BMJ  2006;333 (30 September), doi:10.1136/bmj.333.7570.0-g

Editor's choice

Character building

Career Focus this week collects together a series of "character building" experiences (http://careerfocus.bmjjournals.com). These include being suspended from practice for a cocaine habit, being exposed as a plagiarist, and being a colleague of serial murderer Harold Shipman and subsequently being criticised by a public inquiry.

The point is that all these doctors survived these experiences and probably came away from them stronger. The anonymous former cocaine addict found that the strictness of the General Medical Council's processes worked in his favour and became a powerful motivator to his becoming abstinent. The former plagiarist, writing under a pen name, has clearly learnt her lesson—possibly because the personal consequences of being found out were severe. And Raj Patel, who practised opposite Harold Shipman's practice and sometimes countersigned his cremation forms, explains how, stung by criticism over the way his practice continued to handle cremation forms, he and his colleagues started to behave differently. What started with routine discussion with relatives and examination of the medical records when countersigning cremation forms developed into other forms of "cultural openness."

These are all extreme episodes, but this week's journal contains other reminders that life as a doctor can be difficult, both personally and professionally. According to a research paper by Erica Frank and colleagues, bullying and harassment are rife among US medical students, 42% having experienced bullying and 84% belittlement during their time in medical school (p 682). The reported rates are lower among UK students, explains Diana Wood in her editorial, possibly because of cultural differences, but the negative effects can be severe (p 664). In his personal view (p 709) Arnob Chakraborti muses over the appropriateness of disclosing personal details to patients as a means of showing empathy in a therapeutic relationship: "it is so easy to get it wrong." A series of letters show how well intentioned measures may have perverse effects. Graham Mackenzie and colleagues criticise the eligibility criteria for over the counter statins in UK pharmacies for misclassifying people at both ends of the risk range (p 704). D Schlosshan and colleagues struggle with the use of an absolute left ventricular ejection fraction as an eligibility criterion for the use of trastuzumab in early breast cancer: there are three ways of measuring it (producing different results) and no consensus on what is normal (p 704). And there's more on plagiarism, including Andrew Weeks' suggestion that Google can help identify the cheats (p 706).

Finally, it seems that someone in government reads the BMJ. In April Fiona Godlee wrote in her editor's choice: "Gordon Brown's first act as chancellor was to give the Bank of England independence to set interest rates. His first act as prime minister should be to give independence to the NHS." This week Mr Brown (though not yet prime minister) has proposed to do just that (p 669).

(jsmith{at}bmj.com)

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