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:

off the wheel: off the wall?

To the editor,

Dear Sir,

Hamster health care

Morrison and Smith’s analysis of current problems with health care
provision (1) will ring true to many general practitioners working in the
British NHS. The issues of lack of time with patients, increasing
complexity of care, and the rising expectations of both patients and
funders of care, combine to make for unhappy patients and pressurised

Redesigning health care, their suggestion for the way forward, is a
necessary but certainly not a sufficient solution. The roots of the
problem lie in the complex and confused relationships between medicine,
perceptions of health, and society, which are not addressed in the
editorial, and which tend to be ignored in medically based analyses of
these problems.

Hanson and Callahan (2) suggest that unless we (doctors, politicians,
media, society) start to look at the goals of medicine and not just the
technology and processes of care, we risk medicine becoming economically
unsustainable, clinically confusing, socially frustrating and lacking
coherent direction and purpose. The title and content of your editorial
suggests that this has already happened.

Perhaps the time is right for a theme issue of the BMJ on the biggest
issue that will face us and our children: What’s medicine for?


John CM Gillies,
general practitioner,

Selkirk Medical Centre, Selkirk TD7 4LL

1. Morrison I, Smith R. Hamster health care.BMJ 2000;321:1541-2.

2. Hanson M, Callahan D. The Goals of Medicine; the forgotten issues in
health care reform. P12-13. Georgetown University Press, Washington DC

Competing interests: No competing interests

09 January 2001
John C M Gillies
general practitioner
Selkirk Health Centre, Selkirk TD7 4LL