanced ratio of economic
active people to the needy, crisis of government
taxation system and the critical pressure of the
finance, personnel and resources on the societyetc.
Also, the outbreak of SARS and Avian flu in the early
21st century raised our alert again to the possibility of
a global disaster following the Spanish flu pandemic
which killed 50 million to 100 million people
worldwide over a year in 1918 and 1919. The deadly
influenza virus, mainly H5N1 and H5N2 is still being
evaluated today. Therefore, the need to identify the
development of viruses and inherited diseases with
early diagnosis and treatment leads more and more
doctors to playing a major role as preventers rather
than the curers. Nevertheless the question of why the
simplest micro-organism has the ability to create the
most complex chemical, antibiotics, is being revisited
again as well as the new found type of vaccines.
However, that doesnt mean the doctors in 2050 have
left their original job role completely. Doctors today
still follow the fields the doctors followed 50 years
ago including gynaecology, psychiatry, radiology and
surgery. Due to the seriously polluted environment,
pregnancy is much more difficult than ever to take
place. Therefore, more and more test-tube babies are
born relying on the assistance of the gynaecologists.
With the appearance of revolutionary I-robots, senior
housemen, junior doctors and consultants are all now
working in the safety wards for protecting them, the
valuable human resources due to the excessively low
fertility rate in most MEDCs. I-robots can now take
over some relatively dangerous jobs for the caring
profession such as treating suspect patients with
highly infectious diseases or new found infections in
A&E and by working in the highly infectious wards.
Surgeons are still needed to lead the operations but
specialised artificial intelligent arms also assist during
Rosanne Ching Runner-up

the surgeries with their pin point accuracy, reducing
the possibility of human errors. As more and more
medication is available to help the suffering patients,
many diseases can be cured or at least, the pain
relieved, including the fearful cancer of all kinds.
These all make a doctors job much easier to be done
in order to spare time for meeting the high demand of
the patients.
Although the number of patients have declined
compared to the early 20th century, the working time
of doctors has not decreased in the same time. Apart
from healing the sick and preventing diseases, the
doctor also acts as a lawyer, a financial consultant
and an ethicist (its sad to say but thats the case!).
The debate of the most controversial issues from the
cloned organs transplantation, stem cell therapy to
the euthanasia legalising are still ongoing and the
decision is currently generally made by the patients
and their families. Medical fraternity has the
responsibility to give clear explanation to their
clients about the benefits and effects the treatment
may bring, without upsetting their particular cultural
and religious sensibilities in all circumstances. This
new and damaging stress is now putting more people
off from medicine which results in the difficulty of
fostering young bright doctors.
Medicine is a caring profession and the role of doctors
is to provide a service to the public by diagnosing and
treating illnesses and infections. Over the years,
doctors tend to work and be on call for long hours.
Life-long learning is integral to medicine and the
career is strenuous and challenging. However, the
rewards of the career are usually much more better
than most of the other occupations, although the
work is not always appreciated by the patients and
relatives.
Last but not least, although the role of the doctors is
changing from time to time, the nature of the job will
not be changed to help the patient in your best
ability and to provide professional advice according to
his/her greatest interests.
Good doctors not only require knowledge, techniques
and professional experience, but most importantly,
they need to take responsibility and be willing to
learn.
I do hope that I didnt bore you that much. One day
when you come to my age, you may have a chance to
give a long speech to bore the ones who follow as
well. Until then, you can first collect your certificate
and again, I wish you all success in the future.
11
References
Student BMJ (January 2006)
Student BMJ (February 2006)
The Rise and Fall of Modern Medicine James Le Fanu
The complete illustrated guide to chinese medicine Tom
Williams (PhD)
Natural alternatives to antibiotics Leon Chaitow
The Times: New vaccine found may be key preventing
pandemic; on 2/2/06
Online resources:
www.bmj.bmjjournals.com

This is a diary entry for a Senior House Officer working in an East London hospital.
We see a growing relationship between illness and the 21st century lifestyle.
The increasing weight that is put on preventative medicine is also highlighted.
There is a clear change in the relationship between doctors and nurses.
The doctor continues to find her work both challenging and rewarding.
Alexa Dean
Runner-up
1 January, 2050
Today was the first day back to work after the
Christmas holidays. Most of my colleagues had today
off as a public holiday but I had switched with
another SHO on the randomly generated rota to
spend Christmas Day with the baby. As I came
through the main entrance of Olympic Hospital, I
could see the Immediate Admissions patients being
sorted into their different departmental lines. All the
older members of staff still called them geriatrics,
paediatrics or orthopaedics but at the University of
Harrogate Medical School, one of the countrys new
and radical campuses, wed learnt to refer to them as
Medicine of the Elderly, of Children and of the
Musculoskeletal System. It had been explained that
the GMC wanted to encourage patients to become
more involved in every aspect of their own health,
and so the terminology had been changed to make it
more accessible for the wider public.
As I walked along the hospital corridors, I could see
that new displays had just gone up, warning doctors
and nurses that Olympic hospital had a strictly
enforced Junk Food Ban. I had conflicting feelings
about this. On one hand, freedom of speech seemed
to be rapidly disappearing from the GNHS, now even
named the Governmental National Health Service.
On the other, I could see that senior hospital
managers had to do something, as the obesity rate in
Britain continued to soar despite all the campaigns
over the past decades and hospital staff had to at
least try and set a good example.
I arrived at the post-operative ward reception, and
pressed my index finger to the print ID machine. I was
logged in, and went straight to the changeover
meeting, which was beginning at the other side of the
room - consisting only of Median and Senior nurses. I
listened to the Seniors and signed off under the
treatments programmes that they had decided on for
12
patients during the night. Nurses, these days, quite

rightly had much more responsibility. The Median
nurses explained what drugs or therapies they felt
their charges needed for the day, and in most cases I
agreed or in a few, suggested more suitable
alternatives. When Id finished I checked the obs
recorded overnight for all patients - the computer was
playing up again! I really need to get my palm laptop
back from the lab.
The theatre list this morning was liposuction with Mr
Patel and we had three to get through. Two were NHS
considered to merit the operation. One, classified
self-inflicted, was paying and so I had eight pages of
pink forms to fill out. Fortunately, we had the
consultant anaesthetist with us today because of a
lucky rota dropout, so he and Mr Patel were having a
good laugh about their New Years Eve out. The first
two operations went well, but the final one posed a
dilemma. As we were removing the last areas of fat,
we could see the patient had severe cirrhosis of the
liver, obvious from the light coloured dots over the
entirety of the organ. It was clearly very serious.
However, recent patient permission rules meant we
could do nothing about this; the new GMC
instructions were that we could only touch what the
operation specified, and nothing more. As we closed
up, Mr Patel asked me to go and discuss what wed
found with the patient when she had come round
from surgery.
I still find breaking bad news difficult. Despite all the
counselling that we doctors now go through (and a
large part covers this topic), you couldnt be a human
being and not be affected by having to do it. As I
talked to Miss Smith, I found out that her cirrhosis was
due to excessive recreational drug taking. She
admitted to having used speed and crack cocaine
regularly, not uncommon for someone in their early
20s. It still seems such a huge waste of life to me to
kill yourself when youve only lived maybe a third of
your expected years. I explained there was nothing the
Alexa Dean Runner-up
hospital could immediately do, but offered her the

chance to submit her name to the liver transplant list.
The legalisation of recreational drugs has of course
had a major impact on my work. Despite the lower
crime figures, the numbers using have shot up with
the increased availability and the Immediate
Admissions Department has seen a doubling of
patients under the influence of drugs. Despite the
charges imposed for operations needed as a result of
drug use, more and more people with related diseases
of the heart and nervous system seem to be coming
through our doors. I think it is right that our focus is
now changing to try and prevent people from taking
drugs in the first place, or at least ensuring that they
understand the huge risks involved. Prevention in
every aspect of our work has become so much more
important than cure.
After a quick vitamin smoothie, I went to see Josh (the
Median Nurse who I am mentoring) in the preoperative department for some more prescribing
tuition. In the couple of hours I spent with him, I could
see good progress in the case studies we worked
through together and he seemed to have been reading
up on drug side effects. Josh also mentioned that his
Staff Consultant felt he was working very well and had
been giving him some extra training on certain
conditions such as diabetes and hypertension, to take
into account when prescribing drugs. I am hoping that
he can soon move on to viewing surgical procedures
and if all goes to plan, he should then be able to take
his Senior Nurse examination in the summer, so that
by September he will be independently diagnosing and
treating patients.
At four oclock we had the SHO discussion session in
the Lecture Theatre. There were some interesting
cases; one in particular concerned a patient in the
Medicine of Mental Disorders Department, the
daughter of a long-time anorexia sufferer who had
died five years previously. The girl had begun to worry
about her weight and had admitted herself,
concerned that she was genetically disposed to the
disorder. The Senior Nurse had referred her to the
SHO, who wasnt sure whether to start therapy or to
wait until she had been clinically diagnosed (on
consultation she had been borderline). It was
generally agreed that she should start immediately, as
she probably needed counselling anyway following the
13
death of her mother. However, it was pointed out that

no research has yet shown a genetic link for anorexia,
so in the end she was referred to one of the Mental
Disorders consultants.
My final task was a lecture to some 3rd year medical
students, who were based at the hospital. I was very
nervous, and had spent a long time preparing at the
weekend. The topic was standard, Preventative
Medicine - my particular interest and 40% of medical
students now choose this as one of their training
choices. Today my theme was alcohol. As they walked
in, I could see the students raising their eyebrows at the
computer heading, but Id more or less expected that.
I started off by talking about the alcohol-related cases
we saw regularly and how they were caused. I tried to
make it interesting, using examples and diagrams of
the effects of alcohol abuse. I hope I managed to
convey how serious a problem this is and went on to
talk about how to prevent it, and as doctors, what
they could do. I described the associated areas;
hospital and school teaching or campaigns, and the
latest research uses of liver stem cell cuttings.
I finished the talk around six oclock and went to see
the ward staff on post-operative to check how they
were doing and rectify any problems - luckily nothing.
Finally Mr Patel and I went through the notes on the
computer, before talking about the SHO discussion
session and looking ahead to some of tomorrows
cases. I managed to get out of hospital by seven, and
then came home and resisted the temptation to pour
myself a glass of wine.

In this essay I will discuss the following:
The changing status of hospitals in the community.
Steps to prevent common complaints humans suffer with at present.
New health problems caused by development in technology.
New methods of treating patients.
Whether the fundamental role of doctors will have changed by 2050.
Tiffany Kemp
Runner-up
Fast forward fifty years, to a time where the entire

dynamics of the world are totally abstract to the
logical mind. New mega cities will be a compacted
version of the capital cities of yesteryear, the
innovative terrain unimaginably dense in population.
Revolutionary hospitals tower over the city dwellers a look to the sky at any point in the metropolis
confirms the contemporary vigilance of the medical
profession. Even on the streets, we humans are
constantly observed for any sign of infirmity or illhealth.
An elderly woman cycles past at top speed, her age
only exposed by the mop of grey curls that cascade
from beneath her shiny cycle helmet. I say cycles at
some risk of disillusioning the reader - for todays
cycling is not the pursuit it once was. New
preventative measures have been enforced to prevent
the onset of osteoarthritis arthritis - a condition
caused by wear and tear which once commonly
troubled a large proportion of the elderly population.
Consequently, such primitive activities which placed
large amounts of pressure on the body have been
replaced by more cautious alternatives. This new
variety of cycling involves only the push of a button
and the various pads attached to the body massage
the muscles of the thighs and calves - ultimately
effort-free exercise.
I feel a small quiver on my right wrist and look down
inquisitively. My e-Health device has unearthed some
symptom of ill-health and is informing me of the
most appropriate action to take. I am not frightened, I
am warned at least hourly of a new condition I may
be vulnerable to - and not once have I gone on to
develop this peculiar problem. However, such a device
is invaluable to any hypochondriacs among us - who
seem to find pleasure in finding numerous potentially
fatal health complaints.
Increased air pollution - leave the area. The actions
of our predecessors has left the atmosphere saturated
14
with polluting chemicals, one of the biggest dangers

to human health. Nearly all children now experience
some form of asthma, caused by narrowing and
inflammation of the bronchial tubes. Unable to find
an effective cure, sufferers are still reliant upon
primitive technology, which can relieve attacks by
breathing in a bronchodilator drug that makes the
bronchial tubes wider. Medical researchers have spent
many years experimenting with technology to no
avail; the problem remains. If the increasing levels of
intoxicating gases had been monitored from the
outset, we would not be obliged to live the way we do
at present.
As I enter the hospital, I can tell I am going to have a
busy day. After being welcomed to the premises by
the robotic receptionist, I remove my pager from my
pocket to see which room I have been allocated. We
doctors are no longer trained in only one area of
medicine. Instead, we rely on the assistance of
technology to help us diagnose a variety of problems.
It has been suggested that human doctors are now
non-essential, but I am inclined to disagree.
I enter Room 6 - and am greeted by a vast amount of
flashing machines. One wall is painted totally white,
and I can already see my list of patients projected
against it. The patients will all be sat at home waiting
for their turn to be seen, instead of cramming into a
packed waiting room. A benefit of these new hospitals
- a patient very rarely has to venture out of their own
homes if they wish to be treated.
I sit down heavily at my desk and swing my chair
towards the white wall. Smith, Peter. I call out the
name of the first patient on my list, and immediately
the voice recognition software inputs my command
and Peter Smith is displayed on screen.
Simultaneously, his medical notes are displayed
electronically on the smaller screen sitting on the
desk in front of me.
Okay Mr Smith, what can I do for you today? As he
Tiffany Kemp Runner-up
talks, the voice recognition software once again

detects what is being said and adds it to the notes on
screen. I listen carefully although the computer in
front of me is already forming a diagnosis. I watch as
the list of possible problems is dwindled down as Mr
Smith adds more symptoms to the search criteria.
Suddenly, a loud beeping noise fills the room, Mr
Smith looks startled. Im sorry Mr Smith, I am going
to have to refer you to someone else - I have an
emergency coming through. On the small screen in
front of me, his notes have been replaced by a large
warning sign - Emergency patient.
Where Mr Smiths face had been shown a few seconds
earlier, I was now presented with the inside of an
operating theatre. No longer a room full of people,
the area was occupied by a large number of machines
that were to assist me in my procedure. I say my
procedure - yet in fact all I would be doing was
overseeing the operation. There is no need for me to
carry out an operation when technology provides
much more accurate results, and leaves the patient
much more aesthetically pleasing. Gone are the days
when doctors were required to open up a patient in
order to treat them effectively; a majority of todays
procedures are carried out microscopically with only
one minute site of access required.
I am required only to oversee the operation - nothing
yet has been developed with the capability of
replacing human initiative. I sit in the comfort of the
office, watching as the robotic arms carry out the
painstaking process of modifying a specific gene
detected in this patient. I do not once need to
intervene, and in a matter of minutes the dangerous
Alzheimer gene had been removed. Unlike in previous
years, we now have the potential to remove
unwanted genes before they have the opportunity to
wreck havoc on our lives.
In fact, we have the potential to do most things if we
put our minds to it. The boundaries of medicine are
being constantly stretched - a new cure being found
daily. However, sinisterly a new problem seems to
arise equally as often; possibly a result of our
technological environment.
As a doctor, I deal with vast numbers of patients
suffering from stress-related conditions. Our new
radical world places a huge emotional strain on those
living within it, leaving time for very little human
15
interaction. Of course, we can treat almost every

physical illness, but our expertise in the mental field is
clearly lacking.
The immense speed at which we are making progress
means we barely experience the technology before it
is replaced by something better, but where will this
evolution end? It will not be long before we learn
how life can be sustained for more than is natural in
humans - and then the ethical dilemmas presented to
patients will further add to the burden of difficulties
they face.
Back to the present, the year 2006. The above
description shows the possible developments in the
medical field in only fifty years - the world as we
know it could have changed drastically. Our methods
of practising methods could have changed
unrecognisably; or alternatively they could have
stayed very similar to the present.
I believe the fundamental role of a doctor will have
stayed the same - they are caregivers, people in a
position of responsibility. Often at the centre of a
community, doctors aim to provide care to those
most in need; and I do not think technology has the
potential to alter this fact.
It is difficult to predict how the medical field will
develop in the next fifty years, but it is certain
changes will be made to the way patients are treated.
Whether that be through the equipment used or the
place patients go for treatment, I believe there will be
some alterations.
If you want to understand the future, it is important
to look back to the past. Over the last fifty years,
technology has undeniably evolved, but the primary
concern of doctors has remained constant; the wellbeing of patients. Travel back in time further; to the
Roman era, and it is clear the doctors here had the
same aspirations as they do today. Through their
work, they endeavoured to heal patients mentally and
physically.
Is fifty years really enough to change this
fundamental idea?
Reference
Readers Digest Illustrated Dictionary of Essential Knowledge

These are the points on which this essay will be based:
Will robots replace doctors, or will they aid them?
Will supermarkets have machines that can replace the GP?
How will nanotechnology affect doctors and the way they treat patients?
How will changes and advances in technology that affect ordinary people affect doctors? Will doctors need
extra training to learn how to use this equipment?
Will the ethics of medicine have changed with the discovery of new methods of treatment?
William Phung
Runner-up
In the present day, doctors play a crucial role in the

lives of people. When a person gets sick, their
immediate reaction is to go to their local GP and
book an appointment, and hope that their GP will be
able to find out what is wrong with them, and
prescribe medicine to cure them.
However, as the technology around us improves,
there seem to be more ways to avoid going to see the
GP. The most obvious of these is the family book of
illnesses, which many households will possess, for
example: The A-Z of Medicinal Drugs: A Family Guide
to Over-the-counter and Prescription Medicines
(Oxford Paperback Reference S) Market House, Jan
Hawthorn, paperback, October 9 2003.
Of course, books are now outdated, and have been
replaced by the internet.1 Instead of laboriously
flicking through pages to find out what is happening,
all you have to do is type the ailments into the
internet. Which is very convenient for many people,
as they save the time of waiting for an appointment
to see the GP.
As we know, technology will inevitably evolve and
improve over the next 44 years until the year 2050,
and will probably carry on improving past that2. So the
question is: What will the role of doctors be in 2050?
Currently, the most advanced robots working with
doctors is the da Vinci Surgical System3. Strictly
speaking, it is not working with the doctors, but is a
rather advanced piece of surgical equipment.
However, over the past fifty years, many
developments and advances in technology have
occurred. The internet was created. Computers went
from amazing pieces of technology that were created
in universities for the US army4 to an essential part of
human life5. If technology has developed so much
over the past 50 years, then there is a chance that the
robots will eventually replace the surgeons6.
In the news recently, there was the idea of
supermarket doctors7. This will most probably become
a widespread concept within 10 years, and by the year
16
2050, they will most probably be commonplace. But

suppose doctors were bypassed, or replaced. Though
at this time it does not sound likely, this may well
happen. There could be computers that could read a
human; like an advanced CAT scan8. This could then
tell the patient everything that was wrong with them,
the appropriate medication, the seriousness of the
illness, and what to do. This would then relay the
details to the rest of the supermarket, and the
medicine could be by the counter waiting to be
collected. These machines could also detect dormant
illnesses, and alert the central computer that controls
all of the supermarket machines.
However, the most likely situation that we will see in
2050 is that the robots and machines will not have
taken over the job of a doctor. This is because even
though robots are more precise than a surgeon, and
possibly more accurate during diagnosis than a GP,
they will never have the same effect on a patient. A
human feels safer when they are being treated by
another human, as there is a certain level of trust
between a doctor and a patient. Doctors have the
ability to empathise with a patient, as they are
human9. Even though the ability to not feel, not have
emotions would seem to be an asset to a doctor, a
patient who is fragile and needs sympathy will not
see it that way. So, by 2050, robots will be the hands
and eyes of a surgeon, but they will not be the actual
surgeon or doctor.
One of the topics that looks set to revolutionise
medicine is nanotechnology. This is not limited to the
production of nanobots, which is what most people
perceive to be nanotechnology. No, nanotechnology
is actually anything to do with structures one to
several hundred nanometers long in at least one
direction.10
The possible application of nanotechnology is almost
seemingly endless. They could be used to physically
destroy cancers. They can go straight to the source
of an infection, and release the appropriate antibodies
to deal with it. With this new technology, doctors
William Phung Runner-up
would be better equipped against epidemics of

possible new diseases and they could cure diseases
that are incurable at this moment in time.
objects in ones body (most possibly an argument

from a religious group). This will mean that doctors
will face controversy very often in their working lives.
Nano-bots could be used as cameras to view the

insides of patients, rather than using the current
method of an endoscope. This will mean less pain for
the patient, and the doctor will have more control of
the camera. This will result in more efficient
operations, and previously impossible operations
could now be carried out10.
The Human Genome Project has many ethical

implications about it15. The project aimed to determine
the complete sequence of the 3 billion DNA subunits
(bases), identify all human genes, and make them
accessible for further biological study. One of the main
ethical concerns was the control of the data. By 2050,
this will probably not change; we will still have a
debate on who controls the information that doctors
hold. By 2050, there will be more machines that will
find out more about humans (eg nanoprobes looking
deep in the body, and the early detection of diseases).
This information would most probably be held by the
health services, with doctors able to access it.
Therefore, in 2050, security will be extremely tight
concerning medical services, and there will doubtless
be highly trained computer technicians programming
software to protect this data.
Doctors would also be able to administer drugs that

previously would have induced an allergic reaction on
a patient, as nanotechnology may give doctors the
ability to deliver the medication to the exact location
where they are needed10. By 2050, nanotechnology
would no longer be an obscure and promising subject
of medicine, it would be a widely used commonplace
technology, and doctors would discuss it as though
they could not live without it.
All of the technological advances would mean that
doctors of the future will need extra training to learn
how to use this equipment, and it would be logical to
think that computer programming, and electronics will
become a specialised section of medicine by 2050.
University courses in medicine would no longer be 5
years long16, they would be longer due to the extra
information the doctors would need to know.
Of course, by 2050, not only will doctors be different,
life will also be different for humans. By 2050, many
of the problems that the environment faces will either
have been dealt with, or they will have turned into a
much bigger problem. Technology will also have
improved for humans, such as advanced video calling11.
There will also be flying cars12. These technological
advances will also aid doctors, as they will be able to
rush to the scene of an accident, and ambulances will
be much faster.
In conclusion, by 2050, doctors will still have the same

attitude that they have today; hard-working, patient.
Working hours will have been cut short due to less
illnesses (as they are detected early), and quicker
methods of treatment. Operations will be faster, and
more efficient. Doctors will use robots to their full extent,
but they will not be replaced by robots. They will also
have more convenient lives due to the technological
advances that will occur, such as flying cars.
References:
1 staff.philau.edu/bells/crldpresent
2 www-03.ibm.com/autonomic/pdfs/autonomic_computing.pdf
3 electronics.howstuffworks.com/robotic-surgery1.htm
4 www.nsf.gov/statistics/seind00/access/c9/c9s1.htm
5 gadgetshow.five.tv/features
6 biomed.brown.edu/Courses/BI108/BI108_2005_Groups
Another thing that will follow doctors to 2050 is

medical ethics. This is something that will most
probably never change. There will almost always be
something that does not seem right in the eyes of one
group concerning new medical methods or
breakthroughs, and there will always be groups that
support it13. A present example would be stem cell
research. The potential for stem cells in medicine is
truly massive. They can develop into any other type of
tissue in the body14, and therefore they could possibly
be used to treat incurable diseases, such as Parkinsons
disease. Should doctors be able to use
nanotechnology, and other advanced robotics, there
may be an argument about having metallic artificial
17
7 society.guardian.co.uk/primarycare/story/0,8150,945886,00
8 science.howstuffworks.com/cat-scan1.htm
9 www.psychological-hug.com/
10 www.geocities.com/cosdeaconu/nanomed.html
11 news.bbc.co.uk/2/hi/technology/4488806.stm
12 www.moller.com/skycar/
13 www.diabetes.org.uk/infocentre/state/stemcell.htm
14 www.dh.gov.uk/AboutUs/MinistersAndDepartmentLeaders
/ChiefMedicalOfficer/ProgressOnPolicy
15 www.ornl.gov/sci/techresources/Human_Genome/elsi
16 www.ucl.ac.uk/prospective-students/ug-degrees2005/medical-school/medicine/the-degree/index.shtml

Tissue engineering and regenerative medicine.
Advances in technology with respect to medicine.
Changing needs of patients and their effect on doctors.
Global issues and the role of doctors in controlling pandemics.
Human Genome project and genetic research.
Sophia Stephanides
Runner-up
Over the last fifty years there have been major

advances in sciences, which have had a huge impact
on the world of medicine. One example is the
development of fibre optics that has enabled surgeons
to perform keyhole surgery to minimise discomfort for
the patient. The other major advance in the field of
surgery is the ability to perform organ transplants, as
anti-rejection drugs have become more effective. The
advances of the last fifty years will become the
stepping-stones for the future. The knowledge that
doctors have acquired will enable them to make huge
advances by the year 2050. For example the
development of anti-rejection drugs will be
instrumental in the introduction of spare-part surgery
and the further development of transplant technology.
Tissue engineering and regenerative medicine is a field
in which much research is being carried out. It is
potentially going to become a cost-effective longterm solution to age-related problems, as transplant
organs are in short supply. Tissue engineering will
enable doctors to provide a cure for diseases such as
Parkinsons, Alzheimers, osteoporosis and also sports
injuries. Living cells from the patient are harvested
and grown in a laboratory. They are then stimulated
to form specific tissues. Scientists predict that in the
future doctors will be able to regenerate neural, spinal
and brain tissue and they will be able to use this to
eliminate paralysis.
A major role of doctors in the year 2050 will be to
respond to an increasingly knowledgeable and
demanding patient. In the news lately we have seen
women with breast cancer going to court to gain
access to the drugs, which they feel, will be of benefit
to themselves. Also the desire of patients to control
the time and means of their own deaths has been
revealed by sensationalist newspaper articles about
the dying travelling abroad or persuading their GPs or
relatives to assist them in the process of death.
Euthanasia has been pushed into the public and
medical arena for debate and by the year 2050 it
seems likely that doctors will be able to take a more
18
active role as legislation is forced to take account of

increasing public demand.
Another area where doctors have responded to public
demand and will increasingly do so is in alternative
medicine. Fifty years ago this seemed to be the
province of cranks and had little recognised
application. Today GPs recommend St Johns Wort for
depression; in Germany Ginko is the second most
prescribed drug; doctors recommend the use of herbal
remedies to treat symptoms of the menopause.
Scientists have started to seriously examine the
application of acupuncture, in China for example,
where it is used for major surgical procedures. By the
year 2050 it seems likely that alternative medical
practices will have been seriously researched and
increasingly put into practice in some instances.
Doctors in 2050 will also have to respond to the
mobility of their patients. This may lead to changes in
doctors working patterns and the availability of
treatments. Recently the government discussed the
implication of patient mobility, the introduction of
workplace GP clinics, computerised records and the
development of polyclinics. This may affect the way in
which the NHS works and how doctors and other
medical staff operate. Doctors may have to be more
flexible in the services they provide, responding to
demands of the social and economic groups they
serve.
In the future the role of doctors may not be limited
by their physical or geographical location. It is quite
probable that in the next fifty years doctors will find
that machines are providing replacements for some of
their roles. The advances in robotic technology are
already having a huge impact on the world of surgery.
During minimally invasive keyhole procedures,
surgeons can now insert a small radio controlled
robot. This robot acts as an extra eye for the surgeon
and provides a new perspective. Not only does the
robot contain a camera but it is also equipped with a
retractable needle which allows the surgeon to
perform biopsies. Over the next fifty years this
Sophia Stephanides Runner-up
procedure will be developed further. There will be

telecommunication between surgical teams and even
the possibility that the surgeon could digitally control
a robot to perform surgery whilst he/she is in another
country. St Marys in London is already carrying out
telemedical trials, with two robot medics performing
ward rounds. These robots do not physically examine
patients but they are fitted with video screens that
allow for patient/doctor communication with a
doctor who is anywhere in the world. Doctors
themselves will soon have to use computers as a
method of diagnosis. They will be forced to consult a
computer database before diagnosing patients. The
computers will draw on global research from many
sources to provide expert opinion.
Predictions for the future of medicine tend to focus on
technology and scientific advancements. However the
World Health Organisation decided that their
objective for the new millennium was the achievement
of goals set out in the UN Millennium Declaration.
Doctors in 189 countries committed themselves to
reducing poverty and hunger, improving access to
clean water, gender inequality, lack of education and
environmental degradation. These goals were to be
reached by 2015, but clearly this is not going to be
achieved. The role of doctors in 2050 must involve
addressing these problems. This must also include
dealing with the catastrophe of HIV/AIDS and avian
flu. Doctors in the third world need to be encouraged
to stay in their home countries rather than work in the
West if there are to be improvements in world health.
Only then can these populations achieve a
development in health education. Furthermore global
co-operation among doctors will need to function in a
far more organised basis in the next fifty years. The
outbreaks of avian flu around the world have revealed
a lack of co-operation between governments;
incidents seem to have been played down or to have
gone unreported. Avian flu has revealed how doctors
and governments in the West need to build up a
system whereby there is complete trust and cooperation with colleagues and governments
throughout the world. The West has been made to feel
very vulnerable and reliant on countries like Turkey
and China dealing effectively with their response to
avian flu. In the next fifty years doctors worldwide will
need to establish networks whereby they
communicate and co-operate with each other so that
they can deal effectively with the outbreak of disease
which may lead to a global pandemic.
19
The role of the doctor in 2050 will change

dramatically due to genetic research and its
application. The Human Genome Project will have a
major impact on medicine over the next few years.
Researchers can pinpoint errors in genes that cause or
contribute to disease and find new ways to treat, cure
and even prevent thousands of diseases. The first
thing researchers must establish is the function of
important genes. Once doctors know this they can
alter genes to cure diseases, supplement a defective
gene and even increase the lifespan of their patients.
Scientists predict that by the year 2050 lifespan could
be extended to around 125 years. This research will
also revolutionise drug design. The drugs will be made
much more specific to the disease they are intended
to cure and there will be far fewer side effects. Genes
themselves will also be used to treat disease as faulty
genes are replaced by normal ones. This means
hereditary genetic diseases will be curable. By 2050
many patients will want to know their genome and
what diseases they will contract in the future. They
will want doctors to be able to use drugs or gene
therapy to prevent their diseases from occurring. This
is a completely new role for doctors as in many cases
they will have to cure diseases before they are even
contracted.
It is exciting to look forward to the year 2050 and to
predict the changes that may occur in medicine and
their impact on the role of doctors. Much of what has
been discussed here will rely on the availability of
funds, for example in research and development.
Government policy will also have an active role on
the work undertaken by doctors. However the future
appears to be exciting as the developments in science
and technology enable doctors to fulfil their ultimate
goal, to treat and prevent disease.
References
www.newscientist.com
www.ornl.gov
www.guardian.co.uk
www.who.int
www.nhgri.nih.gov
www.imperial.ac.uk
www.globalchange.com
www.bbc.co.uk
Medical students category

Biomedical advances, particularly in the realm of genetics and pharmacogenetics, will lead to greater life
expectancy resulting in a large increase in elderly members of society.
This demographic change will create a growing burden on health care services, with more resources being
channelled towards an increasing dependent sector of the population.
As patient health becomes more genetically determined, doctors in their training, research and practice will
focus less on environmental causes of disease.
Doctors will be entrusted with a great deal of confidential information arising from patient genetic codes;
they will be expected to make use of this knowledge in a directed, specified manner.
Gary Cooney
First prize winner
There will be a notable imbalance between an excess of biomedical knowledge and an uncertainty of what
to do with it, however doctors will be expected to act uniformly, though they may disagree on the pathway
their profession is taking.
Medical students
category
Life extensions
Vera Pilfrig is never late. We meet her now as she
advances along a cylindrical tunnel, carrying a
microclip in one hand, a tall cappuccino in the other.
Silvery hair fastened in a bun, her frosty eyes alert but
expressionless, aged 60 and a bit. This morning, she
will address an auditorium of 400 medical students
on professional ethics, and though she has delivered
this lecture series in its evolving forms for close to
three decades, never before has it seemed to her so
monumentally important. A recent high-profile
medical scandal adds, she feels, a certain weight and
purpose to her strides. Sensing her approach, the
automatic tricuspid valve doors slide open before her.
The students quickly fall silent.
Gatekeepers of Knowledge, she cries by way of
introduction, Guardians of Lifes Secrets. A long
pause while Prof Pilfrig surveys her surroundings. She
is not impressed. Fifteen years previously the medical
school had commissioned university engineers to
design its lecture theatres to resemble the chambers
of the human heart. This marriage of anatomy and
architecture was not unprecedented, but Pilfrig had
been vehemently opposed. Her own suggestion of a
kidney-shaped alternative, practical though it was,
had met with little support, and so she found herself
shunting, as she put it, between modified left and
right atria to deliver lectures.
The year 2000, with all its turn of the century
optimism, promised the world a genetic and
biotechnical bloom with profound implications for
humanity1. Fifty years later and it is undeniable that
such anticipations were indeed well-founded.
However, as any historian of medicine will tell you, so
20
giddy were our predecessors with wide-eyed talk of

medical revolutions and the prophesised golden era of
health that, regrettably, very little heed was paid to
how this would fundamentally alter what it meant to
be a doctor. And so, here we are, in the year 2050,
with I daresay almost an excess of knowledge at our
disposal, but still grappling with how exactly this
should shape current practice. Indeed there is no
shortage of guidelines, rules and laws, which it is my
responsibility to teach and yours to learn, but we are
quite far, I think, from achieving a consensus that all
our policies reflect the very best course of action.
She thought it wise to let this thought simmer for a
moment. The students nestled into their ovular pods
would quickly connect her words to the Simon Roslin
case, the infamous general practitioner whose cavalier
approach to medical practice had, in the Crown
Courts opinion, led to the early deaths of an
estimated 120 patients. Though convicted, Roslin
maintained he had always acted as every communityconscious doctor should. He had shocked spectators
with his defiance and audacity, encouraging fellow
practitioners to follow his lead. To respect life fully, he
argued, is to respect its natural limitations; medical
martyrs were needed, he insisted, to counter
societys obsession with longevity. He spoke with a
disquieting logic that many had found hard to refute.
The professor slid the microclip into a discreet panel
in her chair. Instantly 400 student pods whirred, as
translucent screens emerged and flickered to life. A
scene from a courtroom came into focus, with the
ghostly figure of Roslin in the dock, his tweed
waistcoat fully buttoned, his well-coiffed mullet
shown to full advantage.
Gary Cooney First prize winner
The man you see before you needs no introduction,

Prof Pilfrig continued, some view him as a murderer,
others as a crusader for change, a saviour of a
profession which has responded inappropriately to its
own advances. These recordings taken from his trial,
will serve well for a discussion on what you, as students
in 2050, think the role of the doctor should be.
At this, the atrial chamber lights dimmed softly and
the crisp courtroom image sprang into motion before
the students. A poised and collected Dr Roslin began
to speak:
Centenarians should be the exception, not the rule.
We parade our elderly around as if their longevity is
the true mark of medical accomplishment. We speak
progressively of life extensions, take foolish pride in
five generations under one roof. The resulting topheavy skew in our population has forced us to
become a nation of care-takers, our progress stymied
as attention is diverted to accommodating an
increasingly dependent population. Intoxicated on
biotechnological progress, physicians in pursuit of life
everlasting have dismantled social order. As
practitioners we are expected to pitch a continual
battle against death, the most natural of
developments in my view, for a patient spending their
115th birthday in fulltime care.2
As I see it, the real problems arrived with the mixed
blessing of genomatrons, almost 30 years ago. Their
introduction changed forever the medical landscape.
A drop of blood onto the fixing slide and 15 seconds
later a complete DNA reading with statistical
interpretation for practically any variable.3
Consultations changed drastically: Thats just fine,
Mrs Grimes, you may continue smoking. Your cancers
are inevitable, but eminently treatable.
Here Vera Pilfrig paused the proceedings. Access to
information! she pressed. Of course, the internet
had for years been a tremendous source of patient
knowledge, but combine this now with ones own
personal DNA profile, how might this have affected
the doctors role? Your thoughts please4 The
professor adjusted her classroom controls to random
selection. In the third row, a pod lit up and its bluehaired occupant knew it must be her turn to speak.
Patients were permitted access only to their personal
DNA profile, strictly in a clinical context under
medical supervision. Some argue that these
limitations were enforced to prevent physician
unemployment, but the prevailing opinion was that
patients might misinterpret their readings and
21
respond inappropriately. Indeed this was shown to be

the case in a number of studies of those who had
obtained black-market readings and had consequently
exaggerated and precipitated symptoms, or worse
again, ignored elevated risk readings.
Prof Pilfrig quietly conceded that here was a bright
student. However, she abhorred the electric blue
hairstyle - what would patients think when this young
doctor-punk moved in to take a blood pressure
reading? She would gladly have given her a good
dressing-down, but the university in its wisdom
encouraged expressions of identity and since Vera
was on a second verbal warning she restrained herself
with effort. Fine, she barked, and of course this
meant that patients were asked to trust that their
doctors would reveal fully all medically relevant
genomatron readings, following assessment, and
would devise a contract of care in the best interests of
the patient, as identified by the patient.
The voice of Dr Roslin returned to the auditorium:
Who suffers most, we must ask, under this tyranny
of longevity? It is certainly not the pharmaceutical
companies, with the ever-tightening science of
pharmacogenetics.5 Genomatron readings and
assorted biochemical markers allow teams of
scientists to tailor products so precisely that they can
forecast with confidence the long-term survival of
their consumer base. It is estimated now that most
patients spend 40 years following a regimen of
assorted pills, the tab for which is picked up by the
NHS, or more accurately, by the tax-payers who
sustain it.
No, no, while we whittle away resources on the
elderly, it is, as it always has been, those in the poorer
social classes who suffer most. Their abysmal working
and living conditions exposed them to chronic air
pollution during the 20s and 30s. This, coupled with
the terrifying spate of bioterrorist attacks of the 40s,
has meant that for some unfortunate people,
genomatron data is largely irrelevant.6 Those who
have been exposed to what we, in our clinical
coldness, term environmental insult suffer greatly
under a health care system reconstituted upon a
foundation of genetic determinism. It seems there is
little room for compromised body systems in this new
order with its false quest for immortality. Selective
reproduction has removed the necessity to find cures
it is the rare medical student nowadays who has
even heard of cystic fibrosis, and yet the knowledge
we might have gleaned from tackling its associated
respiratory infections would doubtless serve those
who are now rendered physiologically weak.

I expect the court to find me guilty, but I, in turn,
find society guilty of crimes far worse than my own.
How can you justify drugging an old man into his 11th
decade, when a mere two hours flight south in
Nigeria, a mother has lost half of her children to
preventable diarrhoeal disease? Closer to home and
you will find that continued grinding poverty,
arguably the result of misdirected health care funds,
means that for a sizeable number, environmental
factors still trump genetic influence. Our microbial
arms race has for decades threatened resistancestrain epidemics and as climate change triggers
further political turmoil, the threat of a new season of
bioterrorism is never far off.7 For either eventuality we
are woefully ill-prepared.
Whatever judgment you may pass, I find comfort in
knowing that I have acted as every moral physician
should. We cannot, as doctors acting in good faith,
support a regime so patently detrimental to our
nations health.
The screens vanished with a small crackle and Prof
Pilfrig gave a loud cough to redirect attention towards
her. She selected a few students for comments (she
knew well the faces that could be relied upon for
controversy) and very soon the entire atrium was
engaged in vigorous debate. She conducted the
proceedings with her classroom controller,
illuminating those who had been granted the floor.
One rather histrionic young woman had dubbed
Roslin a raving Marxist, whilst another had proffered
an unhelpful analogy to Hitler, but overall the
standard of debate had been good. It seemed that the
students were as divided on policies of best practice
as the professionals they sought to emulate.
Enough! the professor cried clapping her hands.
For the final word, we turn to the presiding judge.
With echoes through the quivering room, like the
voice of an angry god, the judge spoke in heavy,
solemn tones. Vera had of course willed it so, and had
adjusted the speakers accordingly, for here lay
perhaps the only kernel of goodness that could come
from the whole sorry affair:
Simon Roslin, your training afforded you a truly
privileged position, with access to the nucleic secrets
that would govern your patients lives. Your
professional role was to ally your expertise with the
responsibility to use nucleic knowledge exactly as you
had been directed.
22
Each of the patients whose lives you curtailed had

lived for over a century, a good innings as you so
tastelessly put it. Their untimely loss has brought
immense grief to the families that put reasonable
trust in you. Since the arrival of the genomatron,
patients have had the luxury of relaxing their health
vigilance; they understand that their DNA, interpreted
by a trusted physician, will provide them with due
warning of most serious health concerns.
Your actions, though inexcusable, are not without
reason. I appreciate that such crimes may indeed
represent the sad and bitter culmination of a
lifetimes frustration with the direction of your
profession. Many would agree that biomedical
advances have exacerbated inequalities, have
privileged individual over community health.
However, a refusal to fall in line with colleagues, to
instead act according to ones own convictions above
those prescribed, has no place in medicine.
Safeguarding uniformity of practice is one of the most
enduring roles of the doctor. In the face of unnerving,
unpredictable change, professional bodies work best
when their members stand as one.
Yours is not the realm of poets or politicians.
Sentencing will be handed down in eight weeks.
Vera Pilfrig returned to her seat and watched the
students filter out. Bunched together, happily
chattering and laughing, riding the crest of a wave.
Her face fell and she eyed the slight tremble in her
hand. A long time indeed, she thought, before theyll
be washed up.
References
1 Isaacson W. The Biotech Century. Time 1999; 153/1
2 In his defence, Roslin cites the following antiquated
sources as evidence that, even forty years ago, mankind
was well aware of the potential dangers of rapid
biotechnological growth. Office of National Statistics:
News Release. Over 80s set to reach nearly 5 million by
2031. July 2004.
www.statistics.gov.uk/pdfdir/proj0704.pdf Commission of
the European Communities. The future of health care and
care for the elderly: guaranteeing accessibility, quality and
financial viability. December 2001.
europa.eu.int/eurlex/en/com/cnc/2001/com2001_0723en
01.pdf.
3 Department of Health. Our Inheritance, Our Future:
Realising the potential of genetics in the NHS. June 2003.
www.dh.gov.uk/assetRoot/04/01/92/39/04019239.pdf
4 Lazoff, M. Patient Education. Medical Computing Today.

September 1998.
www.medicalcomputingtoday.com/0nvpted.html
5 The Royal Society. Genetics and Health: What is the
Future of Pharmacogenetics?
www.royalsoc.ac.uk/page.asp?tip=1&id=3961.)
6 United States Department of Health and Human Services,
Centers for Disease Control and Prevention. Emergency
Preparedness and Response: Agents, Disease & Other
Threats. www.bt.cdc.gov
7 The World Health Organisation: Antimicrobial Resistance,
Fact Sheet.
www.who.int/mediacentre/factsheets/fs194/en
Other references
Commission of the European Communities. The future of
health care and care for the elderly: guaranteeing
accessibility, quality and financial viability. December 2001.
europa.eu.int/eurlex/en/com/cnc/2001/com2001_0723en01.
pdf
Department of Health. Our inheritancer, Our future;
Realising the potential of genetics in the NHS. June 2003
www.DH.gov.uk/assettroot/04/01/92/39/04019239.pdf
Isaacson W. The Biotech Century. Time 1999; 153/1
Lazoff, M. Patient Education. Medical Computing Today.
September 1998. Available from: URL:
www.medicalcomputingtoday.com/0nvpted.html
Office of National Statistics: News Release. Over 80s set to
reach nearly 5 million by 2031. July 2004.
www.statistics.gov.uk/pdfdir/proj0704.pdf
The Royal Society. Genetics and Health: What is the Future
of Pharmacogenetics?
www.royalsoc.ac.uk/page.asp?tip=1&id=3961
United States Department of Health and Human Services,
Centers for Disease Control and Prevention. Emergency
Preparedness and Response: Agents, Disease & Other
Threats. www.bt.cdc.gov/
The World Health Organisation: Antimicrobial Resistance,
Fact Sheet. www.who.int/mediacentre/factsheets/fs194/en/
23

This essay will address the following issues:
The diminishing role of the physician in performing clinical procedures
The increasing dominance of computer-aided decision-making as an adjunct or alternative to clinical
judgement
The move of health care provision from a secondary to a primary context
The greater emphasis on prevention, and care rather than cure
The shift of a doctors role from the provider of health care to the provider of more general guidance to the
community at large.
Christopher Hands
Runner-up
It can seem very worrying to be a doctor at the

moment. Many correspondents writing in the letters
page of the BMJ are concerned that they are losing
aspects of their role as clinicians to nurse
practitioners, and some are anxious that the
traditional boundary between medicine and nursing
be reinforced.1 This is supposedly in order to protect
the integrity of care, but it could equally be about the
preservation of the physicians image, and her social
and professional position. The imagined
encroachment of nursing into medicine is only the
first in a litany of perceived threats to the doctors
field of activity; physician assistants threaten on the
opposite flank, improved diagnostic software may
render many aspects of clinical judgement obsolete,
and lay personnel may begin to take on many of the
tasks involved in specialised operations. However, it is
perhaps too soon to sound the alarm. Doctors remain
the only health care professionals to have a
comprehensive understanding of pathophysiology,
and therefore the possibility for insight into all of a
patients health problems. The potential breadth of
their vision allows for the development of the doctors
role as an advisor in ways that have up to now
remained only hints and signposts.
In the future, those who graduate from medical
school will perform fewer and fewer clinical
procedures. Examples of this pattern already come
from all over the field of medicine. It is possible, for
example, that possession of a medical degree will
become much less important for those who wish to
work in surgery. Centres that are super-specialised in
one type of operation or even one operation only,
consistently report a higher percentage of good postoperative outcomes for that procedure than general
surgery teams. An extraordinary example of this
phenomenon in the United States is the Shouldice
Hospital, which performs only hernia repair
operations. Procedures performed in general hospitals
see a 10-15% recurrence rate. At the Shouldice
24
Hospital, the rate is 1%. Many of the surgeons at the

hospital have not completed general surgery training,
and yet they are amongst the best hernia repair
surgeons in the world. If they do not need general
surgery training to achieve this level of success, do
they even need a medical degree?2
In both primary and secondary care, nurse
practitioners are performing cannulation, suturing,
and stoma care, and are sometimes substituting for
PRHOs in pre-op assessments.3 In order to cope with
the forthcoming further reduction in junior doctors
hours, and to offer a cost-effective alternative to
those hours, the GMC is also considering the
introduction of the role of the physicians assistant in
the UK;4 nurse practitioners and physician assistants
have been accepted faces in patient care since the
1970s in the USA and Canada. In principle, having
various members of the team with different skill
levels and types will allow doctors more time to
concentrate on unusual pathophysiologies, and
thereby develop their clinical judgement. At the same
time, practical procedures will always be carried out
by staff with the appropriate competencies.
However, the clinical judgement of the individual
physician, which these changes will supposedly
nurture, is possibly about to lose its primacy.
Clinicians already rely on image interpretation
software in the fields of haematology and cytology,
and the influence of such software may become
predominant in areas traditionally left to the human
being, such as ECG interpretation. In 1997, Lars
Edenbrandt published the results of a study which
matched the clinical judgement of an experienced
Swedish cardiologist, Hans Ohlin, against the
diagnostic skills of an artificial neural network.5 The
two contestants scanned 2240 ECGs, in an attempt
to determine which ECGs came from patients
suffering myocardial infarction. In Edenbrandts
words, the study found that The neural networks
showed higher sensitivities and discriminant power
Christopher Hands Runner-up
than both the interpretation program and

cardiologist. Currently, more than half of Canadian
physicians under 35 carry PDAs as an immediately
accessible source of information, and they have
reported that handheld devices have prevented a
significant percentage of medical errors.6 It may not
be long before those same PDAs are giving accurate
and reliable advice about patients conditions and
management.7 Human beings are famously fallible,
and any technology that will help to eliminate those
peccadilloes of their performance that are dependent
on stress and sleep levels will be encouraged.
When doctors do make clinical decisions and practical
interventions, they will increasingly make them in the
context of primary care. Although the future of
primary care is currently surrounded by uncertainty
(as evidenced by the recent lively debate in the British
Medical Journal),8 there are many reasons why
primary care centres should benefit from the
allocation of more resources, and should take on a
greater share of patient management. Expanded
primary care centres could provide short-stay
accommodation. This would be available for patients
undergoing minor surgical procedures performed by
the resident GP with a special interest, or for patients
who needed short-term acute management, such as
those who required an intravenous antibiotic infusion.
Such patients currently occupy bed-space in acute
hospitals, which is inappropriate considering the
discomfort occasioned to the patient, the infection
risk, and the cost of the service. The availability of
technology such as radiography equipment will allow
more patient care to be delivered on the same site,
making life easier for everyone. The availability of
services like physiotherapy at the centre, an approach
already encouraged by many GPs, would make
continuous assessment of a patients condition more
practical. All of these shifts in favour of health care
based in the primary care centre would make the
continuity of care easier to achieve, and would
therefore likely be popular with patients.
If possible, we would prefer to prevent people from
getting ill in the first place, rather than fixing them
afterwards. It would be more pleasant for the patient,
easier for the physician, and less stressful on our
creaking NHS budget. Already primary care physicians
are concentrating very hard on trying to prevent highrisk behaviours in their patients, and to make them
partners in their own care. Instead of dispensing
advice like a prescription, with the distant authority of
a professional man (or woman), the thoughtful ones
25
amongst modern GPs have made friends with their

patients, and attempt to conceive, along with the
patient, a plan for their care that will effectively serve
their best interests. Of course, there are always plenty
of people within a GP practices catchment area that
think their health-related behaviour is none of the
doctors business, but physicians are succeeding in
making it their business. There is a new concentration
in medical schools on communication skills, which
serves as an acknowledgement that it not only makes
sense to tell medical students that the manner in
which they interact with their patients is important,
but also to ensure that every last student learns how
to understand and address the patients agenda.9
So far, so ordinary. The success of the doctor-patient
relationship has been at the heart of medical care at
least since Hippocratus drew up the first care contract.
But if doctors, as hinted above, begin to have
responsibility for much less of the treatment of
physiological disorders, the medical consultation may
begin to take on a new significance. The primary care
physician (and there wont be many other kinds of
physician) will be above all interested in preventing
risky behaviour on the part of their patients. She will
cultivate an open and honest relationship with her
patients, so that they will feel comfortable about
telling her about those incidents the diabetics
Belgian chocolates after dinner; the teenagers
unprotected sex; the borderline alcoholic that may
lead to health difficulties in the future. Patients will
come to her surgery on a regular basis to be dispensed
not pills, but wisdom, which will help them to avoid
the venal sins of exercise avoidance and bad diet.
In an era when mental health problems are increasing
exponentially in the West, the physician will be a
source of comfort and support to her patients, trying
to help them avoid despair by offering them the
solace of perspective. Such perspective will derive
from the physicians own global understanding of the
body and disease processes, but also from her
contacts with many and various patients, whose
individual narratives would enable her to offer
benevolent guidance. Patients who arrive at a GP
surgery to ask for the tenth time about their back
pain, are currently stigmatised in some quarters as
heartsink patients.
The future of medicine involves the recognition, not
just on an individual level, but by the regulatory and
professional bodies, that these patients are just as
much our charges, and that in some ways their care
Christopher Hands Runner-up
involves the practice of medicine in its purest form.

When there is no pharmacological intervention that
will help, the physician must genuinely seek to treat
the whole person, to offer practical succour. In the
nineteenth century, the man of education and
standing whom one would go to see in time of need
was the local vicar. Bright second sons went into the
Church to help their fellow man whilst being assured
of a good salary. The person of education and
standing who has assumed this role is the doctor. In
the twenty-first century, with the body established in
the West as our secular temple, doctors are the new
priests, and a ten minute consultation will not be long
enough for the salvation of anyones soul.
References
1 Letters and rapid responses to Young, G., The nursing
professions coming of age, BMJ 331:1415.
2 These remarks are drawn from Gawande, A.,
Complications, (London: 2003), pp.40-41.
3 Kinley, H., et al, Extended scope of nursing practice: a
multicentre randomised controlled trial of appropriately
trained nurses and pre-registration house officers in preoperative assessment in elective general surgery, Health
Technology Assessment, 2001; 5:20.
4 Laverse, E., Helping Hands, student BMJ 2006;14:1-44.
5 Heden, B., Ohlin, H., Rittner, R., and Edenbrandt, L., Acute
myocardial infarction detected in the 12-lead ECG by
artificial neural networks, Circulation 96 (1997):17981802.
6 Martin, S., More than half of MDs under 35 now using
PDAs, Canadian Medical Association Journal, 169(9):952.
7 Olson, D., Scott, J., Techo-philic, studentBMJ
2005;13:353-396.
8 Walker, D., Wishful thinking about primary care in 2015
BMJ, Jan 2006; 332: 180.
9 Hall, A., Sedgwick, P., Teaching medical students and
doctors how to communicate risk, BMJ, Sep 2003; 327:
694 695.
26
27

Changes within the NHS: The introduction of an NHS tax and biotechnological companies taking over the
running of hospitals following the failure of repayment on the Private Finance Initiatives. Primary care now
takes on the vast majority of operations in GP mega-surgeries serving large areas of the community.
Training/working hours: As a medical student and junior doctor. There is a contractual obligation for doctors
to teach and to be trained. The working hours and time to become a consultant have reduced but there is
also a fall in pay and an obligation to work at night as a general consultant before you can specialise.
Role of nursing: Nurses are able to prescribe and have encroached into the traditional role of a doctor. The
gap between nurses and junior doctors is much less in terms of pay and care of the patient.
Ashish Marwaha
Runner-up
Litigation: The increase in litigation has increased insurance premiums for doctors further reducing pay. The
doctors must follow NICE issued care pathways for every patient and must re-register with the GMC every 3
years to prove core competence.
Technological advance: There are no paper records and every doctor carries a PDA with updated electronic
patient information accessible anywhere in the hospital. Organs can be grown from adult stem cells in a
laboratory. This has made organ replacement the main treatment for most major diseases.
A transcript of a conversation in the year 2050

between a patient Dr Jones (a retired doctor)
and his grandson Care Consultant Jones, a
doctor of the future:
Care Consultant Jones: Hi Grandad, I have washed
my hands in the cleansing pod1. The button should be
flashing so you can let me in.
Dr Jones: Found it. All this new technology, Ill never
get used to it Roger. You know in my day we just
trusted people would have the common sense to
wash their hands. I heard there was a gentleman in
ward 15 whose cleansing pod broke. He was stuck in
his room for days.
Care Consultant Jones: How did you manage

without PDAs? How would you know a patient
history when they came in?
Dr Jones: Roger, we used to re-take the history every
time a patient came into hospital. It was good
practice for the medical students.
Care Consultant Jones: My medical students would
have a fit if I asked them to take everyones histories
from scratch. They would probably sue me for not
providing a proper education5.
Dr Jones: All this litigation. First the patients and now
the medical students, your insurance premiums must
be through the roof6.
Care Consultant Jones: Now Grandad, thats just a

malicious rumour. The engineers from Biotech corp2
would never let that happen. Who would want to
book into this hospital if that were true?3
Care Consultant Jones: I am just lucky that Angela

works as a lawyer. If we had to get by on my wage
minus the insurance premium then we would never
survive.
Dr Jones: When I was a doctor, no one got to choose

where they went. We all foolishly assumed that all
hospitals tried their best! Speaking of the Biotech corp
engineers could you tell the health care assistants on
the way out that my plasma screen is broken?
Dr Jones: Speaking of Angela, how is she and how are

the children?
Care Consultant Jones: There will probably be several

forms to fill in. Biotech corp is notorious for their
paperwork. Do you know in one ward round I have to
file at least 100 different electronic forms on my
PDA? Biotech corp are so afraid of litigation. Its
ridiculous the amount of time I spend on
documentation for a patient.
Dr Jones: Roger just count yourself lucky you have these
PDAs4. We used to write down everything by hand.
28
Care Consultant Jones: They are all fine. Johnny is

now in his final year of medical school.
Dr Jones: Been 5 years already?
Care Consultant Jones: No Grandad. You know
medicine only takes 4 years now. Only graduates can
do it and they just learn clinical work7.
Dr Jones: What, no anatomy?
Care Consultant Jones: I think they only do virtual
surgical anatomy. I was asked to teach it but I already
had enough teaching points to fulfil my contract8.
Ashish Marwaha Runner-up
Dr Jones: So Johnny will be starting as a house doctor

soon.
Care Consultant Jones: Well I think his official title is
an FCA. It stands for Foundation Care Assistant.
Dr Jones: Hell be very busy. I remember my days as a
house officer, never enough time for lunch.
Care Consultant Jones: He told me his shifts are
scheduled for 9-3 every day for the first 2-month
rotation. There are so many students coming out now
that they have plenty of FCAs to go around9. They all
only work a few hours each day.
Dr Jones: How on earth do they get the experience
needed to be a doctor in that time?
Care Consultant Jones: Its generally expected that
they dont. However, the rest of the time is set aside
for teaching and further training.
Dr Jones: Do they get paid for that?
Care Consultant Jones: No thats the catch. They
have an obligation to teach otherwise Biotech corp
will terminate their contracts. They also have an
obligation to receive a certain number of training
points otherwise their insurance premium is invalid.
Dr Jones: How will he survive?
Care Consultant Jones: Well, we said we could help
him out a bit. He might have to get a part time job to
see him through though.
Dr Jones: Thats awful. Who would have thought that
one day doctors would need to take a second job? We
always used to moan about our pay but it was never
that bad! At least hell make consultant sooner, I
assume the pay goes up then.
Care Consultant Jones: Yes it does but then so do the
insurance premiums.
Dr Jones: What does he want to specialise in?
Care Consultant Jones: He doesnt really have to
choose at the moment. He automatically becomes a
general consultant after 5 years providing he passes
his competency assessments. After that he is
expected to work as a general consultant on the
hospital at night scheme for at least 2 years until he
can specialise to become a care consultant.
Dr Jones: They make him work night shifts for 2 years.
Care Consultant Jones: Its the only way that the
hospitals can stay open 24 hours. Patients wont be
kept waiting for anything nowadays. Now that they
29
all pay an extra NHS tax10, they expect a good service.

Dr Jones: I luckily retired before this NHS tax came
into effect.
Care Consultant Jones: It should have been reduced
when the Biotech companies started buying out the
PFI mortgages on all the hospitals11. The government
claimed costs had risen so much that a NHS tax cut
would have been the end of the NHS.
Dr Jones: Thats an old excuse. Its not really the NHS
anyway. As far as I can see we pay for the privilege of
going into the hospitals and the Biotech companies
take away all the profit from running them.
Care Consultant Jones: All these extra taxes will be
the end of me!
Dr Jones: I suppose I should count myself lucky that I
still receive the NHS pension12.
Care Consultant Jones: Yes, Biotech corp has decided
that they couldnt possibly provide a pension for their
NHS employees. All the money that they have made
from their new drugs must of course go to pay for
their extensive research and development.
Dr Jones: Thats an old excuse as well. I suppose you
are not put under any influence to prescribe these
new drugs?
Care Consultant Jones: Of course not, grandad. I can
prescribe what I want. However, the hospital
unfortunately only stocks Biotech corp drugs in
house. So if I wanted to get something from a rival
firm it would take 5 days and I would have to fill out
about 5 forms.
Dr Jones: Thats disgraceful. Im surprised no one saw
the conflict of interest.
Care Consultant Jones: The Biotech lobbies are so
large in this country that no one could care. Anyhow, I
hardly have to prescribe anything nowadays.
Dr Jones: Nurse prescribing power!13 What precisely
do you do Roger?
Care Consultant Jones: As far as I can figure out we
basically just keep an eye on things. The nurses
prescribe and follow the care pathways. We are just
there to check that everything is running smoothly.
Dr Jones: God forbid any independent thought goes
into the process. These care pathways are a menace.
My doctor refuses to deviate from it no matter how
much I show him the evidence online.
Care Consultant Jones: Grandad, patients are always

showing us their online evidence. The fact of the
matter is that we open ourselves to litigation if we
deviate from the care pathway. Our insurance also
becomes invalid. They are theoretically evidencebased and updated automatically onto our PDAs.
Dr Jones: Theoretically is the right word. What if I
dont agree with NICEs interpretation of the evidence
and the fact that they update guidance when its a
convenient time to do so? Also surely someone needs
to point out that the Biotech lobby influence the
government and the government controls NICE14.
Care Consultant Jones: Well the nurses claimed care
pathways help them provide a standardised care to all
the patients. We all know how powerful the Royal
College of Nursing has gotten.
Dr Jones: As far as I can see they basically do all the
things I used to do as a doctor. They prescribe drugs
and look after the patient from a medical point of
view. My nurse has called for her consultants advice
once since I have been here.
They get paid standard fees for the annual check-up,

minor operations and specialist health checks.
Although, its mainly the general nurses that do most
of the specialist disease check-ups now. They are even
in training to do the community minor operations.
Dr Jones: There is a big difference between what you
would call a minor operation and what I used to call a
minor operation. In my day the general surgeons still
did hernia repairs.
Care Consultant Jones: The GPs do almost
everything now really. Our consultant general
surgeons mainly do organ transplants now. Its their
answer to anything; if it goes wrong lets just replace
the whole organ.
Dr Jones: We used to have a shortage of organs,
would you believe.
Care Consultant Jones: Relying on donors was always
a terrible way to get organs. We are just lucky that
the government decided to ignore the protestors and
grant the Stem Cell Research Bill16. So now we can just
grow any organ we need in the lab.
Care Consultant Jones: That doesnt surprise me. We

are just there as a check. They see the patient, bring
up the history, follow the care pathway and institute
the evidence-based management. My nurses hardly
call me.
Dr Jones: I am sure that Biotech corp would have

used any means necessary to be able to grow organs
in the lab. They must sell their hospitals the organs at
quite a mark-up.
Dr Jones: I heard a rumour that the nurses get paid

more than the junior doctors now.
Care Consultant Jones: We should try to be a little

less cynical next time I visit. I better go, I have to get
ready for my re-registration exam with the GMC17.
Care Consultant Jones: Thats not really true. They

get paid a slightly lower hourly rate than the FCAs
but they do more hours and so get paid a larger
annual income.
Dr Jones: Thats how it was sold to the BMA then.
Care Consultant Jones: The BMA has very little
power compared to the Royal College of Nursing. If
the consultants went on strike the hospitals would
still be able to run but if the Nurses did then the
whole place would grind to a halt15.
Dr Jones: I suppose if the nurses do all the work they
should get paid more.
Care Consultant Jones: They and the GPs get all the
money.
Dr Jones: My GP just bought a new Lexus. Is it true
they get paid per procedure and not by patient now?
Care Consultant Jones: There would not be much
point in paying them per patient. They all have these
mega surgeries with thousands of patients in them.
30
Dr Jones: Has it been 3 years already?

Care Consultant Jones: Yes, I have to prepare my
patient portfolio and revise for the exam. Shouldnt
have left it all to the last minute.
Dr Jones: Enjoy yourself! Goodbye Dr Jones, visit me
again soon.
Care Consultant Jones: Now now, Grandad you
know the Royal College of Nursing put a stop to the
term doctor a long time ago.
Dr Jones: Yes yes, I know, it increased the divide
between health care professionals or some politically
correct nonsense! I just like calling you doctor for
nostalgias sake but if you insist, Goodbye Care
Consultant Jones.
References
1
All patient rooms have a cleansing pod outside which

automatically sprayed your hands with anti-microbial.
This was in response to the great MRSA epidemics of
2010 and 2020.
2 The hospitals of the future are all run jointly by Biotech

companies and the NHS.
3 Patients are able to book into any hospital they wish for
care.
4 All doctors in 2050 were issued with a PDA. It would
allow them to continuously monitor a patients history,
investigations and management plan from anywhere in
the hospital.
5 In 2039 a medical student successfully sued their
medical school for not providing a good enough
education. His argument was that if he was to be held
accountable for his actions as a doctor then he should be
trained to a high standard in core competency. As a
result of his action all medical schools were required to
provide every medical student with a supervising doctor
who would follow their progress and assure they received
training in core competencies. An obligation to teach was
written into every doctors contract with their employer.
6 Insurance premiums rose to over half a doctors salary
following a spate of litigation from patients complaining
about their care.
7 After the success of the graduate entry courses in the early
part of the century the government decided to adopt the
graduate entry model for all UK medical students.
8 All doctors receive points for teaching medical students.
They must earn 100 points a year to fulfil their contracts
with their employers.
9 Medical student places were vastly increased by the year
2050. The entry requirements dropped to allow most
people to be eligible to become medical students. This
was a reaction to a problem of under-recruitment in the
late 2030s. This was thought to be because of medicine
becoming a very low paying profession due to reduced
working hours and very high insurance premiums.
10 The NHS tax was introduced in 2020. It was a specific tax
paid by all to enable a free health service. It was raised
every year subsequently until the Biotech companies
agreed to buy and run hospitals. It was never repealed.
11 The new PFI building initiatives of the early 21st century
were unsustainable. The NHS fell behind on mortgage
repayments before the buildings were due to be handed
31
over to the NHS. As a result, the Biotech companies

agreed to buy out the existing mortgages on all the
hospital buildings in return for being able to run the
hospitals as private ventures and still receiving
government funding to provide free health care.
12 The NHS pension was abolished for all new employees in
2020.
13 Nurses were given the right to prescribe medication in
2030.
14 The Government Minister for Health was made senior
board member for NICE in 2010 in order that no
guidance was issued without express government
approval. This was in response to Herceptin not being
recommended by NICE in 2007 but after a press
backlash the Minister for Health issuing guidance that it
should be provided to all suitable patients anyway.
15 There were several Nursing strikes in the 2010s. These
had a large influence in making the Royal College of
Nursing a major government lobby.
16 The Stem Cell Research Bill of 2015 allowed any research
to be carried out on Stem Cells from any origin. This was
met with large protests in the country but eventually
allowed Biotech corp to grow human organs in the
laboratory from adult stem cells.
17 Doctors are required to re-register with the GMC every 3
years. They must review in a portfolio all the patients
they have treated since their last registration and must
take an exam to demonstrate core competencies
appropriate for their level.
Other references
Department of Health information on PFIs:
www.dh.gov.uk/ProcurementAndProposals/PublicPrivatePart
nership/PrivateFinanceInitiative/fs/en
The private finance initiative: The politics of the private
finance initiative and the new NHS BMJ, July 24, 1999;
319(7204): 249 253
BMA Private finance initiative: briefing & update
www.bma.org.uk/ap.nsf/Content/Private+finance+initiative:+
briefing+and+update
The changing role of nurses in the NHS (published 01 June
2004)
www.allaboutmedicalsales.com/articles_nurse_advisors/nurs
e_practitioners_nurse_advisors_aj_010604.html
Department of Health information on the Agenda for
change:
www.dh.gov.uk/PolicyAndGuidance/HumanResourcesAndTra
ining/ModernisingPay/AgendaForChange/fs/en
Every patient to get electronic patient record

www.icesdoh.org/news.asp?ID=219
BMA: Joint General Practitioners Committee/Royal College

of Nursing letter regarding nurses in general practice and
agenda for change
www.bma.org.uk/ap.nsf/Content/lettergpcrcn1104
New scientist: Humanised organs can be grown in animals

Dec 2003 www.newscientist.com/article.ns?id=dn4492
One stop primary care:

www.nhsidentity.nhs.uk/onestopprimarycare/
Reduced working hours and surgical training in the UK
www.medicinepublishing.co.uk/resources/surg.22.1.i.pdf
BBC NEWS New era dawns for junior doctors
news.bbc.co.uk/1/hi/health/3940331.stm
What, nurses training doctors?
www.ingentaconnect.com/content/ bsc/tct/2004
NHS Modernising medical careers website: www.mmc.nhs.uk
BMA: improving health - medical students
www.bma.org.uk/ap.nsf/Content/ManifestoMedStudents
GMC the doctor as teacher www.gmcuk.org/education/publications/doctor_as_teacher.asp
BBC News: Nurses' role set to expand
BBC news Litigation: Next NHS crisis
Student BMJ Facing up to the problem of the poorly
performing doctor
www.studentbmj.com/back_issues/0896/08ed2.htm
BBC NEWS GPs blast NHS reform plans
BBC NEWS Woman makes Herceptin court bid
news.bbc.co.uk/1/hi/england/wiltshire/4548950.stm
Fighting for herceptin:
www.fightingforherceptin.org.uk/news.html
GMC licensing and revalidation factsheet: www.gmcuk.org/doctors/licensing/archive/factsheet_2005_08.asp
Guardian: GMC's revalidation plan is still too easy on medics,
says report
www.guardian.co.uk/shipman/Story/0,,1370635,00.html
BMA General Medical Council revalidation
www.bma.org.uk/ap.nsf/Content/GMCrevalidation
32
BBC news: Q&A: Stem cells

Patients could grow their own transplant organs or implants
www2.netdoctor.co.uk/news/index.asp?id=117815&D=18&M
=2&Y=2005
33

This essay is based on the following ideas
The short tale of one man and his doctor.
Will GOD be the answer to our problems?
Insufferable pain?
Perfection?
Medicine without boundaries?
Kieran Mullan
Runner-up
He would have to go. Placing his tools aside Isaiah

accepted hed put it off for as long as he could. He
had tried to hide it. Failing health would be the
beginning of the end for him. He wouldnt be able to
go out and provide for his family. Even GRANDMA,
usually able to remedy all ills, a wealth of knowledge
and experience, hadnt been able to help. He at least
had the comfort that what hed said wouldnt go any
further, no one would find out.
This was all a shock to him. People that had made it
to his age without being cursed with sickness were
usually blessed for many years. His people had learnt
hundreds of years ago that devotion to GOD was the
only way to be protected. They were hardy in
character, thick skinned. Illness was something you
had to ignore, the alternative there wasnt one.
He remembered stories from the past when people
relied on others, they had no GOD. Whole clusters of
society telling people their way to banish sickness was
right. The different entities gathering peoples tributes
in the hope for cured ills. Then his people turned to
the one and only GOD, which protected them
thereafter.
The pain seared into Isaiahs consciousness, reminding
him what had caused his wandering thoughts. He
could barely walk now. A flash of shame accompanied
visions of being stretchered off by the stronger
members of the village. He would walk.
An hour later, floundering, he stumbled, staggering
over row after row of root crops. He lay on his back
looking upwards. Perhaps a short cut through the
fields was a bad idea. At least now he was blessed
with a view of nature, swirling clouds, freshly basked
in screaming blue. An ever-familiar BIRD floated
effortlessly across his perspective. Isaiah struggled to
raise himself as he heard the gentle caress of leaves
caused by a cautious approach. He turned to see a
CHILD.
An astounding creature was before him. A small boy
with blue eyes almost large enough to drag Isaiahs
attention from his bright red hair. At least red was
34
what Isaiah thought it was. He had never seen

anything like it. Hed heard of people of all creeds and
colours but never seen them in the flesh. And just as
quickly as the living, breathing curiosity had arrived it
was gone, bounding away into a field of tall crops.
Again, the pain in Isaiahs leg grappled for ownership
of his thoughts. He had to go on. It was not far now.
Nearby preparations were being made. Mystery
shrouded the work that would be done. A lot of
smoke and mirrors, nothing concrete. This was
medicine. All the villagers knew where he was, and
would avoid coming nearby. They were scared. Only
when desperate would they make the necessary
arrangements.
..
He saw him approach. Walking past, uninterested. The
rituals and ceremony would have to be followed.
Isaiah, Isaiah.
He turned to look.
Abraham, weve not seen each other for too long.
How are you?
Come inside, come inside. We shall catch up over a
broth.
This charade was necessary. Not that anyone would
be fooled. Plausible deniability. Isaiah attempted a
profound walk towards Abrahams dwelling. His
deception was a tattered veil of health. He still
couldnt help but feel a slight swelling of anticipation
about what he might be seeing in the next hour.
.
How long has it gone on?
Months, its got worse and worse. GRANDMA hasnt
helped.
Nothing can replace.
I know, I know.but.
I understand. I think I should have a look.
Locked in an uncomfortable stare Isaiah told himself
Kieran Mullan Runner-up
he knew this would happen. He needed to get help.

He had come. That was the difficult part. He
cautiously removed his footwear. No one knew what
went on, he didnt know what to expect.
Name please?
Can you show me where it hurts?
Region 5A. Abraham was sadly resigned to this

conversation and it brimmed into his voice. He would
have to inform Dr Crick, he would inform the
authorities. Potentially the entire village would have
to be genetically screened. Seven hundred and thirtysix people. The screen flicked on to relay the image of
the mature Dr Crick, Abrahams direct superior and
long-time mentor.
Just here. Under my big toe.

Abraham guardedly pulled Isaiahs foot up towards
the light. He knew instantly what was the matter. As
usual, there were many problems well beyond
GRANDMA.
Do you know what it is?
Yes. Ive never seen one before, but I know what it is.
Im surprised you hadnt come sooner. This kind of
trauma is known to cause high levels of pain. Youve
got a splinter.
Dr Crick.
Location? droned the monophonetic computer.
Dr Watson, how can I help?

Abraham hesitated.
Dr?
I saw a patient today that required an intervention.
Obviously Im required to inform you.
A splinter?
Yes. Hundreds of years ago they were very common.
Ancient materials such as wood could break off in
very very small pieces. These can become buried into
your flesh. This looks to be around a millimetre in
size.
Ive got something in my foot?
Yes. Though as always you seem most unhappy

Abraham.
Abraham paused for thought.
It doesnt seem right.
Abraham, weve been through this before.
Yes. Im afraid so. Can you think where it came

from?
I went to an antiques fair on Fecaro 7 several months
ago?
Im sure thats where it was. I will have to remove it
surgically.
Surgically? Is that necessary? Dont you have to
inform my employer if you do that?
Yes. And GOD. Theyll need to investigate it for any
possible predisposing alleles.
Please, please. Can I try and carry on, just get on
with it? Im sure I can.
The pain will get beyond anything youve ever
experienced.
It already is.
Exactly.
Theyll examine my children. The whole village even.
That is what is necessary. Im sorry.
..
Yes, I know, but do you know, I read something last

week, a novel, I think, about peoples lives in the 21st
century. They were sick yes, but they werent
unhappy. Dr Crick seemed exasperated but
continued to listen.
They werent ashamed to be unwell. It was
common, continued Abraham.
Yes they werent ashamed. Thats right. People were
so used to ill health and other people taking
responsibility that they stopped looking after
themselves. GOD (Genetic Obliteration of Disease)
helped remove enough disease from society that
sickness became abnormal.
But its not abnormal. Its normal. Now if youre ill
and you go to the doctor you have to submit yourself
to genetic study, your family. You, your children, lose
their procreation licence. You lose your job. And this
man, he has other qualities. Who else do you know
that would have tolerated a splinter without
treatment for months? I couldnt have. Were losing
our ability to withstand illness.
People ate themselves to early graves. Consumed
carcinogenic chemicals. They lived with pollution until
35
Kieran Mullan Runner-up
they had BIRDs (Biosphere Impurities Reconstituting

Drone). We dont have to withstand illness any more.
Abraham knew there was much sense in what Dr
Watson was saying. By honing their genome humans
had been mostly free from disease for hundreds of
years. Infection, degeneration, mutation. Technology
had been used to neutralise any threats posed by the
environment.Trauma was the only, and very rare
cause of illness. At first people became even more
irresponsible but as perfect health became easily
attainable with just a little effort; society became
engrained with this objective.
We are not doctors anymore. Do you know that?
Abraham.
Do you know doctors used to spend their time
treating commonplace illness. They were seen as
healers, people were proud to be doctors.
Im proud to be a doctor, Abraham.
Comfort them, ease their suffering. Not increase it.

What vaccines will I need? There must be numerous
diseases Ill be vulnerable to.
Abraham was sure he saw the beginnings of a smirk
on Dr Watsons face.
Yes, many Im sure. But Im afraid from last
November we stopped producing vaccines.
Emergency stocks only. There is no longer any need
amongst our population.
But I wont be amongst our population.
Thats your choice. When are you leaving? Its a 5
day journey to the boundary.
An awkward silence engulfed the office as Dr Watson
eagerly awaited a reply from a suddenly hesitant
Abraham...
The End
Yes, because you practise true medicine.You

safeguard the health of as many people as possible,
future generations, I know the mantra. What would
be so bad about being a CHILD (Created Human with
Inherent and/or Latent Defects)?
You are being foolish now.
Do you know what GRANDMA (Geyrx Ranyes
Automated Neo Diagnosis and Management
Augmentation) used to mean? It was your biological
sources source. A human. It wasnt a software
program, the only thing people feel can help them
without consequence. They were figures of love and
affection.
Youre a doctor!
Im a genetic policeman!
Where does this get us? This discussion, over and
over. Other superiors would have reported you by
now. This is what we need to do to keep ill health
from our society.
Our society. Maybe thats not mine. I saw a CHILD
today. He must have wandered over the boundary.
Dr Crick sighed, having suspected this would be the
eventual end to his relentless ethical debates with his
charge.
Thats your choice. They are always in need of
Shamans and Voodoo Men. Dr Watson would be
inclined to be derogatory. But that would not put
Abraham off. He would leave and really help people.
36
37

Expectations of future doctors include:
Greater levels of specialist knowledge and skill continually progressing via sound clinical governance.
Understanding and debating the ethical questions raised by the advancement of medical science.
Maintaining a strong sense of professional identity, based on commitment to the health of individuals,
populations and society.
Being flexible in the face of social, political and economic change.
Collaborating across professional and international boundaries.
Laura Spence
Runner-up
English Medical Journal

Volume 354:323-325
January 29 2045
Number 4
The Progress of Values

If I were writing a case report, I might describe my
first consultation of the morning as follows: Mrs X
attended the Pfizer-Microsoft Multidisciplinary Cancer
Clinic for discussion of adjuvant therapy after subtotal
mastectomy for breast cancer. This obese, 45-year-old
woman with no documented oncogenetic diathesis
was referred to the clinic three weeks ago after wellwoman health-check mammography revealed an 8
mm calcified mass in the lower-outer quadrant of the
left breast. One week ago, left-subtotal mastectomy
with reconstruction and incision stem-cell treatment
was performed. Intra-operative sentinel node biopsy
and 18-F-fluorodeoxyglucose PET-CT were negative
for lymphatic involvement and metastasis. Moleculargenetic analysis identified stage-1, ER, HER-2 positive,
invasive ductal carcinoma showing estriol-quinine GA
adducts and catechol-O-methyl transferase
downregulation. Today, the cost-benefit balance of
COMToctin treatment was discussed and decision
postponed until follow-up assessment in 8 weeks
time. Lifestyle modifications were agreed upon and an
appointment with the clinics chronic disease
prevention team was scheduled.1
I am not writing a case report. I create this vignette, in
part, to marvel at how advanced our detection,
treatment and holistic care of oncology patients has
become. It might be tempting to dismiss this as a
straightforward case of stage I breast cancer: little
challenge for todays oncologist, minimal long-term
consequence to the patient. Yet, my consultation with
Mrs X was anything but straightforward. This patient
challenged me to consider genetic screening, private
38
health checks, expensive imaging, obesity, and

whether a patient can demand specific treatments, all
before 9.30 am. As is often the case, I found myself
refereeing a contest between the demands of my
patient, medical science and society. It is this
balancing act of practising medicine, often neglected
by the technical prose of our profession, that I wish to
address. The discussion will draw out how doctors
have responded to changing contexts of science and
society. Through identifying the core values that have
allowed us to respond, we can strengthen our
performance in both the consultation room and
classrooms of future doctors.
First, lets consider the scientific and technological
changes of recent decades. In the realm of cancer
therapy alone, the advancements have transformed
medicine. Full classification of the molecular
pathways leading to cancer have allowed us to detect
genetic diatheses years before cancers emerge and to
create individual in silico disease models that predict
how a patient will respond to treatment. Drugs that
specifically target the aberrant molecular pathways
have become the magic bullets of cancer treatment.
With high resolution fMRI monitoring, drug effects
can be measured in the smallest of metastases.
The challenge for doctors has been how to use these
scientific tools in the most ethical and economical
manner. Two ongoing debates have sparked particular
media and public interest. Firstly, should we identify
individuals with cancer-susceptible genomes when we
know that many other factors contribute to
oncogenesis? Secondly, how can we ration funding so
that needy patients benefit from magic bullet drugs
without leaving other branches of medicine
underfinanced? The ability of doctors to withstand
such debates stems from consistent adherence to
sound policies.
Doctors, working with public representatives and
ethicists to comprise GMC subcommittees, propose
national guidelines for all medical practitioners to
Laura Spence Runner-up
follow. While setting ethical and economic

benchmarks has become the domain of medical
regulatory bodies, individual doctors must still rise to
the challenge of an advancing medical science. To
maintain excellence in the face of an expanding body
of knowledge and skill, doctors have had to become
more specialised. Communicating this knowledge to
patients is core skill. With more patients educating
themselves through the internet, doctors have had to
adopt the roles of interpreter and educator. We must
assist patients to access relevant, reliable sources of
information and help make scientific information
tangible. This allows patients to effectively contribute
to treatment decisions; an element of health care that
is now expected.
The changing expectations of the patient need to be
considered in the broader context of how society
views medicine. Loss of public faith in the medical
profession has been a concern for several decades.
NHS budget problems have left doctors struggling to
balance satisfying patients with meeting targets. The
introduction of health care insurance supplements in
the 2020s aimed to ease the pressure on finances.
However, an increasing repertoire of expensive
medicines and an ageing population plagued by
chronic disease has left resources permanently
stretched. Health insurance companies have instead
promoted consumer-driven and litigious approach to
health care that poses an ongoing threat to doctorpatient relationships.
The ability of the medical profession to recognise
societal concerns and to respond has been central to
maintaining cultural legitimacy. One important
approach has been to take the alternative out of
holistic medicine. Strengthening relationships
between mainstream and complementary medicine
has left fewer patients opting out of government-run
medical care. Enabling patients to access acupuncture,
physical therapies and nutritional guidance as part of
holistic treatment plans has vastly improved patient
satisfaction. The role of doctors in this success has
centred on greater inter-professional collaboration
with the ballooning number of professions allied to
medicine. This collaboration stems from a
commitment to patient, rather than consumercentred care.
To retain public regard in the face of media, business
and political strains, doctors have had to rethink their
professional identity. Turn of the century physicians
became increasingly aware of deep seated flaws in
39
the culture and regulation of the medical profession

(Sir Donald Irving, 2001).2 The Harold Shipman and
Bristol Royal Infirmary inquiries were two of several
high profile cases highlighting criminal lapses in
professionalism. Coordinated by the GMC, doctors
have drafted an oath of professional values to which
all medical graduates attest. Individual doctors must
practise visible scientific method, clinical governance,
excellence in communication and empathy. More
transparent procedures in regulating standards have
strengthened this professional identity.
While image has proven important in maintaining
good relationships between doctors, patients and
society, successful management of economic and
political issues is at the root of patient satisfaction.
The early 21st century has often been regarded as the
era of medical politicisation. With a media quick to
highlight government interventions hinting of nannystatism, public health politics has received much
criticism. Obesity has steadily risen since the
millennium, making type II diabetes the largest health
burden in Britain today. Yet public health politics has
had to re-evaluate how far it can attempt to control
our lifestyle choices. Medical rationing has also seen
the spotlight of political contention. Since the
Herceptin trials of 2006-8 and the subsequent
development of similar treatments, both medical
rationing and protest against it have pervaded. In this
context, it has been important for doctors to reaffirm
that their contract is not just with the health of the
individual patient, but with health of populations and
society. Rationing to benefit the population has
demanded transparent and empirical assessment of
clinical need, combined with nationwide policies to
avoid post-code prescribing.
Despite the changing demands placed upon doctors in
Britain, commitment to a set of common core values
has helped maintain a stable health care system. The
same cannot be said of health care in developing
countries. The burden of infectious diseases, primarily
HIV/AIDS and tuberculosis, has persisted despite
global eradication efforts. Financial constraints and
political unrest in some countries continues to take
toll on the health of their populations. In recent
decades, the health of developing nations has become
a recommended concern for all British doctors. UN
guidelines have suggested that all developed
countries facilitate transfer of medical knowledge and
skill across international boundaries. International
collaboration brings the challenge of working amidst
unfamiliar national and cultural expectations.
Laura Spence Runner-up
Successful efforts have required that doctors work

flexibly and use ingenuity to adapt their skills to new
situations. Regardless of international variations in
medical practice, the importance of working
transparently, methodically and with good
communication, has been evident.
Have the affairs of the wider world greatly changed
the way in which doctors practise? The answer is yes,
but subtly so. For me, tomorrow morning may bring
another Mrs X, a conference call to our sister-centre
in Burundi or the launch of the next magic bullet
drug. Yet, I can have confidence that our common
professional values will help me rise to the challenge.
Working methodically, communicating well, seeking
excellence in our specialist fields and collaborating
across professional and international boundaries has
allowed doctors to succeed against a backdrop of
social, political and scientific change. Conviction in
these values, attention to the changes affecting our
work and flexibility in adapting our practices should
allow us to face the myriad changes the remainder of
the 21st century will bring.
References
1 Speculative ideas based on current research in the
following articles:
Davidson N, Morrow M, Kopans D, Koerner F, 2005. Case
35-2005 A 56-year old woman with breast cancer and
isolated tumor cells in a sentinel lymph node. New England
Journal of Medicine, 353:2177-2185
Juweid M, Cheson B, 2006. Positron-Emission Tomography
and Assessment of Cancer Therapy. New England Journal of
Medicine, 345:496-507
Yager A and Davidson N, 2006. Estrogen Carcinogenesis in
Breast Cancer. New England Journal of Medicine, 354:270-282
Pui C and Evans W, 2006. Treatment of Acute Lymphoblastic
Leukemia. New England Journal of Medicine, 354:166-178
Royal College of Physicians. Doctors in society: medical
professionalism in a changing world. Report of a Working
Party of the Royal College of Physicians of London. London:
RCP, 2005.
www.rcplondon.ac.uk/pubs/books/docinsoc/docinsoc.pdf
2. Irvine D, 2001. The changing relationship between the
public and medical profession. The Lloyd Roberts Lecture,
Royal Society of Medicine. In Scambler G, 2004.
Sociology as Applied to Medicine, Fifth edition. Elsevier,
London, pp236
40
41

Abolition of the NHS in favour of private medical practice.
Technology centred care - the doctor as technician.
The inhumanity of medicine, the art of medicine versus the science.
The extinction of General Practice and the reign of the Specialist.
Medicine gone too far a warning.
Jennifer Strawson
Runner-up
Patients must be able to trust doctors with their lives

and well-being. To justify that trust, we as a profession
have a duty to maintain a good standard of practice
and care and to show respect for human life.1
I am reading through an old copy of the GMCs Good
Medical Practice. It was published at least fifty years
ago, so unsurprisingly it is a little battered and
bruised. On the front cover is a picture of a geranium.
I seem to recall that all the booklets had different
flowers on them. I never really understood the
significance, apart from the one with the foxglove on
it. Foxglove, less commonly known as Digitalis, was
used to make an old cardiac drug, but we dont use it
anymore. I am just settling down to read it when my
daughter Rosie hurries through the lounge in a suit,
clutching her briefcase under her arm. She is going to
a conference today, so I have offered to babysit.
Offered being a rather loose term.
Why on earth are you reading through that old book
Mum, the GMC must have published that in the Dark
Ages. What have I told you about keeping up to date honestly! Youll be all right with Jessica wont you? Ill
be back at six. Love you, bye!
Hello, little one. I suppose I should introduce myself. My
name is Claire and I am your grandmother.
I am 68 years old and I am a doctor. I used to be
young and pretty, I know, hard to believe it, to look at
me now. I have been working for 44 years and have
another seven years to go. Seven years more service
to The Great British Public. I have promised Nick I will
go on a cruise with him. I cant think of anything
worse, but its the least I can do. Weve been married
for 40 years, but as he likes to remind me, I have
always been married to my job first, him second.
My friends always said I should have gone private like
everyone else, but I wanted to stay loyal to the NHS,
or at least whats left of it. Free health care at the
point of access, thats what Ive always believed in.2
42
The day Michael Henwood became Prime Minister

was, without a doubt, the worst day of my life. I voted
for the Peace Party that General Election. Michael
Henwood, the Anglo-American (English mother,
American father, British passport) who spoke of
patient choice and said in his syrupy Connecticut
voice I dont understand what the problem is with
the opposition. The NHS has had its day. Yes it was
great for the twentieth century, but it is an archaic
institution which must go. Health, like anything else,
is a commodity. Privatisation is the only way to give
the people the best. Competition must prevail, the
monopoly must be quashed. If you only look to the
other Superpowers, the United States, Russia, Japan,
China Even now I cannot stand the man. Everyone
else seems to think the sun shines out of his, well, you
know what. My daughter Rosie, your Mum, says Im
stubborn. She is a doctor too. She likes to remind me
how wonderful health care is now that its gone
private no waiting lists, 24 hour access, no
restrictions on resources, drugs, scans, operations, no
MRSA and no one in hospital corridors dying on
trolleys. Then of course theres the green tea and
comfortable chairs in the waiting room and need I
forget, rooms with plasma screens, ensuite bathrooms
and a monitor that beeps if you fart.
Sorry, I must stop going on, I wouldnt want you to think
that your Granny is an old grouch. There, there, shall I
give you some more milk? Thats better isnt it? Good
girl.
Its not just the privatisation that gets me; its just
that its so different now. I know change is the only
certainty in life, but - oh never mind. Look, theres my
stethoscope in that frame there. A Littman with
burgundy tubing. I can remember spending hours in
Peacocks deciding on the colour, I almost went for
the turquoise, but decided at the last minute that
burgundy was more serious, more professional
looking, much more Carter in ER. (Emergency Room,
an American series that ended in 2006.) Sorry, Im
Jennifer Strawson Runner-up
showing my age, you wont remember that show. I

framed it in protest the day the GMC advised in
Maintaining Good Medical Practice that Given the
advances in imaging technology and its ready
availability, doctors using out of date equipment for
diagnostic purposes, such as the stethoscope, may be
considered negligent. I hardly touch my patients now.
Forget bedside manner, more like scan-side manner.
To put the patient at ease the clinician must always
operate the scan from the right side. Before
commencing, ensure that the patient is adequately
exposed and comfortable within the scanner.
Background music may help to relax those patients
suffering from anxiety or claustrophobia.
Had I known we were to become technicians in the
end, I might have made more of my time on the
wards when I was a junior. It sounds a little strange
but I miss the clinical signs. The wet, deep sea sound
of crackles in the lung bases, the dull percussion note
of fluid beneath skin, a playful tendon reflex in the
knee, an unexpected liver edge pressing on my
fingertips like a tortoises head peeping out of its
shell, peering into an ear and seeing the drum
suddenly, red and angry. I suppose the problem is I
was never really a scientist. I was more of an artist
with an interest in science. I grew up in a time when
medical schools happily accepted students who had A
levels in the arts, sorry UEEs (Universal Entrance
Exams) to you, because they thought medicine was to
a certain extent an art in itself. I even completed a
module in the humanities as part of my degree. A
transient trend in medical education supported by
Calman and Downie who warned against the
impending inhumanity of medicine. What did they
know? If they could see this country now they would
turn in their graves.3,4,5
Im not saying medicine today is bad, its just
different. Your Mum Rosie is a brilliant doctor. She
was always good with computers, anything technical;
she was working the GPS in the car when she was
four. She could touch-type at six. I wish I could say
she gets it from me, but I cant even work the
webcam. And your Daddy is a marvellous surgeon.
Truly amazing what they can do now. Triple heart
bypass in an hour, discharge before teatime. Its the
tiny scopes they use, so fine, so precise..6 Truly
amazing.
computer. You see I work part time for the GP

Database, for a little extra spending money. On 28
March 2028 the friendly GP was driven to extinction
by a computer programme. The powers that be
decided that the only way to ensure the best care
possible for patients was to abolish General Practice
in favour of Specialist health care. So instead of seeing
a GP, patients enter their symptoms onto the GP
Database and the computer calculates which
specialist it would be most appropriate for them to
see. I wouldnt mind, only Id always fancied myself as
a GP. I thought I had the right personal skills, good
communication, empathy and whats more I used to
truly like my patients - even the annoying ones.7,8,9
Work has been more stressful than usual this week.
Ive been moved to the Customer Services Complaints
department. Despite the very small writing in the
conditions of contract stating that the company will
not be held responsible for any breach in
confidentiality or the loss of security of personal
information that may arise through the use of this
database, the public will continue to complain.10,11
Shall we go and see your Uncle Tom later? Hey, would
you like that?
Toms been on the Intensive Care Unit on Warton
Road for three months now. He got meningitis out of
the blue in February. Its a marvellous health centre
with 200 beds which deal solely with critical care
patients. There are quite a few of them around the
country now; London, Sheffield, Newcastle. I
remember the time you were lucky if your hospital
had four ITU beds, let alone 200 of them. Forty years
ago he would certainly have died, I know he still
might, but with the new inotropes theyre using and
the imported Japanese ventilators, the doctors are
hopeful. I am more than hopeful, hes my only son,
my blue-eyed boy. Maybe I shouldnt take you, its a
bit, how can I put it, eerie in there. Theres just
something unnerving about the row upon row of
beds, all the wires and tubes, the screens and the
constant hum of machines. Its like one big physiology
laboratory filled with human rats lying in bed. In
Toms ward theyre mostly young men. Car crashes,
nuclear plant accidents, AIDS, Atlantic flu. Men that
might have died or some might say, should have
died.12,13
There, there, please dont cry little baby, there, there.
Youre getting grumpy now, arent you? Yes you are, yes
you are. (tickle, tickle)
Ive been getting these terrible headaches recently.

Nick thinks its all that time spent in front of the
To think your Mummy even thought about not

keeping you. We had some horrible arguments. I
43
Jennifer Strawson Runner-up
remember her saying without a trace of

understanding I know it sounds ridiculous, but I just
always wanted a boy, thats all. Of course it would be
different if I were having two, but John and I have
decided on just the one with my career and
everything, so I just want it to be perfect. I think that
is the only time I have been truly disappointed in her.
In fact Ill go as far as saying I was disgusted. I dont
care if everyone else is doing it, I told her. Maybe I
was unfair; maybe I am just an old fuddy-duddy with
outdated values. Well she didnt have the termination,
but she still went ahead with the genome testing
despite my insistence.14 Its my duty as a good
parent, she said. If I dont know what diseases shes
at risk of how can I possibly protect her from them?I
tried telling her about the misery of living under a
Damocles sword (Damocles in the Greek legend was
seated under a sword that was suspended from the
ceiling by a single hair) but she stared back at me
blankly, with her high IQ, scientists blue eyes. She
cried when the results came through. She didnt speak
to me for a week.
Where was I? Ah, yes, here we are. Patients must be
able to trust doctors with their lives and well-being.
To justify that trust, we as a profession have a duty to
maintain a good standard of practice and care and to
show respect for human life. Oh dear, the letters
have faded terribly, what does that say? Make the
care of your patient your, your oh, what does it
matter anyway.15,16,17,18,19
There, there, little one, dont cry.
References
1 Good Medical Practice, General Medical Council,
www.gmc-uk.org
2 Department of Health website, http://www.dh.gov.uk
3 Calman, K. Downie, R. Why arts courses for medical
curricula, The Lancet, volume 347(9014)June
1,1996:1499-1500.
4 Morris: Humanities in medicine, The Lancet, volume
354(9190) November 6, 1999:1651
5 Greenhalgh, T. Narrative based medicine, BMJ, volume
318(7179) January 30, 1999:323-325
6 Lomanto et al, Robotically assisted laparoscopic
cholecystectomy: A pilot study, Arch Surg, 2001, 136:
1106-1108
44
7 Franks P, Gatekeeping revisited protecting patients from

over treatment, N Engl J Med, 1992, 327: 424-429
8 Marshall M, How well do GPs and hospital specialists
work together? A qualitative study of co-operation and
conflict within the medical profession. Br J Gen Prac,
1998, 48: 1379-82
9 Chen-Tan Lin et al, Reasons for referral in GatekeeperModel Managed Care Plan, The American Journal of
Managed Care, June 2000, 670-678
10 Confidentiality: Protecting and Providing Information,
General Medical Council, www.gmc-uk.org
11 Data Protection Act, http://www.medicalprotection.org
12 Deciding for Others: The ethics of surrogate decisionmaking, Buchanan &Brock, Cambridge University Press,
1989, Ch 5.
13 Ethics: The Heart of Health Care. David Seedhouse. John
Wiley, Oxford University Press, 1988, 25-30.
14 Richards, T. Three views of genetics: the enthusiast, the
visionary and the sceptic. BMJ 2001, 322: 1016
15 Maintaining Good Medical Practice, General Medical
Council, www.gmc-uk.org
16 The New Doctor, recommendations on general clinical
training, Jan 2005, http://www.gmcuk.org/med_ed/newdoc.htm
17 Carlos A Rizo et al, Whats a good doctor and how do you
make one? BMJ, Sep 2002, vol 325: 711-716
18 Ashcroft R E, Searching for the good doctor, BMJ, Sept
2002, vol 325: 719
19 Paice et al, How important are good role models in
making good doctors? BMJ, Sept 2002, vol 325: 707-710
45

The growing amount of medical information to be found online and the education of the public as part of
the doctors role.
An example of technology to be used in the future, how doctors may have to adapt, and a brief look at the
role doctors will have to play in Genetic Counselling.
The growing culture nutritional therapy and of alternative medicine and what will be expected of doctors.
Describing the effects of an ageing population on the doctors workload and role in their care.
Final word: The core values expected by the public.
Nathalie Turpin
Runner-up
In 1900, William Osler, Regius Professor of Medicine

at Oxford, gave a description of what is expected of a
doctor. He noted that it was to acquire in the art of
diagnosis, which must everywhere precede the
rational treatment of disease, to grow in clinical
judgement, appreciate the relative value of symptoms
and the physical signs and in giving a prognosis,
conduct the treatment so that the patient may be
restored to health, or failing that, be given the
greatest possible measure of relief. 1
Are doctors to always concern themselves primarily
with diagnosis and treatment? Or will future public
expectations push doctors to assume roles that
concern more preventative and holistic approaches?
Although medicine will undoubtedly advance over the
years; will the overall expectation of doctors change
at all? In this text, Ive selected a small number of
themes to illustrate what the future may hold for
doctors, and subsequently what will be expected of
them.
MONDAY: Morning surgery: 40-year-old woman
comes with a list of websites shed found on a
Google search. She was looking at the weight-loss
drug, Sibutramine. The evidence and efficacy of the
drug was studied on www.patient.co.uk 2.
More than 100,000 medical websites now exist3 and
that number is set to rise due to the publics growing
interest in their own health. The massive consumer
demand for online health resources must be taken
advantage of as it gives rise to multiple benefits.
Being able to access medical information allows the
patient to understand further about their condition;
and in understanding their condition, there may be
greater motivation to stick with treatment. Public
Health doctors have already realised that if they
promote health on the internet appropriately, the
young people of the future may become as skilled in
healthy living as they are in web-use 4.
But are patients able to assimilate online health
46
information appropriately even if they visit

recommended resources? Doctors of the future must
be able to critically appraise new information and
stay abreast of current areas of research in order to
maintain a high standard of caring for their patients.
MONDAY: Afternoon teaching at secondary school:
A new government initiative a few years ago was
the introduction of Basic Medical Learning.
To complement increasing public interest in health
issues and the increasing wealth of information at
their fingertips, it would make sense to equip people
with a basic understanding of medicine and disease.
With the government promising a more patient-led
NHS in a bid to win voters, patient expectations may
rise much faster than the ability of the NHS to
deliver5. Clearly it is always necessary to improve the
provision of health care, but perhaps a way of doing
this is through basic medical education. Educated
patients are more likely to know how to care for
themselves and their families. They are more likely to
make responsible use of health service and to get
more benefit from any treatments they undergo6. All
doctors of the future should be expected to take part
in educating society about disease and preventative
medicine.
TUESDAY: Morning surgery: A COPD sufferer is at
home post discharge from hospital. He is 70 years
old and finds it difficult to get to the surgery. The
Wireless Health Outcomes Monitoring System
(WHOMS)7, allows doctors to send short
questionnaires to patients mobile phones which
they can complete and send back to the doctor.
Information received is displayed on a secure web
page on the internet.
Remote monitoring of patients has already been used
in the case of people becoming ill whilst on board an
aircraft; sending the ECG recordings via satellite to a
physician on the ground. There is scope for medical
sensor technology which includes implantable heart
Nathalie Turpin Runner-up
monitors that can transmit data from the patient at

home over the internet to the physicians offices 8.
Doctors may be expected to monitor patients
remotely through remote sensors recording vital signs
recorded onto a computer. If these reach certain predetermined levels the doctor will be expected to
reach the patient quickly. The need for doctors to
understand the early warning signs of critically ill
patients are paramount. The potential risks of medical
technology are not yet fully known and the
acceptance of such technologies will rely also on
public opinion9. Doctors in the future will be expected
to become technologically literate and more reliant
on computers, but be able to keep their patientspecific knowledge.
TUESDAY: Afternoon genetics training session: All
GPs now undertake basic genetics training in
diagnosis and counselling to cut down on waiting
times to see the clinical geneticist at the local
hospital.
Much has been written about the human genome
project and its potential effects on medicine10. Its
completion in 200311 and further genetics research
will hopefully lead to the identification of many genes
that are responsible for disease. The discovery of
several genes that underlie certain familial cancers
has already led to increased referrals to clinical
geneticists 12. The likely increase in the availability of
DNA based tests and demand for genetics testing
means that all doctors will need to become
genetically literate12. Clinical geneticists may not be
able to cope with the increase in demand for their
services, so all branches of medicine, particularly
primary care, may be required to give advice. Gene
technology is still far in the future but it inspires
ethical questions: Will couples be able to select their
baby based on their height or intelligence? Will
people be refused life insurance or employment due
to their genes?13 Doctors of the future must be
adequately trained in the ethical issues of medical
technology and will need to be prepared to adopt
new responsibilities12.
WEDNESDAY: Morning surgery: Complementary
therapy: 35-year-old female comes to an
acupuncture session for alleviation of her chronic
headaches. In addition to her treatment, other
alternative treatments such as cranial sacral
therapy and meditation are discussed.
Patients are increasingly using complementary and
alternative medicine14. This has made an impact on
47
conventional medical practice with around 40% of

general practitioners providing access to such
therapies for their NHS patients14. Five NHS
homeopathic hospitals now exist and the British
Medical Acupuncturist Society has over 2000
members who incorporate acupuncture into their
normal medical practice14.
But to advise patients about alternative therapies,
doctors of the future will be expected to understand
their basis as well as their possible benefits and
limitations. Patients will expect doctors of the future
to think beyond what research trials reveal and to
appreciate that for some individuals, these therapies
provide an alternative form of treatment and relief.
The evidence for the efficacy of such treatments may
be anecdotal, but this does not mean that it is any
less important.
WEDNESDAY: Afternoon surgery: Patients
increasingly want advice on their diet. Eg oily fish
for their arthritis15, vitamin E supplements for their
hypothyroidism16.
2500 years ago, Hippocrates said to his students, "Let
thy food be thy medicine and thy medicine be thy
food"17. The public is becoming more aware about
what they put into their bodies and there is a
minefield of nutritional information to sift through.
Consequently it may be the free NHS doctor and not
the costly private dietician that has to give advice.
However, there is little training in nutrition at medical
schools; so a doctor is unlikely to be sufficiently
informed to advise about optimum nutrition 17.
Doctors of the future may need to give nutritional
advice about the diet in specific diseases as well as
giving basic nutritional advice for lowering blood
pressure, cholesterol etc. Some doctors may find it
hard to preach what they do not do themselves and
because there is limited evidence that supports the
benefits of dietary change in disease. However,
doctors of the future must be prepared to accept that
the evidence for nutritional therapy may become
strong with more money being poured into its
research. As one well respected physician said:If the
doctors of today don't become nutritionists, the
nutritionists will become the doctors of tomorrow17.
THURSDAY: Day spent at the Institution of Long
Lifes. All the clients there are over 90 years old.
Many of them are well and need advice about how
to stay well in old age. Some of them have much
co-morbidity.
In 1901, the average life expectancy was 47 years. In

2000, that rose to 77 years18. What will it be in the
third millennium? Some researchers claim that we are
programmed with a life expectancy of 120 years, and
people are becoming more aware that living longer is
almost a certainty. Many however do not want to live
into old age without a good quality of life. They will
look to the doctor, a professional of the human body,
to help them attain this.
Preventative Gerontology is the study and practice
of those elements of lifestyle, environment and
health care management that will provide the
maximal longevity of the highest quality for
individuals and the population19. This is a discipline
that public health doctors today might have a role in.
However, it is important that doctors of the future
must become well versed in the art of preventative
medicine, not only to prevent disease, but to sustain a
long, full and happy life. They must become even
more aware of the impact that nutrition, exercise and
the avoidance of toxic substances has on the body;
and set themselves as role models for the public.
On the other hand, in living longer, people may find
themselves suffering with numerous co-morbidities.
Doctors must be aware that patients may develop
significant illness that would have previously been
avoided by death occurring earlier. Even though
doctors appear to be moving towards being specialists
and super-specialists, we must not forget that there
will always be a need for generalists and it will be
expected that all doctors of the future will be able to
understand a wide variety of ailments and take into
account a more holistic view of the patient.
FRIDAY: All day surgery: Visit in the afternoon to
see a patient with a terminal illness. Spend an hour
liaising with palliative care team and listened to
family concerns and anguish.
There will be many medical advances to enjoy in the
future, but it is important to realise that there are
many core values that will stay the same, and will
always be. Human beings will always need to be
loved, needed and cared for. When they are ill, they
will expect compassionate, sensitive and responsible
professionals to treat them with the dignity, empathy
and respect they deserve.
48
Conclusion
Trusted professionals will be in even greater demand
in a rapidly changing and confusing world20. With the
promise of new technology and greater advances in
our knowledge of disease, comes the hope of cure.
Doctors of the future must be careful not to promise
too much too soon and be sensitive to those that
have no chance of being cured.
Doctors of the future may find themselves in a
strange situation. On one hand, there will obviously
be advances in medical technology and therefore,
they will be expected to have knowledge of them and
be able to counsel the public on the various ethical
issues that arise. On the other hand, the public is
increasingly looking to more natural ways of living
with disease and therefore doctors will be expected to
have knowledge of the more simple and alternative
measures which may not be evidence-based. People
of the future may embrace technology
wholeheartedly or shun it in favour of holistic
alternatives with an emphasis on quality of life and
individuality. Doctors will need to be versed on both
opinions to treat both sets of patients.
The overall expectation of a doctor may not change
significantly at all. The public will always wish for a
doctor to take overall responsibility, be professional
and be empathic. And part of being a doctor is
keeping their skills and knowledge up to date in an
ever-evolving world. What they will become
competent in is for the future to decide.
References
1
Van Der Weyden, M.www.mja.com.au/public/issues/

179_02_210703/martin_21070
2 www.patient.co.uk/showdoc/22
3 Eysenbach, G. Diepgen, T. Shopping around the internet
today and tomorrow; towards the millennium of
cybermedicine. British Medical Journal, November 1999.
319:1-5.
4 Wilcox, L. Revolution: Preventing Chronic Disease Public
Health Research, Practice and Policy, October 2004.1:4.
5 Smith, R. The NHS: Possibilities for the endgame Think
more about reducing expectations. The British Medical
Journal, January, 1999. 318:209-210
6 Neuberger, J. The educated patient, new challenges for
the medical profession. (Review). Journal of Internal
Medicine. 2000. 247:6-10
7 Bielli, E. Carminati, F et al. A wireless health outcomes

monitoring system (WHOMS): development and field
testing with cancer patients using mobile phones. BMC
Medical Informatics and Decision Making, June 2004. 4:7
8 The Advisory Board Company Implantable Device to
Monitor Heart Patients. I Health Beat. March, 2004.
9 Hackney, E and Clark, S. The Applications and Future of
Nanotechnology in Medicine. Based upon
Nanotechnology, a hard pill to swallow. www.isis.org.uk/nanotechnology, 2004
10 Coulter, I. Genomic Medicine: the sorcerers new broom.
West Journal of Medicine, 2001. 175: 424-426
11 Valle, D. Genetics, Individuality and Medicine in the 21st
Century. American Journal of Human Genetics, 2004.
74:374-381
12 Emery, J and Hayflick, S. The challenge of integrating
genetic medicine into primary care. British Medical
Journal, April 2001. 322:1027-1030
13 Website: http://www.globalchange.com/medicine3.htm
The Future of Health Care
14 Owen, D. Lewith, G and Stephens, C. Can doctors
respond to patients increasing interest in
complementary and alternative medicine? British
Medical Journal, January 2001. 322:154-157
15 www.besttreaments.co.uk/btuk/conditions/14185.html
16 www.internethealthlibrary.com/healthproblems/hypothyroidism
17 www.trans4mind.com/nutrition/medicine
18 Sanders, R. Medical Technology: A Critical Perspective.
The Internet Journal of Medical Technology. 2004. 2:1
19 Hazzard, W. Ways to make Usual and Successful
Ageing Synonymous. West Journal Medicine, 1997.
Volume 167:206-215
20 www.globalchange.com/medicine2.htm New Medicine
for Designer People.
49
General Medical Council Offices

London
Regents Place, 350 Euston Road, London NW1 3JN
Manchester
St Jamess buildings, 79 Oxford Street, Manchester M1 6FQ
Scotland
5th Floor, The Tun, 4 Jacksons Entry, Holyrood Road, Edinburgh EH8 8PJ
Wales
Regus House, Falcon Drive, Cardiff Bay, CF10 4RU
Northern Ireland
20 Adelaide Street, Belfast BT2 8GB
Tel: 0845 357 8001

Fax: 0845 357 9001
Website: www.gmc-uk.org

Doctors of The Future - PDF 25397472 PDF

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Doctors of The Future - PDF 25397472 PDF

Uploaded by

Copyright:

Available Formats

Winning essays by doctors

of the future on what

16- to 18-year-olds category:

Medical students category:

Doctors of the future

What will the role of doctors be in 2050?

Doctors of the future

16- to 18-year-olds category

What will the role of doctors be in 2050?

An article published on 12 February

Professor M Valhalla, Senior ANI Consultant,

issues that the hospital faces3. Since the introduction

Doctors of the future

16- to 18-year-olds category

Myura Nagendran First prize winner

curriculum time to exercise and fitness. Obesity is

the patient. In the event that a diagnosis does not

Doctors of the future

16- to 18-year-olds category

Myura Nagendran First prize winner

about as technological as it seems possible without

Doctors of the future

16- to 18-year-olds category

Myura Nagendran First prize winner

10 Nanotechnology: Small science, big deal. Tony

26 UK surgeons report that EU directive has cut training time

11 Effect of reducing ambulance response times on deaths

27 Surgeons in England lobby Prime minister on working

28 Website Transcript of Presidents of RCSEngs Letter to

13 Teenagers face health timebomb. Danny Penman

29 Website New Consultant Contract as a result of EWTD

14 Development of a collaborative model to improve school

30Website Frequently Asked Questions on the da Vinci

32 Minimally Invasive Surgery: Future developments. J E A

16 Website Modernising Medical Careers The Next Steps

33 Recent advances in minimal access surgery. Ara Darzi,

17 Waiting times for breast cancer tests have risen in past

34 Science, medicine, and the future: Virtual reality in

18 Website Electronic Patient Records Project

35 Website Worlds First Telesurgery from New York to

Doctors of the future

16- to 18-year-olds category

What will the role of doctors be in 2050?

to 45 billion in 1998 - an increase of 21.5 billion.

Doctors of the future

16- to 18-year-olds category

Rosanne Ching Runner-up

Doctors of the future

16- to 18-year-olds category

What will the role of doctors be in 2050?

patients during the night. Nurses, these days, quite

Doctors of the future

16- to 18-year-olds category

Alexa Dean Runner-up

hospital could immediately do, but offered her the

death of her mother. However, it was pointed out that

Doctors of the future

16- to 18-year-olds category

What will the role of doctors be in 2050?

Fast forward fifty years, to a time where the entire

with polluting chemicals, one of the biggest dangers