All changed, changed utterly

News p 1924 Letters p 1986 “The Bristol case,” in which judgment was passed last week1 will probably prove much more important to the future of health care in Britain than the reforms suggested in the white papers. Reorganisations of the NHS come round with monotonous regularity, but changes on the wards and in surgeries are slow and often unrelated to the passing political rhetoric. 2 3 In contrast, the Bristol case is a once in a lifetime drama that has held the attention of doctors and patients in a way that a white paper can never hope to match. The case has thrown up a long list of important issues (see box) that British medicine will take years to address. At the heart of the tragedy, which has been Shakespearean in its scale and structure, is, as the GMC said, “the trust that patients place in their doctors.” That trust will never be the same again, but that will be a good thing if we move to an active rather than a passive trust, where doctors share uncertainty. The trust between doctors and patients works on two main levels: between individual patients and doctors and between society and doctors' organisations. The Bristol case will affect both. The most profound—but least easily measured—effect may well be on the relationship between individual doctors and patients. In the past two weeks the case must have been in the minds of many patients consulting doctors, particularly those about to undergo operations. Worldwide, the doctor-patient relationship is changing.4-6 For instance, the main theme of last week's world conference of general practitioners in Dublin …