We need to be more pragmatic

doi:10.1136/bmj.39423.425174.1F

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Adam Paul Fitzpatrick, consultant cardiologist

¹Manchester Royal Infirmary, Manchester M13 9WL

adam1{at}maxwellton.me.uk

I worked for two years as an attending physician at the University of California, San Francisco, and the past 12 years as a consultant in the NHS. Rampant commercialism in health care doesn’t work well,1 2 but nor does health care by slavish social dogma, as in the United Kingdom.

In my experience in the United States, university medicine was of a high calibre; knowledge and procedural skill levels were the best I have encountered, and patients were treated …