Pligget

It really is a "high horse" day for me today.

The retiring head of the BMA said yesterday "The right to practise medicine as a professional and not a government bean counter is worth fighting for".

I have a lot of empathy with highly-trained people who want nothing more than to practise their specialism with minimal interference from lay managers. The cornerstone of being a specialist is the fact that no-one knows your job better than you and your peers. Although I don't work in the medical field, I have a highly specialised job, probably with less than a hundred peers in the world (spacecraft manufacture is not a big business), and a large chunk of my time is taken up asking people to trust my judgment because that's what I bring to the job.

However the other side of the coin is that we specialists, by our very nature, tend not to have a view of the bigger picture. We want to excel in our field, and we want to be recognised for the difference we make as individuals. We're less interested in how well our particular cog integrates into the big machine.

If you ask any automotive engineer what sort of car they would want to work on, they would be more likely to talk in terms of Ferrari or Rolls Royce than of Volkswagen or Ford. They'd rather see a few individuals getting the unfettered benefit of their excellence than a large mob getting about in adequate comfort and safety, having saved a few quid.

I have no argument with the fact that the medical profession has the best insight into the "engineering" of the national health, I just don't think it follows logically that it also knows what's best for the efficient running of the service. Of course there will be a few individuals who combine clinical excellence with great administrative skills, but we shouldn't assume that one necessarily leads to the other.

If someone were to step back and look at the broad question of health (rather than ill health), it would become clear that the intervention of a doctor indicates that there has already been a failure in the system somewhere. Someone has become ill. I'm aware that I'm talking at a very ideal level here, but the overall aim of the National Health Service should be to remove the need for doctors altogether. You'll never get the BMA to go along with that.

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