Much recent discussion around healthcare has been focused on the NHS reforms and the scandal at Mid Staffordshire NHS Foundation Trust, where hundreds of patients were found to have died needlessly. But do the medical profession’s problems run deeper than this? Many technical changes to the way medicine works, from shorter working hours and altered training structures to revalidation and increasingly protocol and guideline driven practice, have altered medicine’s day to day working in recent years. Meanwhile, patients increasingly relate to NHS trusts rather than traditional GP practices. But is the professional ethos of medicine in crisis too? Do doctors still enjoy the automatic respect they once did? And if things are changing, is it for better or worse?

Some argue target culture and the increasing commercialisation of healthcare have overwhelmed the clinical judgement and scientific knowledge that make medicine a true profession. Others insist the changes the profession is undergoing are a long-overdue overturning of unearned social deference, with increasing patient autonomy and involvement. At the same time, however, medicine seems to command greater respect as a source of moral authority, with public health campaigns citing medical research to persuade us to eat healthily, not to smoke or engage in other risky behaviour. There is little sign of the end of deference or patient power when medical staff insist patients divulge how much they drink, or when representatives of the British Medical Association appear on television to lecture us on our lifestyles. So has professional trust in fact been supplanted by medical authoritarianism? Is professionalism a ‘conspiracy against the laity’ or does it represent something worth defending? Has medicine become just another job? And what kind of relationship should we expect to have with those charged with looking after our health?