Intended for healthcare professionals

Feature Christmas 2016: Professional Matters

The Gatekeeper and the Wizard: the Gatekeeper goes digital

BMJ 2016; 355 doi: (Published 13 December 2016) Cite this as: BMJ 2016;355:i6541
  1. Paul Hodgkin, founder of Patient Opinion and former GP
  1. 6 Friars Rd, Hadleigh IP7 6DF, UK
  1. paul.hodgkin9{at}

The fairy tale of the Gatekeeper and the Wizard first appeared in The BMJ in 19891 and illustrated the relationship between GPs and specialists. Paul Hodgkin, one of the original authors, updates the fable for the digital age

The Gatekeeper was tired. She had spent years sorting out which ill people needed to see the Wizards up in the castle so as not to waste their fancy machines on people who did not have a disease. But now her gate was gone. Instead, endless pathways snaked up the hill. If you fitted on a pathway, up you went; if you didn’t, tough. Admittedly each pathway was exceptionally NICE, and each was still routed past her front door so she knew who was coming and going, but that couldn’t hide the fact that her professional role and diagnostic responsibilities were diminished. The Itinerant Sociologist, a down at heel soul who sometimes stopped by, said that these care pathways were a good example of a “regime of discipline” aimed at reducing professional variation. Or was that professional vocation? The Gatekeeper was so tired that she couldn’t remember.

In fact the whole gate thing was a bit retro now, and she no longer understood what her role was. Searching for answers, she had downloaded a fancy new epistemology app. It told her that gatekeeping had changed because the nature of knowledge had changed. The paper …

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