Posted by: Witch Doctor | October 27, 2007

Tooke Report – Richard Smith comments in JRSM



Richard Smith is a former editor of the BMJ.

He is executive director of the Ovations initiative to counter chronic disease in the developing world.

He is a visiting professor at the London School of Tropical Medicine.

He is a member of the governing council of St George’s, Universty of London.

He is chief executive of the UK subsidiary of the US health corporation United Health.


The Royal Society of Medicine is an independent organisation founded in 1805. It promotes the exchange of knowledge, information and ideas in medical science and continued improvement in human health.


Dr Richard Smith wrote an editorial in the November edition of The Journal of The Royal Society of Medicine.


For those who are shy about clicking the above here are some extracts to whet your appetite:

Sir John Tooke and his panel who have been inquiring into Modernising Medical Careers (MMC) are like a team who arrive at the scene of a terrible air crash.1 There are bodies, blood, and wreckage everywhere, and the air is filled with rumour, speculation, and blame. How did this awful thing happen and who is at fault?”…………

“Instead, we have a plethora of self-interested, ineffective, squabbling bodies. My hope is that out of the wreckage of MMC and MTAS will come the leadership that British medicine desperately needs.”………..

“The report quickly dismisses the idea that the disaster was all the fault of the government. It describes the Byzantine advisory structures and makes clear that many medical bodies were involved. Sir John’s panel even examined the attendance of representatives of the bodies and shows that they were present when poor decisions were made: ‘The question of selection into specialty training was discussed 17 times between 2004 and 2007 in at least three different MMC bodies.”……….

“Because doctors lacked a body capable of analysing the environment and setting a strategy for the whole profession, doctors were overwhelmed by a ‘blitzkrieg from the right’ at the end of the 1980s. To regain their influence, doctors needed a top body concerned primarily with strategic and high political matters. Otherwise, warned Sir Maurice, ‘the profession will never be able to punch its weight.’”………

“Medical organizations have been reluctant to surrender power and independence, but none of the existing organizations is up to the task—as the MTAS disaster illustrates.”……….

“The royal colleges and specialist societies are like Italy before the Risorgimento, a gallimaufry of city states with limited interests and clout, many of which are politically naive, poor, and incapable of strategic thought”……….

“The Academy of Royal Colleges is dysfunctional”……….

“The Postgraduate Medical Education and Training Board seems to have been almost stillborn and is recommended by Sir John’s panel to be swiftly merged with the GMC. So, as the cliché has it, medicine has lots of leaders but no leadership.”…….

“So will the obvious now happen? Will a high level, effective body be formed? Three elements are needed for change: a burning platform (‘we can’t go on like this or let this happen again’); a vision of what would be better; and clarity on who will do what tomorrow. We certainly have the burning platform, although complacency can break out at any moment in the medical profession. Sir Maurice provided a hasty sketch of what a better organization might look like, and surely Sir John and his panel can in their subsequent work strengthen the vision and provide next steps. Then, as is so often the case in human affairs, disaster will provide the catalyst to something long overdue and very valuable”…………

Strong stuff.

Eh, My Black Cat?………..

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