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non-NHS component of their working lives in the way thatmen working part time are. The first-hand experiencewomen at home get in paediatrics, administration, andpersonnel management should be acknowledged as thevaluable medical resource it is, instead of being downgraded.

THE WAY FORWARD

Most doctors are in medicine because of the satisfactionthey get from doing it. But isn’t the present system askingtoo much of the young doctors being forced through it? Thenew manpower proposals’ would give consultants the

option of reducing their sessions on favourable terms,without loss of career credibility, job security, and pensionrights; the proposals thus show awareness of the pressureson older doctors. They seem less in tune with the stressesand disaffection of young doctors. In particular, the inherentdisadvantages to women of the present system are notconsidered, despite the prediction of 50% women graduatesby the end of the century.There is a growing suspicion among women that the male

establishment secretly hopes the competitive pressures andhostile environment of medicine will encourage women withdomestic commitments to opt out of clinical practice,thereby banishing the spectre of medical unemployment.The data show the opposite trend: the proportion of womendoctors in clinical practice who were married rose from 80 %in 1962 to 90% in 1976. However, the suggestion has thepotential of a self-fulfilling prophecy: those who want it tohappen can make it happen. The fear is that when it comes tothe crunch, career prospects for men will be givenprecedence over those for women.The threat of direct Government intervention has

shattered the institutional inertia of the medicalestablishment. Here is a chance to examine critically thepremises, assumptions, and attitudes that have mouldedmedical practice and politics to the present archaic form andto question their validity for the future. The medical careerstructure needs flexibility and the creation of new options. Itshould be easier for individuals to move from one specialtyto another within a professional lifetime; it should be easierfor juniors as well as seniors to modify their pattern ofworking to meet their immediate needs; young doctors withenergy and enthusiasm should be encouraged to broadentheir outlook by working abroad for a time. The prejudice ofageism which is blighting medical appointment committeesshould be confronted and stamped out; it has no biologicalbasis, destroys initiative, and invalidates part-time training.

Less-than-full-time work should be established as a

viable option for all doctors at any stage of their careers. Itcould take various forms—part-time, job-sharing, blocks of"time out". Such possibilities may present managementproblems, but it is the job of management to solve them.Medicine needs to change within, to keep pace with changewithout. We owe it to our patients, ourselves, and oursuccessors.

I thank Brian Greener, Mr Mills, Mrs Mirska, and Miss Cooper of theDHSS for providing the data.

REFERENCES

1. Day P. Women doctors. Choices and constraints in policies for medical manpowerKing’s Fund Project Paper 28. London: King’s Fund, 1982.

2. Collier J, Burke A. Racial and sexual discrimination in the selection of students forLondon medical schools. J Med Educ 1986; 20: 86-90.

3. Lorber J. Women physicians. Careers, status and power. London: TavistockPublications, 1984.

4. DHSS/JCC Manpower Initiative. Hospital medical staffing: achieving a balance. BrMed J 1986; 293: 147-51.

5. Rees L, Van Someren V Personal view Br Med J 1984, 289: 827.

In England Now

I WELL remember the day I first suggested to my family that Imight write an autobiography. We were all at lunch, it was a finesunny afternoon, and everything was peaceful, except for the cockerspaniel trying to get at the chops.The first reaction was expectant smiles: what would the punch

line be? But when it became apparent that there was no punch line,that I was in earnest, and actually intended to do this dreadful thing,their eyes widened, their pupils dilated, and one after the other theystopped in mid-chew. It was my son who first found words. "Butyou’re not famous!" he said, crystallising the general view of thegathering.

This was a shrewd thrust. I cannot conceal from myself that in the20th-century hall of fame I cut no sort of figure. I did not discoverpenicillin. I was not under the table at the Yalta conference. I havenever reached the Top Twenty or captained England, and I cannotclaim to be the illegitimate son of Hitler’s chambermaid. Forautobiographical purposes these are grave disabilities. But just asDaisy Ashford’s Mr Salteena could not help not being quite agentleman, I cannot help not being famous, and I said so, addingthat I didn’t see why only famous people should have the fun ofwriting autobiographies.

This did little to calm my dependants. Slowly their jaws began tomove again, but above each head I could sense a small invisiblebubble containing the invisible words "God help us all!" Theyglanced cautiously sideways at each other to indicate how sad it allwas, and the subject was tactfully changed.

For days afterwards I encountered little groups of people on thestairs or in the kitchen, usually attended by a worried-lookingdog-people engaged in low-voiced conversations which broke upthe moment I appeared. It seems that the main preoccupation hadnow become the intimate revelations that such an autobiographymight contain. If I was really determined on this desperate course,where would it all end? They knew their P. G. Wodehouse, and myactivities had at once been equated with those of the Hon GalahadThreepwood. The disreputable stories of family and friends, thelaw-suits, the blush-making sharing with strangers of matters bestkept firmly concealed-all this was cause enough for concern. Butperhaps I might eventually forget about it.

I did not forget. But after approaches to some 20 publishers-most of whom did not even examine my masterpiece-it becameclear that it was destined, like so many exotic literary flowers, toblush unseen in my filing cabinet until a more discerning futuregeneration takes over. If I had been a mass murderer, now, or ahomosexual politician! But I fear it is too late to change my career inthis direction, and I am resigned to my pitiful lack, not only of fame,but also of notoriety.

I MUSED, during a long day interviewing candidates for a chair innursing, how Florence Nightingale would have come across to anappointment committee. What would she have said about her plansfor the future of nursing? Whom would she have trusted to act asreferees?

’

She would, of course, have rigged the committee if she hadwanted the post. Letters would have been written to the highest inthe land. She would have lectured the members and poured outstatistics, or, as Prof F. B. Smith would have us believe in FlorenceNightingale: Reputation and Power, damned lies and statistics. Shewould have been impressive and quite ready to browbeat us all. Shewould have laid down very stiff conditions before she agreed toaccept-and even the toughest Vice-Chancellor would have foundhimself yielding. And it would certainly have turned out to be agood appointment for the University although not so good fornursing. I caught myself wondering whether Florence’s personahad not descended upon another lady.