The performance of doctors embraces attitudes to practice, knowledge, and skills. It is the outward and visible expression of our professionalism. In general, people think highly of the medical profession in Britain; rising expectations are a mark of our success. Nevertheless, self regulation, on which our professional independence and self respect depend, cannot be taken for granted. Sympathetic critics such as lay people, sociologists, and doctors reflect a wider public perception that we seem reluctant to assure doctors' competence and protect patients from poor practice. There are also criticisms that we are not addressing the widespread dissatisfaction with the attitude of some doctors, including their paternalism and poor communication with both patients and colleagues, and are failing to make self regulation demonstrably effective and responsive.

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Extreme temperature stress (ETS) is recognized as an important threat to the food supply in China. However, how much yield loss caused by ETS (YL ETS ) to the irrigated rice production still remains unclear. In this study, we provided a prototype for YL ETS assessments by using a process-based crop model (MCWLA-Rice) with the ETS impacts explicitly parameterized, to help understand the spatio-temporal patterns of YL ETS and the mechanism underlying the ETS impacts at a 0.5°×0.5°grid scale in the major irrigated rice planting areas across China during 1981-2010. On the basis of the optimal 30 sets of parameters, the ensemble simulations indicated the following: Regions I (northeastern China) and III 2 (the mid-lower reaches of the Yangtze River) were considered to be the most vulnerable areas to ETS, with the medium YL ETS of 18.4 and 12.9 %, respectively. Furthermore, large YL ETS values (>10 %) were found in some portions of Region II (the Yunnan-Guizhou Plateau), western Region III 1 (the Sichuan Basin), the middle of Region IV_ER (southern China cultivated by early rice), and the west and southeast of Region IV_LR (southern China cultivated by late rice). Over the past several decades, a significant decrease in YL ETS was detected in most of Region I and in northern Region IV_LR (with the medians of −0.53 and −0.28 % year −1 , respectively). However, a significant increase was found in most of Region III (including III 1 and III 2 ) and in Region IV_ER, particularly in the last decade (2001)(2002)(2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). Overall, reduced cold stress has improved the conditions for irrigated rice production across Climatic Change (2016) 134:635-650