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Logo of brjgenpracThe British Journal of General Practice
Br J Gen Pract. 2007 March 1; 57(536): 253.
PMCID: PMC2042559


I thought I was in a Kafka novel. One of my colleagues has worked with the same surgeon for 17 years. They did a busy all-day list. They arrived first thing in the morning, and just worked on through the day until the work was done. Sometime around midday, they'd reach a mutual decision to stop, grab a sandwich, and then get on with the list. There would be a 20-minute break.

Then someone started counting. They didn't count how many patients were operated on; they counted theatre ‘downtime’: this is the time when there is no patient in the operating theatre. The informal, snatched-on-the-go lunch break counted as downtime, and this was deemed unsatisfactory. Things would have to be rearranged.

One day, the surgeon and anaesthetist arrived to find a much shortened list. Except that it wasn't shortened; it had been published as two separate lists, a morning list and an afternoon list with a formal lunch break of 1 hour — because this hour would not count as downtime. Because of this rearrangement, fewer patients could be operated on in the day; but downtime figures were better. Sometimes the morning list ended a bit earlier than expected, but the protocol required afternoon patients to be fed so they couldn't be operated on earlier.

I would like to say that this is all middle-management nonsense, but the truth is more indicative of NHS ills. First, instead of employing more people to treat patients, trusts are forced by the Department of Health to employ bean counters. And the poor bean counters do not have the best means of counting the beans. Our operating theatre logging program dates from 1982. The computers are lovely: big flat screens that can show X-rays quickly and in enormous detail. But the inflexible logging program won't allow a lunch break in an all-day list; it understands only a fixed 1-hour lunch break taken between separate lists.

So I'm not in a Kafka novel; it's just the old, old NHS story of having to make do. And while I'mon the subject of computers, why doesn't someone sort out a utility in email that checks messages for the word ‘attach’, and then, before sending the message, asks the dumb fool typing the message whether they have attached the attachment? Modern computer programs take up megabytes of memory, allow you to do all sorts of fancy things undreamed of in our theatre logging program, and then allow you to appear a complete idiot by forgetting to click on the paperclip.

Articles from The British Journal of General Practice are provided here courtesy of Royal College of General Practitioners