Why are doctors so unhappy?

Sir

Was the separation of this editorial from that of Klein in the same
edition chance or deliberate?

Entering the profession I was anticipating expending myself in the
service of those who might benefit from my efforts. A naive aspiration no
doubt but one shared, I suspect, by many. I have no regrets or remorse
about the hundreds of 100+ hour weeks in hospital nor the many months that
have past in general practice when there were no profits left to draw. I
am an unreconstructed, heart and soul, vocational dinosaur and defiantly
committed to that model of medical practice. I served and was glad to do
so. An impartial observer would conclude, I hope, that the harm I have
done has been decisively outweighed by the assistance I have been able to
render.

The unhappiness I experience derives from the culture prevalent in so
many aspects of life, that of managerialism. A pervasive and pernicious
delusional mindset whose response to a given circumstance is to carpet
bomb with paperwork, disrupt productive work with interminable meetings,
distract the workforce from productive work with half-baked follies, breed
committees, hatch neologisms, maze with circumlocution and intimidate with
impenetrable newspeak. It is a deeply entrenched, cynical, self-serving
conspiracy against both the laity and the professions.

The nadir, the monstrous rebarbative idiocy of fundholding, is now
past, though echoes can still be heard from the pit into which this
government so wisely cast it.

Perhaps the professed good intentions of Milburn can be brought to
fruition but to do so may require an extraordinary degree of radicalism.
The NHS needs to be administered not managed. As a consequence of the
vocational predisposition of so many within it, it is the right setting
for the development of a culture devoid of managers, something more akin
to a hive. Does there need to be anything interposed between the centre
and the coalface of primary and secondary care? Why not rely upon the
expensively created professional cadre's own impulse to serve? Honouring
and trusting the integrity of a vocational workforce might run counter to
the prevailing vicious and disaffected zeitgeist but could be the epiphany
that is so earnestly sought by so many.

Broadbrush policy, established by a depoliticised health body, would
be locally interpreted to suit circumstances by professions and users in a
DHA/PCTlike body. Such latitude would permit the development of responsive
services diverse careers and time committments and would constrain the
more vainglorious of diktats of central committees. Performance would
likewise be a locally scrutinised issue - another role for the DHA/PCTlike
body. Underperformance would be deliberately sought out and not tolerated
and lifelong learning would be actively instituted.

Klein's corset of strong control beautifully embodies the central and
fatal defect of managerialism. Tying things down ever more tightly does
not improve anything. Liberation, on the other hand, is an aspiration to
which all but the most anankastic can subscribe.

Steven Ford