Diseases of the alimentary system. View from general practice.

159 It has to be accepted, therefore, that within the profession there can be conflicting views and actions that are equally valid in ethical terms; and, therefore, that ethical considerations alone will not provide the answers to all of the problems that the profession has to face in its relations with the State as a near-monopoly employer of doctors. This makes it doubly important for both sides to avoid causes of conflict to a point at which some withdrawal of services becomes the only remedy for doctors to preserve their professional standards and protect the long-term interests of their patients. Government has a special responsibility not to create such conflict by pursuing purely political ends. The profession has a special responsibility not to create such conflict purely to further the advantage of its own members. If both sides were to accept these principles the relationship between the profession and the State (and perhaps between other professions and the State) would become clearer and more manageable. Conclusions (1) In a national health service, while the ethical responsibility of a doctor to his individual patient remains unchanged, the ethical responsibility of the medical profession itself to the community becomes part of a joint responsibility shared by Government and the profession. If there were some joint announcement of the acceptance of this principle by Government and the profession it would be to the advantage of all. (2) Both parties should admit that the machinery of consultation now available does not effectively minimise the possibility of confrontation between Government and profession, nor effectively and speedily resolve confrontation when it occurs. (3) It follows that both parties should admit that the responsibility to the community is not being discharged and cannot be discharged unless some more effective machinery of conciliation is introduced. (4) It is a matter of urgency that discussions between the Government and the medical profession shall start in order to decide how best such machinery can be introduced. In general practice alimentary diseases form the smallest proportion of diseases of the major systems that can be classified in traditional hospital terms, but the largest proportion (nearly one-third) of those handled on a symptomatic basis. The recent national study of morbidity seen in general practice' recorded only some 4%,, of all episodes of illness as caused by classifiable disorders of the system, with a further 4% of episodes grouped under the category of …