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    Doctors are rarely accountable for the average quality of their work in terms of outcome. They have to answer for exceptional events, unexpected disasters lying outside the normal range of experience, but rarely for assessment of average process, and virtually never for average outcome. If disasters don’t occur, or don’t reach the ears of authority, quality of work is assumed to be satisfactory. Even if it is so obviously unsatisfactory as absolutely to demand enquiry, that enquiry will use process rather than outcome measures. For example, the expected mortality of a planned operation for repair of inguinal hernia in a […]
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    The National Health Service (NHS) Act was promised in the Labour landslide election of 1945, passed into law in 1946, and the service itself launched in 1948: a non-contributory comprehensive service making all forms of medical, dental and nursing care, in hospitals or in the community, available free to the whole population, paid entirely from central government funding. I qualified from St. George’s Hospital in London four years later, and will retire from full-time clinical practice in 1988; the NHS allowed me to do my own work and refer my patients to the full range of specialist services during an […]
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