The National Health Service: A Political HistoryBMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7138.1176a (Published 11 April 1998) Cite this as: BMJ 1998;316:1176
- JP Bunker, visiting professor
- Department of Epidemiology and Public Health, University College London Medical School
Oxford University Press, £9.99, pp 233
ISBN 0 19 289296 7
Doctors in the United States still express a strong distaste for what they perceive as socialised medicine in Great Britain. But, of course, few of them are familiar with the NHS and how it functions. They are not familiar, for example, with how much greater freedom of practice the British doctor has had, at least up to the recent past. It could be argued, as J R Hampton did in his famous 1983 editorial, that clinical freedom was at an end. But Hampton was arguing that it was the freedom to ignore what we now call evidence based medicine that was at an end. It is another kind of freedom, the freedom of what Eliot Freidson has called “the flexible discretionary judgement that is necessary to adapt to individual [patients’] needs” that is being eroded as the NHS adopts the worst of managerial style, American managed care.