Medics need twin track

Rapid advances in molecular biology are outstripping the current medical curriculum, according to a leading scientist, who has called for changes in the role and training of doctors.

George Poste, chief science and technology officer at pharmaceuticals giant SmithKline Beecham, spoke at a meeting of eminent scientists last month. "We need to consider a two-tier medical curriculum," he said. This could include three- or four-year courses for general practioners and then further lengthy training for those who want to specialise.

Dr Poste envisages an era when molecular biology will allow very early diagnosis of disease. Genetics and advanced computing tools will help doctors make genetic profiles that show which patients are at risk from certain diseases and take preventive action.

"The role of the GP would begin to focus more on the sociology of medicine and how best to maintain wellness and quality of life," Dr Poste said. The GP would be responsible for monitoring a patient's overall health-care and would refer people to specialists for treatment when needed.

"Even in the current curriculum, GPs do not need the level of training they receive. I think we need a new generation of GPs that understands much better the social context in which their patients live and is trained to advise patients of the impact of environmental circumstances from a far better informed standpoint."

Dr Poste acknowledged that his suggestions may be resisted as an erosion of doctors' autonomy and as a move towards a nursing practioner role for GPs. "We should be less concerned whether our professional status is changed and more concerned about what is better for the patient," he added.

Sir Keith Peters, chairman of the council of heads of medical schools, disagreed with Dr Poste.

"The challenges he outlines mean we should have highly educated medical students no matter which branch they go into," Sir Keith said. "I do not back the idea of a two-tier medical system. I think GPs are probably the ones who are going to face the greatest intellectual challenges in the future."