Is idealism in medicine dead? Did the inspirations and role models that motivated successive generations of doctors disappear when professional lives became dominated by contracts, working time directives, politically motivated targets and perpetual reorganization? Perhaps idealism in medicine is a myth, as elaborate a hoax as any history of Keyser Soze; it simply never existed. Humans are beasts driven by greed, lust and vanity. Why should doctors be any different?

B Sethia argues in this month’s issue that advocates for idealism and altruism are to be found in abundance among new recruits to the medical profession.1 But materialism and pragmatism dilute or extinguish compassion and dedication. When the Department of Health wavers on introducing plain packs for cigarettes, the idealism reflex in medical professionals immediately twitches;2 a reflex that supports Sethia’s argument. The question that Sethia poses is an important one: how can medical leaders nurture these attributes more effectively?

One focus is the evolution from medical student to doctor. What occurs at that transition? The process should convert a diligent student into a competent professional. Instead an idealistic, compassionate creature is transformed into a materialistic, pragmatic beast. Does the problem lie with the annual introduction of the most junior doctors in August? Senior consultants traditionally flee to warmer climes to escape the chill of transition, leaving patients in less-experienced hands.

Mark Edwards and colleagues focus on competence not idealism but argue that the preparation of junior doctors to enter the medical workplace requires examination and reform.3 They ask: how well does the medical profession perform in its task of producing competent junior doctors who are sufficiently self-aware and confident in their abilities? Not nearly well enough is the answer.

Perhaps the medical profession is distracted by pragmatic woes? In the spirit of idealism doctors would not strike and withdraw care from patients. Yet on 21 June 2012 the British Medical Association sanctioned medical practitioners to take industrial action in a disagreement over government pension reforms, the first doctors’ strike in England since 1975. Emergency and urgent cases were dealt with as usual and only around 8% of doctors took industrial action, but a new analysis by Milagros Ruiz and colleagues suggests that the 24-hour strike significantly affected provision of healthcare by NHS hospitals.4

Philosopher Bertrand Russell said that ‘much that passes as idealism is disguised hatred or disguised love of power’. If Russell is right then Sethia’s call for genuine idealism requires broad and staunch support. In reaching out further to that lost spirit of medicine, we begin a two-part series on the origins of vaccination that remember an age when idealism reigned supreme and pragmatism was unknown.5