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A British blight

Martin B Van Der Weyden
Med J Aust 2005; 182 (7): 313.
Published online: 4 April 2005

“Retired at last! Retired at last! Thank God Almighty, retired at last!”

So began a polemical piece in The Spectator* by its celebrated columnist Theodore Dalrymple — the nom de plume of a British psychiatrist. He was reflecting on his exit from the National Health Service, after many years of service, which, latterly, had been marked by “drudgery, servitude and subordination to politicians and their henchmen, the managers . . .”

He describes a dark and depressive health system, infected by a Dickensian blight — a distinctive brand of suffocating managerialism, pursued by a public service bent on enforcing the centralist policies of successive governments.

Trapped in this bureaucratic fog are droves of disillusioned doctors who entered medicine to care for patients, only to find themselves preoccupied with government directives and the querulous demands of health quangos. Significantly, given modern management practice, the petty vindictiveness and endemic dishonesty in dealing with clinicians’ concerns is ironic.

And all the while “a miasma of intellectual and moral corruption hangs over every hospital . . .” Nor do doctors escape Dalrymple’s scathing pen. They are accused of “remaining entirely supine” in not marshalling much resistance to managerialism, or, even worse, of manipulating it to their advantage.

Such managerial mayhem is orchestrated to let doctors “know who is boss and that Big Brother is watching them.” Dalrymple argues that the UK government has long since lost the trust of the people and postulates that: “If it cannot improve its own reputation . . . it can at least destroy that of the medical profession by undermining the basis of the popular trust placed in it, for the government wants no autonomous professions with which it can be unfavourably compared.”

Australia was colonised because of a unique British blight — an overcrowded prison system. Has this latest British blight also reached our shores?

*Dalrymple T. A doctor’s farewell. The Spectator 2005; 22 Jan: 14-15.


  • Martin B Van Der Weyden

  • The Medical Journal of Australia

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