Abstract Although there are records of medicine as early


The profession of medicine is
an ever evolving one. With developments in technology and medical science,
along with continuously changing professional guidelines set by regulatory
bodies such as GMC (General Medical Council) and CQC (Care Quality Commission),
the professional role of the doctor has changed drastically in recent years.
But these technological and professional changes, alongside other factors, have
contributed to a change in the doctor’s role in society. This literature review
aims to address some of the main concepts related to what the position of the
doctor currently is in UK society, how this differs between different societies
and how their societal role has changed throughout history, as well as how the
attitudes and values of a doctor can have an impact on the health of their patients.
This will be achieved by a systematic review of research and data surrounding
the subject.

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The historical changes in the role of the

Although there are records of
medicine as early as the time of the ancient Egyptians, it wasn’t until the opening
of early medical schools in Western Europe in the 14th Century that medical
science really had the means to advance through sound scientific research.
During this time period, however, ‘Any views different from the established Catholic
Church view could veer towards heresy with the punishments that entailed.’ This
led to a somewhat standstill in medical advancements due to the associated dangers
within society at this time. As such, scientific knowledge/diagnosis on
illnesses was often disregarded and the role of the doctor in society was
mostly limited to treating minor ailments.

                In the 19th century, church interference
in medical advancement had dwindled. Branches of the medical profession
established ‘examining and disciplinary bodies providing recognized
qualifications’. Medical knowledge was expanding at a rapid rate and death
rates from ‘post-operative shock’ and ‘hospital gangrene’ fell dramatically due
to the use of aesthetic and the use of disinfectant. Over the last 100 years,
the role of the doctor has changed significantly due to the establishment of the
National Health Service (NHS) in 1948. Although prior to this change there were
a number of institutions ran both my government and charitable organisations, ‘it
was a patchwork of institutions which were not accessible according to need.’,
including limitations such as ‘lack of access to hospital care and lack of
access to health care for dependents – the families of working men.’ This
limited access to healthcare meant that doctors did not yet have the role of
safeguarding vulnerable members of society as they often didn’t have the means
to access healthcare from a doctor. The inception of the NHS has increased
national interest in healthcare, and as such doctors have become a means of
relaying scientific knowledge to the community, allowing them a further role
within society than what they previously may have held. The future of the
doctor is still largely uncertain – whilst still an integral part of society,
according to a 2010 report from GMC, ‘the future role of the doctor will
increasingly include significant input into managing and leading’.

How doctors’ attitudes and values can influence
the health of their patients.

The attitudes and values of a
doctor is perceived to be an influencing factor in the health of their patients;
‘The attitude of doctors towards the profession influences to a large extent a
number of aspects of clinical competence. Their attitude towards patients is
particularly important as it determines the quality of communication’. A number
of attributes of a ‘good’ doctor, such as strong communication skills and
empathy are paramount to patients, as ‘by focusing the information exchange on
the medical agenda and stressing symptoms and clinical history, doctors may
miss significant patient concerns’ which are important to discuss in order to
decrease the stress of patients and to ensure that all related symptoms are
properly discussed to aid correct diagnosis.

The need for a strong
doctor-patient relationship in regards to the health of a patient is further
supported by a 2002 study on doctor-patient relationships, which concluded that
‘to facilitate autonomous decision making it is important to ask patients about
treatments that, in their view, worked or did not work, as well as whether they
have heard something positive or negative about treatments that they have not
yet tried…. If you propose something that is inconsistent with their experience
or knowledge there is a risk that they will not listen to you.’

How the role of the doctor may change between
different societies.

The role of the doctor may
differ significantly between countries with different levels of affluency; data
gathered on the amount of doctors per 1000 population shows stark differences
between countries with higher affluence having a higher percentage of the
population being doctors, compared to the more impoverished areas having less
doctors per 1000. For example, data from 2004 shows that third world countries
Malawi, Burundi and Niger had 0.2, 0.3 and 0.3 (respectively) doctors per 1000
population, compared to developed countries such as Italy, Iceland and France
having 4.2, 3.62 and 3.37 respectively. Many people living in impoverished
countries may not have easy access to medical professionals, especially those
who reside in rural, remote parts of such countries: ‘the extent to which
medical practice aligns with local needs differs between nations; the
increasing overmedicalisation and commodification of health care in high-income
settings contrasts sharply with the more community-based health focus of others’.

                The demographics of doctors also differ between
different societies. In the UK, the percentage of female doctors was 38% in
2007, and had risen by 7% to 45% female doctors in 2016. This differs
significantly from countries which are still largely dominated by males – an
example of this is in Pakistan, where, despite approximately 70% of students
enrolled at medical school are female, ‘only 23 percent of the nation’s doctors
are women, according to the Pakistan Medical and Dental Council.’ This almost
mirrors the trend of India, where 51% of students joining medical colleges were
female, however there is still a shortage of female doctors due to a number of
women doctors ceasing to practice medicine due to family responsibilities,
among other factors.

There is consensus from The
Lancet’s Commission on Medical Education that: ‘health professionals in all
countries should be educated to mobilise knowledge and to engage in critical
reasoning and ethical conduct so that they are competent to participate in
patient and population-centred health systems as members of locally responsive
and globally connected teams’ – although the role may differ among societies,
there is now more means to move closer to a universal set of standards expected
of doctors, which may have an influence on the future role of the doctor on an
international scale.

How patients currently view the role of the
doctor in the UK

The British Social Attitudes
(BSA) surveys of 2002 and 2014 collected data on how much they trusted doctors,
nurses and managers to put the ‘interests of their patients above the
convenience of the hospital’. The majority answered ‘most of the time’ in both
the 2002 and 2014 study. Although there is a slight reduction in the percentage
of respondents which answered ‘just about never’ in the 2014 survey, this is
unlikely to be a sign of growing trust of the profession due to very similar
data sets in both occasions. Despite this, doctors are still often seen as a
trustworthy ‘Polling by the British Medical Association (BMA) indicates that
nine out of ten members of the public trust doctors to tell the truth. That
figure is well above the perceived honesty of television news readers (62%),
civil servants (43%), and journalists (20%). But to rely on this statistic
alone will give doctors a false sense of reassurance about how their work is
perceived by the public.’

                A journal focussing on the attitude of the modern day
doctor concluded that ‘doctors must be encouraged and empowered to tackle ill
health and injustices as they enter an era where all doctor serve as “societal
doctors”, and not merely siphon these duties off to the public health
professions’, which highlights how doctors are responsible for many aspects
within society which differ from just healthcare, with examples including
safeguarding vulnerable groups of society, increasing management
responsibilities and relaying scientific knowledge to laypeople. However, not
all views of the medical profession are as positive, with counter arguments
such as it being ‘slow to adapt to changing societal expectations. High-profile
cases highlighting poor professional practice have been enormously damaging to
the reputation of the profession.’ With increasing access to media, it is often
widespread knowledge of society when mistakes are made by doctors, which may
ultimately have an impact on how trustworthy and reliable doctors are seen in


It can be clearly seen that the role of the doctor has
changed significantly throughout recent history, particularly through the
advancement in technology and general beliefs of society, with medicine now
being practiced on the grounds of solid scientific research rather than theory
and religious beliefs. Now, doctors have a more caring role within society,
often acting as outlets for scientific knowledge to the general public. Although
general views of the doctor within society are positive reflections of the
profession, such as doctors being ‘trustworthy’, widespread media coverage and
increasing expectations sometimes lead to members of society having a negative
view of doctors.