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Br J Gen Pract. 2009 April 1; 59(561): 304.
PMCID: PMC2662120

Real pirates any day

‘I don't think much of our profession, but contrasted with respectability, it is comparatively honest.’

Just as sex was not invented in the sixties, as we now know, neither was satire. WS Gilbert, a full century earlier, was reputedly not much cop at the first, but he was consummate at the second. ‘No, Frederick,’ he continued (in the voice of the character I was playing in our little amateur theatre just this time yesterday), ‘I shall live and die a Pirate King!’.

… Cue famous song and then, as you probably know, a fair amount of swashbuckling and carrying-off of ladies of assorted ages, sizes, and willingness. But there, right at the start of the show, Gilbert's joke about respectability contrasting with honesty has been getting one of the best laughs of the evening. Respect for the respectability of people in high places seems, on this evidence, almost as low as it was in Gilbert's day.

People in low places are right to be angry. One of the working assumptions of the past few decades has been that the common sense, experience and (let it be whispered) wisdom, of people who actually do things – the friends in low places I wrote about in 20011 – have been relentlessly trumped by the theories, mantras and jargon-encrusted diktats of people who don't. Life has been progressively codified and regimented into systems of rules created by these people on high, and nowhere has this change been more pronounced than in Britain. And nowhere in Britain, except perhaps in education, has this change been more pronounced than in medicine. As I have argued over the years, to little effect, the danger inherent in this process becomes greater, not less, as the systems of rules become progressively refined. It could be a beneficial result of the straits into which we have been plunged by financial bigwigs who scorned the principles adhered to by any sensible back-street family, that we are now able to reassert the primacy of individual autonomy and integrity. Even in medicine.

I left clinical practice when I decided my professional autonomy was no longer sustainable. I always held, for example, that the confidences entrusted to me to by my patients were sacrosanct. I didn't expect to impose this principle on colleagues but for me it was a matter of trust. I refused, for example, to send details from my notes, and from the notes of previous GPs, to solicitors. Nobody ever persuaded me that this widely accepted practice did not amount to ‘consent under duress’, or that it was a legitimate use of medical records. It would have been much easier to go along with what people usually did, as I imagine hedge fund managers have recently got good at telling themselves, but for me it was unacceptable. Probably I would have complied with a specific court order, but I was lucky enough never to be placed in that position.

Anyway, I remember one indignant solicitor writing and threatening to ‘report me to the BMA’ (no less) if I didn't do what he had demanded. I replied asking him to do so at once, and telling him that I was reporting him to the Law Society. When I had done so, and subsequently spoken on the telephone to a refreshingly understanding official there, I received a written apology from the solicitor's senior partner. They somehow managed without the notes.

It seems to me in retrospect that I lived my life, and my career, as many did, in order to be worthy of trust and respect. And the only judge of that was the only one you couldn't deceive – yourself. That is why it proved to be such an unpardonable affront when Kenny Clark started to treat me as no better than the people he mixed with. Give me real, honest pirates any day.


1. Willis J. Friends in low places. Oxford: Radcliffe Medical Press; 2001.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners