Intended for healthcare professionals

Rapid response to:


Hamster health care

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

Rapid Response:

Etiology of "Hamster Health Care"

To the Editor:

One must endorse Morrison and Smith's (1) clear documentation of the
widespread problem of time pressure on doctors, with its adverse effects
on patient care and professional satisfaction and morale. My geriatrician
colleagues and I are especially plagued by time pressures: histories are
longer and more difficult to elicit and evaluate; examinations take more
time; polypharmacy prescribing requires more thought and greater care; and
advice to patient or caretaker must be given slowly and often

However, I cannot agree that "…organising medical practice in a
way…ill-suited to an information age and a world of sceptical, better
informed patients who…want the best care" are major underlying issues that
can or should be solved. In addition, it seems unlikely that doctors can
"…redesign their work to meet their patients' needs within the economic
constraints, just as…in…other service industries." Certainly, all time-
saving proposals should be explored, such as reduced and streamlined paper
work, easier access to results or consultation and various novel ways to
transmit information or to contact patients. But an irreducible time will
remain for provision of adequate
face-to-face patient contact, for reflection, planning and discussion and,
at times, for further exploration with family members or with a

Morrison and Smith seem hesitant to press for an obvious but costly
solution: more physicians and increased time with patients. The etiology
of "hamster health care" is long exposure to austere health budgets. The
symptoms may be partially and temporarily ameliorated by various
interventions, but the prescription for cure is replacement therapy--
adequate funding.


1. Morrison I, Smith R. Hamster health care.
BMJ 2000;321:1541-1542.


Gerson T. Lesser, MD
Assistant Professor
Dept. of Geriatrics & Adult Development
Mount Sinai School of Medicine

Competing interests: No competing interests

29 December 2000
Gerson T Lesser
Assistant Professor, Department of Geriatrics & Adult Development, Mount Sinai School of Medicine
Jewish Home and Hospital, NY NY