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Time for a new vision of doctoring


A hundred or more years ago, a doctor was a gentleman with warm hands, a smart suit, a whiff of philosophy and limited therapeutic powers. He — they were almost all male then — could hack off gangrenous limbs and set bones, although with pills “little less mischievous than the shots from revolvers”,1 he probably killed more than he saved; but he was well paid for his trouble. As the American anaesthetist and political philosopher (what a combination) Ronald W Dworkin writes in an essay, Re-imagining the doctor, a debate arose a century ago about what distinguished doctors from other caregivers and how many were needed.1 The same debate arises today, as there are calls across the world for more doctors, while others are arguing that doctors can be largely replaced by a mix of nurses, community health workers, robots and computers. Dworkin argues that what we need is not more doctors but “an altogether new vision of doctoring”. He’s right.

Dworkin thinks that present-day doctors are a mix of four types of doctor who emerged in the 19th century — the gentleman, the technician, the benefactor and the scientist.

The gentleman doctor, still present today, is “regularly bred” and of “steady character”. He is an artist, not a scientist, and recognises that “the human condition is too…