I've been abroad for a good while and recently returned to the UK and the NHS. Since I have returned I've had this nagging feeling about the state of the medical profession.

Medical students now spend (it seems) most of their time learning communication skills, and precious little learning about disease and how to treat it. On those occasions where they are taught something clinical, they are frequently now taught by nurses who tell them pink venflons are the only size you ever need, and that plain syringes are not licensed for the sampling of blood.

Instead of assessing these students by looking at their skills or aptitudes, we now ensure they are unfailingly culturally sensitive, and promote patient choice above all.

Junior doctors will have much of their freedom of choice of (1) specialty and (2) region taken from them by the MMC system, which will force many hundreds of them into second and third choices. They will be be denied any chance to see a little wider than their own, narrow conveyor belts which will take our brightest and keenest young people, suck out their autonomy, their enthusiasm, and their professionalism, and spit them out with morale all but gone.

Consultants are already in the situation of applying to be allowed to pay to park in their own hospital. This pedestal of professionalism has been systematically eroded until consultants are nothing other than simply employees, told when to turn up, when to go home, and what (exactly) to do in between. If one of them raises his voice about failures of the system, he is simply dismissed from his post.

Patients who get ill out of hours phone a helpline, staffed by a nurse who cannot see the patient, but can discern enough over the telephone to cancel an ambulance if the situation doesn't seem serious enough.

Hospitals are forced to cook their books to make their waiting lists seem shorter, when the truth is that many patients are now waiting longer than ever, reclassified meanwhile as treated or not requiring treatment.

Our own representative bodies are both toothless and spineless, and capitulate to every government whim dreamed up to put spin and polish on the declining state of the health service.

Where is the sliver of hope? The ray of light? Nowhere to be seen.

I can't put my feelings on this any better than this, John Donne's famous lines:

"If a clod be washed away by the sea, Europe is the less, as well as if a promontory were, as well as if a manor of thy friend's or of thine own were: any man's death diminishes me, because I am involved in mankind, and therefore never send to know for whom the bell tolls; it tolls for thee."

(19/8/06)