What price excellence?

The author, a cardiac surgeon specialising in heart transplantation, argues that excellence in medicine must always be pursued and confronts the problems of specialties and super-specialties with widely varying costs and benefit in which the pursuit of excellence results. He advocates that decisions on resource allocation should be the responsibility of the Department of Health and Social Security, acting on the advice of the public's elected representatives on the one hand and the medical profession on the other. The profession has an ever-increasing responsibility to ensure that its advice is soundly based on rigorous self-audit, which should include considering the costs and benefit of its work. His commentator, Lady McCarthy, until recently chairman of an area health authority, responds by arguing that the tripartite system for resource allocation does not work. Doctors resent the imposition of any priorities other than their own. Their two-dimensional medical ethics, concerning doctors' obligations to individual patients, must be supplemented by concern for society as a whole. Both papers are based on contributions to the 1982 annual conference of the London Medical Group on Appropriate Medicine.