Intended for healthcare professionals


Hamster health care

BMJ 2000; 321 doi: (Published 23 December 2000) Cite this as: BMJ 2000;321:1541

Time to stop running faster and redesign health care

  1. Ian Morrison, president emeritus,
  2. Richard Smith, editor
  1. Institute of the Future, 2744 Sand Hill Road, Menlo Park, CA 94025, USA
  2. BMJ

Across the globe doctors are miserable because they feel like hamsters on a treadmill. They must run faster just to stand still. In underdoctored Britain they must see ever more patients, fill in more forms, and sit on more committees just to keep the NHS afloat. In the government sponsored, single payer system in Canada; the mandatory insurance systems in Japan or continental Europe; or the managed care systems in the United States doctors feel that they have to see more patients to maintain their incomes. But systems that depend on everybody running faster are not sustainable. The answer must be to redesign health care.

Doctors are increasingly dissatisfied with the amount of time they can spend with patients. A recent survey by the Commonwealth Fund found that three quarters of doctors in the five countries studied believed that “spending more time with patients is a highly effective way to improve patient care.”1 Evidence from general practice in Britain shows that longer consultations are of higher quality,2 and patients want more time with doctors. Yet 62% of doctors in Britain, 43% in the United States, 42% in Canada, 38% in …

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