Many people in the medical profession say that times have changed and that people now have more of a focus on a work-life balance and some argue, that financial ‘drivers’ are becoming increasingly important for healthcare professionals.

‘Context’ must obviously be considered in any type of cultural analysis and it must be said that increasing debt, ever improving technology and an increasing burden of health do play a part in driving some of these perceived changes.

But if we scratch beneath the surface, how different is our culture today from the culture that existed 25-30 years ago?

Whilst we have national contracts and working time directives, the reality is that many people still work in excess of their contracted or recommended hours – both out of necessity and to some degree, it must be said, out of choice. The medical culture still rewards hard work and to some extent encourages excessive work. We still admire the orthopaedic registrar who has just completed a particularly tough night having been in theatre and the ED and then stays on till 1200 the next day to complete and lead the ward round.

I think back to handover meetings where consultants encouraged the adoption of an ‘arrogant’ attitude to dissuade colleagues from making referrals to a service. And I often think about how many ‘old boys’ networks still exist and if you don’t play the game, how this diminishes your chances of getting onto certain training schemes.

So our culture still rewards and encourages excessive work, at times encourages arrogance and working in silos and promotes networking to enhance chances of succeeding in a particular specialty…. Exactly how much ‘progress’ have we actually made?