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J R Soc Med. 2006 March; 99(3): 105–106.
PMCID: PMC1383751

Redisorganization theories

You are to be congratulated for publishing the paper by Oxman et al. (December 2005 JRSM1). The authors are to be lauded for it. Underlying their presenting frivolity, they clearly express serious concerns.

It is surely redisorganizational practices which have done so much harm to the medical profession, and thereby to the patient. The first of these arose, of course, as the result of Bevan ignoring the conclusions of the Beveridge Report and the warnings of the Fellowship for Freedom in Medicine, instituting the NHS, rather than what was required—a national health insurance service. Doctor/patient confidentiality was destroyed on day 1, with clinical notes becoming the property of the Minister of Health.

Over the subsequent half century and more, further and further administrative intrusion into clinical matters has resulted in ever-increasing costs to the patient/tax-payer, concomitant with the medical profession being prevented from using more than half its time in the service of the patient. The patient must understand this.

What we need is not a `peasants' revolt' but a `patients' revolt'. We desperately need to mend the long-term damage done by generations of politicians/administrators.


1. Oxman AD, Sackett DL, Chalmers I, Prescott TE. A surrealistic mega-analysis of redisorganization theories. J R Soc Med 2005;98: 563-8 [PMC free article] [PubMed]

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press