What is a doctor, and what does a doctor do?

The Productivity Commission’s recent proposal to modify the roles of health professionals raises these important questions

A century ago, the role of doctors was clear and simple. Sir William Osler, Regius Professor of Medicine at Oxford, noted that it was “to acquire facility in the art of diagnosis . . . to grow in clinical judgment . . . to appreciate the relative value of symptoms and the physical signs . . . to give to the patient and his friends a forecast or prognosis . . . [and] to conduct the treatment that the patient may be restored to health . . . or, failing that, be given the greatest possible measure of relief”.1 It was the age of acute care, and medicine’s knowledge base was contained in a single tome — Osler’s The principles and practice of medicine. Doctors accounted for about one in every three health professionals,2 and practised as general practitioners or consultant physicians and surgeons. The payment for health care was a contract between the patient and the doctor, and not the business of government.