I was shocked to learn at a recent meeting that some clinical geneticists think it's OK to screen patients for underlying cancer risk without discussing the options with them and without seeking their informed consent.
Up to then I'd believed that the clinical genetics specialty was ahead of the game when it came to sharing decisions with patients, so this was depressing news.
So, what is Rethinking Medicine and exactly what needs to be re-thought? Medicine is constantly changing – so, what has happened that requires us to rethink the process and perhaps bring it back into line?
Medical training and care provision have developed throughout the centuries to recognise the current knowledge as well as reflecting disease profiles and social mores. It is imperative that medical training and on-going professional development are based on the needs of individual patients and the population who will benefit from the resultant knowledge and skills.
Rethinking - interesting choice of word. Not review or assessment - more radical. Rethinking is a form of investigation not bound by the past, nor by a process and not constrained by the ecology of the future. Unlike the other option, a review, it is born of inquisitiveness, nourished by anarchy and unpredictable in its outcomes.
I cannot help but think that the group has given itself the harder of the two options.
Change takes time. We need to prepare for the future not just firefight the present. It's a popular time to wheel out some of health policy's favourite clichés. But how do you define long term? And how does knowing a realistic end point affect what you do now?
Let's start with what you're trying to achieve. You need to consider the scale of change needed, but also quite how embedded the status quo is. Trying to reverse decades of hospital dominance sounds like a task for at least a decade. Balancing the attention given to physical and mental health is likely to be even longer.
The NHS Long Term Plan sets out a vision for the future of the NHS that begins to rebalance the way the NHS will care for the population for the next 10 years.
It focusses on care in the community, prevention, and addressing the biggest health challenges of our time. It is difficult, however, to change the culture of an organisation, but this is a good start. The difficulty will be in turning plans into reality.