Doctors' infantalisation

doi:10.1136/bmj.a791

Published 14 July 2008, doi:10.1136/bmj.a791
Cite this as: BMJ 2008;337:a791

Letters

NHS at 60

Doctors’ infantalisation

The first 150 words of the full text of this article appear below.

I have been both manager and doctor in the "intensive commandand control regime of national targets, inspection and regulation,and published league tables" of our 60 year old NHS.¹ My performanceas a manager was measured on my team’s ability to delivergovernment efficiency targets, with original thinking commonlystifled. My performance as a junior doctor is assessed on theability to deliver these targets alongside individual, highquality, evidence based care.

My audit at a foundation trust showed how trust policy activelyignores clinical guidelines to achieve performance indicators.This exposes patients to unnecessary admission and investigations,and prevents junior clinical staff from seeing, learning, andpractising good clinical medicine. Junior doctors and theirpatients have less power than administrative staff and managerschasing after a performance indicator turning red.

Whereas patients now have choice into the who and where of treatment,clinicians grumble they have less choice . . . [Full text of this article]

Alexandra Thomson-Moore, foundation doctor

¹ West Suffolk Hospital, Bury St Edmunds, Suffolk IP33 2QZ

1977atm@doctors.org.uk