Das Krankenhaus als Fabrik...

Behold the factory worker
The foundation year 1 (F1) doctor’s role is like that of a factory worker.1 He or she must look at the patient simply as a product on the conveyor belt of the NHS factory. All empathic sentiments must be left with their coats when the workers clock in at 8.30 am. Any emotional feelings about the product (patient) or extra time spent talking to it would only waste valuable factory time. The product must get through the system in the specified time and the factory worker (F1 doctor) must commit all his or her energy to making sure that as many products get on to the conveyor belt as quickly as possible.
The new factory worker emerging from Modernising Medical Careers must be cold and unfeeling. He or she must also be reasonably efficient, although cutting corners is acceptable as long as the product has a label (diagnosis) on it. The supervisors (consultants and registrars) do not usually check that all the labels are correct as they are so busy themselves, usually in another part of the factory. So even the correct label is not important, the only thing that matters is that the labels are slapped on as quickly as possible and that the products look as if they are finished. Unfortunately, the products often break again after leaving the factory, but that doesn’t matter as long as the managers can tick the boxes on their clip boards and count that the right number of products are delivered for the target count at the end of the day.

Jane A Calne, honorary senior lecturer
1 UEA School of Medicine Health Policy and Practice, Norwich NR4 7TJ
agacalne@ukonline.co.uk

BMJ 2007;335:1169 (8 December), doi:10.1136/bmj.39416.367500.BE