Medical politics in the first six months of 1983 was a heady revolutionary experience with a sense of great change in the air. The British Medical Association (BMA) and the National Council for Civil Liberties were locked in battle with a Tory government over the Police and Criminal Evidence Bill. A scientific report by the BMA Board of Science was described by Tory Ministers as ‘CND propaganda’ and the BMA responded by describing government civil-defence plans as ridiculous, calling on all doctors to publicise the facts about civil defence and the consequences of nuclear war and for the teaching of medical students on the subject. The junior doctors’ conference declared unemployment to be a health hazard, called for a freeze on nuclear weapons and rejected a unilateralist motion by only a narrow majority. The BMA Annual Representative Meeting (ARM) closed with a debate on a motion (overwhelmingly carried) to legalise abortion in Northern Ireland. In this debate a speaker declared that doctors in Northern Ireland would continue deliberately to break the law, and was enthusiastically applauded.
OR
Medical politics in the first six months of 1983 was a depressing example of a reactionary profession sinking deeper into the mire of its own right-wing ideas. Most depressing of all was the ARM debate on overseas doctors which rarely rose above the disgracefully xenophobic level of ‘The wogs are taking our jobs,’ and ended up calling for repatriation. The same ARM decided overwhelmingly to take ‘no political stance’ on nuclear war. The BMA smothered its criticisms of the government during the General Election campaign to let its political friends get on with the job of winning the election so that they could attack the Health Service from a new position of strength. So determined was the BMA to help the Tories that it even censored reports of one of its committees so that news of dissension about civil defence would be hidden until after the election.
OR
Medical politics in the first six months of 1983 was much the same as it has always been. The intricate democratic machinery of the profession continued to grind out its eternal depoliticised message. All four floors of BMA House continued to monitor every aspect of British public life ever vigilant for any threat to a beleaguered profession from the hordes of enemies which surround and beset it. A few skirmishes took place over the status of a few sections of the profession but were resolved over sherry. Overseas doctors had to be put in their place a bit: we came up with a fair compromise in the end, which was that we’d treat them better whilst they were here so long as they went home again afterwards. The Board of Science came up with this absolutely excellent scientific report about nuclear war which caused a bit of a stir when it was published. We had to fight a bit over a threat to confidentiality in the Police and Criminal Evidence Bill – these confidentiality issues do keep coming up, I don’t know why laymen don’t learn that we just won’t let them get away with interfering in the doctor/patient relationship. What with that coming at the same time as the nuclear war report, and the General Election as well, the press were onto us a bit more than usual and it all went to a few people’s heads, but really nothing exciting happened. It certainly wasn’t as exciting as 1982. Now THAT was an exciting year, what with community health doctors pushing themselves up the status ladder a few points and giving the GMSC a bloody nose, and John Marks having to do some nifty footwork to defuse the women doctors issue, and the LMC conference almost agreeing to prescribe condoms. No, there wasn’t anything exciting like that in 1983.
If the labour movement is ever to cure itself of its misunderstandings of medicine it must begin by understanding the medical profession.
If it did, it would understand why all three of the above accounts of medical politics in the first six months of 1983 are true. It would indeed understand that the events described above were entirely predictable and consistent with the history, traditions and mythology of the medical profession. It is only from a political perspective that they seem contradictory, and that has never been the perspective from which the medical profession has viewed its politics.
The labour movement is frightened of doctors. It sees them as monolithic, powerful and hostile and repeatedly trims its health policies to what it sees as their sticking points. When progressive ideas float out of BMA House it hails them as the dawn of a new era, only to be bitterly disappointed when this turns out not to be the case.
Progressive ideas have frequently emerged from BMA House. In 1930 the BMA voted overwhelmingly in favour of a National Health Service run by county and county borough councils. The conflict over the Police and Criminal Evidence Bill had its predecessors in other such conflicts with the police over confidentiality. In the 1940s the BMA fought for the bringing of industrial-health services into the NHS. In the 1970s it campaigned vigorously for legislation on seat belts. It has campaigned actively and persistently against the tobacco industry and for the banning of boxing.
Yet none of these decisions actually represented the start of a shift to the left, and each coincided with the adoption of reactionary positions on other issues. The progressive ideas actually represented progressive strands that have always been present in the thinking of the medical profession, and have always coincided with other strands of thought that could be characterised as reactionary.
Qualifications for Authorship
My qualifications for writing about the relationships between the medical profession and the labour movement are that I have been active in both medical politics and the trade union movement since I qualified as a doctor in 1974. I have been the National Co-ordinator of the Medical Practitioners’ Union (the doctors’ section of ASTMS) and the MPU observer on the ASTMS National Executive, a member of the Negotiating Sub-Committee of the Central Committee for Community Medicine and Community Health, chair of the Junior Members’ Forum of the British Medical Association and a member of BMA council.
Meaning of Terms
I am using the term ‘the labour movement’ in its traditional sense of the Labour Party and other left parties together with the trade unions and co-operative movement. In recent years, however, especially amongst the libertarian left, there has arisen the tendency to attach equal importance to the autonomous social movements – the women’s, peace and environmental movements, community organisations, tenants’ groups and so on. I have embraced these groups within the scope of this book as if they were part of the labour movement, although they do not see themselves in that light. However if there is a common thread which links the three traditional components of the labour movement, it is that they all assert, in their different ways, that people matter more than the system and promote the interests of the people. That belief has always existed beyond the traditional labour movement, and today is present in a peace group, a women’s group or a work-hazards group, just as it is in a trade union branch.
I am using the word ‘Medicine’ to refer to the medical profession as an institution, embodying its organisations, traditions and structures.
Reasons for Writing
I am writing this book for a number of reasons.
First of all, because the various components of the labour movement misunderstand the medical profession and as a result fail to address themselves properly to the conflicts which exist or to the alliances which can be made. As a result the movement’s capacity to influence health and health care is diminished.
Secondly, I hope that this book may make a contribution to the analysis of professionalism by the left. This has been neglected in the past, and it is important that the left begin to explore its ideas about the professions, for the profession/ client relationship plays an important part in sustaining our technocratic society.
The traditional view on the left has been that the eradication of the exploitation of labour by capital will remove oppression. The reality of continuing inequalities and new forms of oppression in the countries of ‘actually existing socialism’ in the East and the experience of authoritarian and paternalistic systems of social democracy in the West ought to have laid that view to rest. The Russian Revolution left intact the patriarchal relationship between men and women, the supremacy of economic over non-economic values and the dominant relationship of professional workers over their clients. In Britain, meanwhile, the Welfare State has increasingly come to be seen as remote, hierarchical and unresponsive to popular demands. It is as a result of these historical experiences that many-on the British left now attach considerable importance to decentralised forms of socialism, to democratic accountability and to the empowerment of clients and communities in their dealings with experts. It is absurd that such an emphasis should now be placed on that element of socialism with so little in the way of supporting analysis of professionalism. I do not pretend to offer an analysis of professionalism. I do claim to offer a description of one profession and its relationships to progressive forces which I hope may contribute to the discussion out of which a political analysis of professionalism might emerge.
Thirdly, this book is for the left in medicine, which needs to understand its relationship to the rest of the profession and to the rest of the left if it is to be effective.
Fourthly, I write this book for medical historians and sociologists, for there are tensions in medicine which have been little discussed. The tendency to analyse the medical profession as if it were monolithic is a tendency that must be overcome if it is to be understood.
Finally, I write for that wide range of doctors who are committed to progressive attitudes to health and health care, but who do not view those attitudes in political terms. There are many such doctors. For various reasons their views are neglected by the medico-political system, and they have difficulty finding a voice because of their reluctance to become ‘politically’ active or to ‘divide the profession’. It is important that they should understand exactly how the system neglects them and how their existing attitudes permit it to do so.
An Apology
It is inevitable that a book aimed at such diverse audiences will not be completely satisfactory to any one of them. Although much of the book’s argument is supported by conventional academic evidence, this is augmented by statements drawn from my own experiences over ten years as a doctor active both in labour movement and medical politics. I have sought to avoid speculative statements or statements which I could not defend in argument, but it would be tedious to the reader, and dangerous to my publisher’s libel insurer, to report every incident or conversation which has led me to draw certain conclusions about my profession. I suspect that the more academic sections of my readership will find it unsatisfying that blocks of argument are supported only by statements based upon unstructured observation of personal experience. On the other hand there are probably other sections of the readership, less respectful of academic rigour, who might have wished I had been less cautious in use of personal experience.
For my failure to resolve this particular conflict, and the other conflicts that result from writing for a diverse audience, and for the book’s other faults, I take full responsibility.