“We are being regulated to death”

Since Alexander McCall Smith recommended to me “A Pattern Language”, I have found myself spotting different patterns:



This is a pattern about regulation as applied to the practice of medicine in the NHS. The pattern begins with this week’s BMJ:Defensive-medicine-16-Jan-2

Just before Christmas last year, the General Medical Council published the review into doctors’ suicides. Dr Marcus Bicknell wrote an article about this, which he titled:

we are being regulated to death

I am not sure that I agree with Professor Terence Stephenson that the practice of defensive medicine is solely the consequence of litigation and that regulatory procedures play little part.

The study below, just published, has concluded: “Morbidity was greatest in cases involving the GMC. Most doctors reported practising defensively, including avoidance of procedures and high-risk patients. Many felt victimised as whistleblowers or reported bullying.”


The Chair of the General Medical Council said last week to the UK Parliament Health Committee:


Dr Christoph Lees and Dr Hilarie Williams have given their review of the current regulatory process. This is a well referenced article which is worth reading in its entirety:

Lees & Williams, Jan 2015

A junior doctor recently wrote to the BMJ:

reliant on policies and guidelines

The pattern that I have noted here is one of an approach to healthcare that appears to be ever more “regulated”, as described perfectly above. I believe that this is not the time to borrow military approaches in healthcare. The risk of this erosion of professionalism is that harm is caused to both patients and doctors.

One Reply to ““We are being regulated to death””

  1. Sadly doctors have been let down by paucity of education which often fails to include Pharmacology & Therapeutics. Since 1992 this subject was removed in the UK by the GMC from medical education guidelines ‘Tomorrow’s Doctors”. Ability to recognise ADRs which when psychiatric are often diagnosed as new disease, plus test for prescribing competence should be examination topics. The medical students are unaware of the extent of iatrogenic illness when they qualify. Those at the top of the profession only speak out when they are at the end of their careers. Back in the year 2000 The NHS inquiry “An Organisation With a Memory’ concluded preventable iatrogenesis and medical accidents should be admitted to and learnt from – they recommended a ‘no blame’ culture should be instigated yet this is still not the case. We are still not learning from past errors.

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