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OBITUARY. St James Church Surgery 1987-2016

                                             Photo by Ruskin Kyle

Location and vocation – some grand entrances: St James Church (Home to the author's NHS surgery for nearly three decades)

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Professional Profile

David Zigmond initially trained in Medicine in the 1960s. From this he developed a lifetime interest in the often dislocated but creative tension between art and science in understanding ourselves, one another and any effort to be 'helpful'. His explorations have led to a crystallisation of humanistic and person-centred approaches to understanding (medically, 'diagnosis'), and influence (medically, 'treatment').

In the decades following his qualification he trained in General Medical Practice, Psychiatry and Psychotherapy (both psychoanalytic and humanistic) - an amalgam initially not uncommon, but now almost extinct. His professional involvement has continued in all of these activities, both as a frontline practitioner in the National Health Service and in postgraduate education of psychotherapists, doctors and other healthcare professionals.

He has written numerous articles, since the 1970s, which investigate often-overlooked social and psychological aspects of care. His perspectives combine, particularly, the pragmatically humanistic with the accessibly philosophical. The resulting appeal, for disciplined and imaginative eclecticism, is more compatible with traditions of liberal education than with the current march towards regulation and hegemonised training.

He pioneered the distinction between dis-ease and disease, and the use of the terms psychoecology, pastoral healthcare, headspace, heartspace and technototalitarianism: the developed themes are evident in his many writings.

Growing trends to the industrialisation of healthcare have often (unwittingly) displaced quality and continuity of personal contact. His recent articles have sought to raise awareness and debate about the seriousness and complexity of this loss. Thoughtful choreography between art and science is required: his writing reflects this with language composed to be both poetic and precise.

Author's note and acknowledgements

The following selection of articles, from 1976, were published in a variety of journals. I am grateful for each publisher's permission to reconvey them here. Acknowledgement of the original publication and date are to be found at the end of each article.

The older articles were written for mainstream medical journals and readers, and have a more formal style and format than later writings, which generally adhere far less to traditional and academic convention.

In 2005 I became belatedly aware of the nature and threat posed by the industrialisation, marketisation and computerisation of NHS Healthcare. Much of what I have written since derives from this. For those wanting a gentle trial introduction I suggest starting with the shorter letters, which present the skeleton of my ideas. The longer essays and articles 'flesh out' these basics with further exploration, documentary narrative and, sometimes, verbally tone-poemed description to attempt to capture subtler aspects of experience - an important strand in the art of Medicine.

I have not changed the old-fashioned, generic 'he' to the now politically-correct 'he/she', merely because it sounds and looks cumbersome (to me).

I decided on only minor editorial revisions, and only to the older articles. With these I have shaved, tightened, reshaped and sharpened some of the language, but have left the design of argument, analysis, examples and narrative as it was.

Medical and social historians may enjoy finding anachronisms and (now) historic relics: Doctors' White Coats and Residents' Messes, dissection tables, Mental Hospitals and militaristic professional titles and patriarchies have all but disappeared. Likewise, the designation of 'Psychosomatic', though not the problems. The older articles may thus seem quaintly dated. Their motivating quest, for holistically caring systems and psychologies - of resonance, imagination and dialogue
is, I believe, now ever-more relevant.

David Zigmond


Photo by Ruskin Kyle

In harness


Introduction to the writings of David Zigmond

David Zigmond's new book

If you want good personal healthcare - see a Vet:
Industrialised Humanity: Why and how we should care for one another?

Further information about David Zigmond's books

Book Review by Pulse

2016 Book Launch in Bristol

Book Launch Videos

Dr Zigmond, founder member of BHMA, GP, psychiatrist and author, has published the anthology of his writings. Meet him in the video below speaking at the London launch of his books held at the Royal Society of Medicine in October 2015.

Short version of video (2 mins)

Long version of video (12 mins)

Radio Podcasts

Radio podcast interview 1: 6 October 2016.

The coerced closure of a much loved small traditional general practice: early experiences and reflections.

Radio podcast interview 2: 19 January 2017

The managed loss of personal medical services: later and broader reflections.


[63] Government may like giant GP practices, but what about the rest of us?
Letter to
The Sun, March 2017

[62] Revitalising the NHS? Get rid of the Internal Market
Letter to
The Guardian, February 2017

[61] Our oppressive Care Quality Commission: our depressed NHS
Letter to Academy of Fabulous NHS Stuff, February 2017

[60] ‘Stakeholders’ in suicide prevention: isn’t that all of us?
Letter to Chair, Parliamentary Health Select Committee, February 2017

[59] Prevention of Suicide. The crux of personal continuity of care
Letter to Chair, Parliamentary Health Select Committee, January 2017

[58] Dying with, or from, dementia? An important distinction
Letter to
Daily Telegraph, December 2016
BMJ Blog, January 2017

[57] Older people often need a different kind of hospital
Letter to
Daily Telegraph, December 2016

[56] Our ailing profession: our consequent fractious collegial misunderstandings
Letter in
British Journal of General Practice, December 2016

[55] CQC Inspection and closure of my NHS General Practice. Farewell from a long career
Letter to Chief Medical Inspector of Care Quality Commission, November 2016

[54] Price and value in personal care: the planned closure of community pharmacies
Letter to
Daily Telegraph, October 2016

[53] Our burgeoning NHS problems are more organisational than financial
Letter to The Observer, September 2016

[52] The doctor is out, but still answering
Letter to
The Observer, September 2016

[51] How and why do we retire? Ill omens for younger doctors
BMJ Blog, September 2016

[50] Letter to NHS colleagues, July 2016

[49] Only personally fulfilled practitioners can deliver good personal healthcare
Interview with
Independent Age, May 2016

[48] General Practice needs more than recruits and money: we need to refind our vocational attachments
Letter to Daily Telegraph, April 2016

[47] Plummeting morale of junior doctors: one branch of our blighted tree of Welfare
Letter to the Chair of the Academy of Medical Royal Colleges,2016

[46] Can we reduce childhood Sepsis by more vigilant management? I doubt it
BMJ Blog, February 2016

[45] GPs’ demoralisation is due to our loss of human connection
Letter to the
BMJ, February 2016

[44] Our demoralised and depersonalised NHS workforce
Letter to Chair of the Parliamentary Health Committee, February 2016

[43] How to make our NHS sustainable? We are losing personal morale and commitment faster than money (re cross-party review)
Letter to Shadow Secretary of State for Health, February 2016

[42] "Airline levels of safety in healthcare"? No, we can't
Letter to
The Telegraph, February 2016

[41] How to make our NHS sustainable? We are losing personal moral and commitment faster than money: Letter to ex Health Ministers, January 2016

[40] Flood defences? It is we that need containing
Letter to
The Independent, January 2016

[39] An electronic questionnaire is far from a personal dialogue: Further reflections on professional Appraisals
BMJ Blog, November 2015

[38] Arguments about money are often about much else
BMJ Blog, November 2015

[37] Competence or Compliance? The corrosive cost of professional practitioner Appraisals
BMJ Blog, September 2015

[36] Burgeoning need: collapsing staff morale – the management conundrums of the NHS
Submission to the Secretary of State for Health, 2015

[35] ‘Curing Dementia’: Medical possibility or political rhetoric?
Letter on
BMJ Blog, May 2015

[34] In public service we need personal integrity, not personal loyalty
Letter to Daily Telegraph, April 2015

[33] The Extinction of Care by Treatment: Our healthcare’s heart-failure
Letter to
BMJ, February 2015

[32] The loss of personal containment in pastoral healthcare
Letter to mental health commissioners, managers and senior practitioners, 2015

[31] NHS Stewardship: the missing personal factor
Letter to
the BMJ, 2014

[30] Reclaiming the NHS: Let’s discard the entire Internal Market
Letter to the Guardian, 2014

[29] Repealing the Health and Social Care Act: why stop there?
Letter to Andy Burnham, Shadow Secretary of State for Health, 2014

[28] The death of Robin Williams: can we ‘treat’ our tragic paradoxes?
BMJ Blog, August 2014

[27] Depression needs more than formulaic treatment
BMJ Blog, July 2014

[26] Personal continuity of care in Mental Health Services
Letter to Minister of State for Care and Support. May, 2014

[25] Personal continuity of care in hospitals. Restoring the role of the General Physician
Letter to Secretary of State for Health. January, 2014

[24] Thank Goodness we now have business-sense to safeguard our Welfare
Letter in the
Independent, January 2014

[23] Form Devouring Essence: When brokered services tend broken hearts
Letter to Mental Health Colleagues and Managers, January 2014

[22] Dementia is not only (or even) a disease: it is a signal of our community cohesion
Letter in The Telegraph, December 2013

[21] We need an appointment with Dr Finlay
Letter on BMJ blog, December 2013

[20] Qualifications may be less than useful
Letter to The Independent, 2013

[19] Dr Frankenstein’s Reprise: Industrialisation of Personal Healthcare. Adverse effects of sequestered psychiatric in-patient services
An open letter to Medical Directors of services, October 2013

[18] Loneliness in the ailing elderly: social and healthcare responses
Letter to Secretary of State for Health, 2013

[17] Re-establishing personal bonds and understandings in NHS Care Letter to Secretary of State for Health, October 2013

[16] NHS Healthchecks: more automation and less intelligence
Letter to The Times, 2013

[15] Psychiatry? Everyone is right - but not for long
Letter to The Guardian, 2013

[14] The high price of commodified healthcare
Letter in
The Guardian, August 2013

[13] How Care Pathways obliterate care: More industrial follies from the NHS
Letter in The Telegraph, July 2013

[12] NHS Savings? Abolish the Internal Market
Letter in The Guardian, July 2013

[11] Physis: healing, growth and the hub of personal continuity of care
A thirty-nine (39) year delayed follow-up correspondence with Sally, June 2013

[10] The rise of business culture in the NHS; our consequent loss of
compassionate healthcare ethos

Letter to
The Times, 2013

[9] 'Fixing the NHS is straightforward'. Really?
Letter in the BMJ, March 2013

[8] Balancing healthcare: Technical vs Personal. Local vs Systemic. Closures at Lewisham Hospital
Letter to Joan Ruddock MP and Lord Ara Darzi, February 2013

[7] Continuity of Care: Of course, but whose? A Sleight of Slogans
Letter to Family Doctor Association, 2012

[6] ‘Evidence’ is both more and less than it seems. The rise of scientism and the demise of the personal in healthcare
Letter to the Secretary of State for Health, 2012

[5] Eric: Another victim of Hypertrophic Obstructive Management Coagulopathy
A letter to the Medical Director, South London and Maudsley NHS Trust, June 2012

[4] Further NHS Reforms: inevitable and unintended consequences
Letter to BMJ, May 2012

[3] Commodification, commissioning and commercialisation: the growing threats to personal healthcare
Letter to the Secretary of State for Health, 2012

[2] Five Executive Follies
How commodification imperils compassion in personal healthcare

Submission to Secretary of State for Health, December 2011

[1] Bureaucratyrannohypoxia
An open letter to Mental Health Services Director, September 2010

David Zigmond would be pleased to receive your FEEDBACK


[1] The Medical Model—its Limitations and Alternatives (1976)

What it says in the title! Uses the example of an ailing, elderly man struggling with later-life changes. The biomechanical can only take us so far: after that we need a certain kind of imagination. What is that?

[2] Suicide and Attempted Suicide: Its Origin and Course (1977)

Serious kinds of mental illness and self-harm are most easily designated. But what about more subtle forms of self-damage and self-sabotage? What are they?

[3] Out of Sight But Not Out of Mind (1977)

Those who professionally care for others are often much harsher with themselves. Overall, doctors have higher suicide risks than their patients. Why?

[4] Scientific Psychiatry: Progress or Regress? (1977)

Medicine and Psychiatry operate from a premise of taking responsibility and defining reality for others. What are the implications for those who need to reclaim these capacities, for themselves?

[5] Illness as Strategy and Communication (1977)

Illness is often best understood and approached beyond the biomechanical. Experiences or conflicts not otherwise manageable can find a refuge and conduit in illness. How and why?

[6] Adjustment or change? Radical issues in psychiatry (1978)

Often mental distress is designated in a way that further ‘pathologises’ and stigmatises the sufferer. How may we, rather, reframe our problems in ways that are self-realising and empowering?

[7] The Elements of Psychotherapy  (1981)

A short survey written for Doctors. How may thinking and talking with another person help the harmony of body, mind and relationships? How to start and when to stop?

[8] Transactional Analysis in Medical Practice: Part 1 (1981)

A clear and flexible model helping us understand the different parts of ourselves and others. How are these related to our unique stories, and then our patterns of concord or discord?

[9] Transactional Analysis in Medical Practice: Part 2 (1982)

A continuation of Part I. How are so many repetitive unhelpful patterns set up in childhood, to last a lifetime? If we can understand, when is this helpful in redirection?

[10] A Psychosomatic Approach (1982)

How, by expanding the biomechanical approach into a more multifaceted holism, can we broaden and deepen understanding and engagement with individuals?

[11] The Psychosomatic Mosaic (1982)

A further coaxing of the biomechanical into a broader holism. How can individual illnesses be encountered and understood in family systems?

[12] Mother, Magic or Medicine? The Psychology of the Placebo (1984)

Placebos are fascinating phenomena of induced interpersonal healing, sometimes by accident! How does this happen? What are the developmental and transactional psychological theories that can explain?

[13] Physician Heal Thyself: The Paradox of the Wounded Healer (1984)

What are the personal vulnerabilities of doctors? How are these related not only to individual wounds, but to idealised roles and depersonalised trainings?

[14] Babel or Bible?
Order, Chaos and Creativity in Psychotherapy

Theories of mind are only ever ‘good-enough’, for now. What happens when psychotherapists (and others) elevate their theories to a realm of Immaculate Truth?

[15] Three Types of Encounter in the Healing Arts:
Dialogue, Dialectic and Didacticism

Knowledge, language and understanding are all human activities and constructions. What are the different types when we encounter others? How do we then ‘pack’ or ‘unpack’ the experience of these others? How, when and why does it matter?

[16] The Psychoecology of Gladys Parlett (1988)

Distressed people often want skilful, if ritualised, human contact. What happens if we unimaginatively and excessively medicalise this? Gladys, in the 1980s, forewarns us.

[17] The Front Door of Psychotherapy:
Aspects from General Medical Practice

The communicative skills - enabling others to heal, grow and become more resilient - have been distilled and documented, especially by psychotherapists. What happens in other venues with these kinds of complex exchanges? How is this enacted in General Practice?

[18] The Shadow of Venus: Atavism and Sexuality (1995)

Our sexuality is one of the more tragi-comic deciders of destiny. Can an understanding of our evolution, as a species and as individuals, explain why?

[19] Edward: shot in his own interest. Technototalitarianism and the fragility of the therapeutic dance  (2005)

We have become accustomed to almost everything being prepacked, containerised and computer-coded. This has happened to knowledge. What happens to personal knowledge?

[20] Planning, Reform and the need for Live, Human Sacrifices: Homogeny and Hegemony as Symbols of Progress (2006)

What are the hidden psychological currents that may lie behind zealous attempts to ‘modernise’ and standardise? Some motives may be obscured and dark. How are they expressed?

[21] Modern Times: True Parables from the Frontline of the NHS  (2008)

Change is often called ‘progress’. Looking at changes in healthcare, this considers two themes: ‘Imagination’ and ‘Belonging’. When is change progress?

[22] No Country for Old Men:
The Rise of Managerialism and the New Cultural Vacuum

The more we control, the less free we are to explore. If we increase the culture of management, what happens to the spirit of enquiry? And patient care? A historical account.

[23] Psychiatry: Love's Labour's Lost
The pursuit of The Plan and the eclipse of the personal

In psychiatric and psychological healthcare, personal attachments and investments in therapeutic work have been eclipsed by ‘objective’ attempts at management. What has this been like for patients and staff? A thirty-five year spanned portrait.

[24] Why Would Anyone Use an Unproven Therapy? 
Treasures in the Mist  (2010)

Much of the most effective work healthcare workers do is inexplicit and undesignated. What does it, then, consist of? The Wizard of Oz has much to tell us.

[25] Idiomorphism: the Lost Continent
How diagnosis displaces personal understanding

Diagnosis is a professional convention enabling us to cluster and code. Sometimes it is essential and crucial to help. At other times more is lost than gained. What? Why? Who?

[26] Resolved or Abandoned?
Irresponsibly lost Transference: a professionally embarrassed tale

Psychotherapists increasingly talk of managed and schematised personal change, but often the catalysts are serendipitous. What can happen?

[27] Sense and Sensibility:
The danger of Specialisms to holistic, psychological care

Few would want an operation done by a non-specialist. So is specialisation always a good thing, with every kind of distress? Can we go too far? What happens then?

[28] How to help Harry - Friend or Foe?
The scientific and the scientistic in the fog of the frontline

Helping others to change can be a very delicate dance. Attempts at ‘civic engineering’ frequently miss nuances of meaning and opportunity. Does this matter? Why?

[29] Eric - diagnosis may sometimes be necessary; it is rarely sufficient (2012)

Centralised planning and control are key to the success of many healthcare initiatives, for example the containment of dangerous infectious diseases. But what are the limits of this approach? Eric shows us what can happen in mental healthcare.

[30] Fallacies in Blunderland: Overschematic overmanagement: perverse healthcare (2012)

Competition, commissioning, contracting ... do such devices really ‘drive up’ the quality of healthcare? Are there other, absurd and darker consequences? What are these?

[31] From Family to Factory: The dying ethos of personal healthcare (2012)

NHS healthcare has transformed looser, informal, colleagueial networks of care into tighter, sharper, more managed ‘production units'. We have turned families into factories. What have we lost?

[32] Understanding the Other: Four elemental questions for therapeutic psychology. A personal view (2012)

When attempting to understand and help the anguish of another, what kind of knowledge helps us most? What lies behind and beyond designated systems? Can one have a ‘holistic psychology'?

[33] Words and Numbers: Servants or Masters? Caveats for holistic healthcare Part 1 (2012)

Holism’s fuller engagement with realities is an aspiration and ideal. It can never be complete, and in practice, there are many obstructions. These range from our use of language to our highly managed and industrialised culture. How does this happen? What are the consequences? This is the first of two articles.

[34] If you want good personal healthcare, see a Vet. Caveats for holistic healthcare Part II (2012)

The over-explicit and over-schematic can block our perception of larger and more subtle realities. This second of two articles portrays how this happens, and what we may be left with.

[35] Democratic Fatigue: information overload (2012)

Is increasing choice and information always what we want? Do these necessarily facilitate democratic sense and empowerment? The non-participation in recent Police Commissioner elections suggests otherwise. Parallels in healthcare are instructive.

[36] Missed and Miscommunications: Personal disconnections in Psychological Healthcare. A letter for embattled colleagues. (2013)

Throughout our most important, difficult and intimate relationships we must be able to listen carefully to what we do not want to hear - without this much is jeopardised. This is true, too, in many of our healing encounters - often these require our best attempts to creatively contain dissonance.

[37] PsychoTapas (2013)

PsychoTapas! Sound-bite seminars for modern conferences!

[38] Institutional atrocities: The malign vacuum from industrialised healthcare (2013)

Flagrant neglect or abuse in our care of the vulnerable within our advanced Welfare State seems shockingly perverse. How and why does this happen?

[39] Beyond Orwell: Healthcare’s hollow governance (2013)

Our smallest difficulties with others are often rich in political complexity. What does this mean? Two apparently trivial examples from healthcare administration are explored.

[40] Language is not just data: it is a custodian of our humanity (2013)

Computers and informatics have become central to NHS healthcare. All experience and activity are now subject to official technical designations. This changes our communications: language becomes increasingly lackeyed to the computer’s requirements. Much else is lost. What?

[41] Post Mid Staffs: A Plenitude of Platitudes (2013)

Can the harmful excesses of depersonalisation in healthcare be usefully addressed by further redesign of systems and management? Or do we need a different kind of thinking and vocabulary?

[42] 'GPs know their patients, families and communities' - Really? (2013)

GPs are increasingly employed as task-directed, upper-echelon healthdroids. They are losing the pastoral skills that depend on holistic views and vernacular understandings. Why is that?

[43] Hello, Health Commissioner. Goodbye, Family Doctor? The new healthcare reforms and their threat to personal doctoring. (2013)

The idea, now diktat, that GPs should lead the complex provision of healthcare for localities may subtract more than it adds to overall health-welfare. How and why could this happen?

[44] All is Therapy; All is Diagnosis. Unmapped and perishing latitudes of healthcare (2013)

Advances in medical science have often subtly and inadvertently subverted human connections and understandings. Vignettes spanning sixty years show how and why.

[45] Our Ill-faring Welfare. The hinterland of our headlines (2013)

Despite ever-increasing funding and management initiatives, our public welfare services seem riddled with unhappiness, corruption and sometimes cruelty. These are alarming paradoxes: how do we understand them?

[46] Bingo! Majoritarian Healthcare! (2013)

Transparency, Accountability and Democracy can seem like a protective triumvirate for public decision making, but these can easily turn shallow, demotic and false. Here is a small example of what is coming.

[47] Where in the World are You? Miraculous cyber; insidious dislocation (2013)
What do mobile communications, Internet sex and modern schematised health systems have in common? – a computer mediated disconnection of intended content from embedding human context. What happens?

[48] Form Devouring Essence: When brokered services tend broken hearts (2014)
Our healthcare rhetoric of data and systems has largely destroyed our capacity to make the kind of personal bonds that understand and heal human dissonance. Stephen and his plight serve to illustrate and explore this.

[49] Autoasphyxiation: The doomed brief of GP Clinical Commissioning Groups (2014)
The corralling of GPs to design and commission health services cannot counter the inherent disintegration and depersonalisation of Marketisation. A glimpse from the frontline.

[50] Some Countercultural Caveats for Pastoral Healthcare – the fractious coexistence of packaged care and therapeutic spirit (2014)
Pastoral healthcare has a crisis of competence, morale and humanity. This currently eludes enormous funds and myriad think-tanks. The elusions are subtle. What are they?

[51] Neglect in NHS Healthcare? (2014)
We have turned familes into factories.

[52] Packaged Mindfulness? Some unpackaged pieces of mind. Can our integrity and wisdom thrive with mass-production? (2014)
Our increasing push-buttoned and systems-managed world has produced myriad losses of human relationship and personal sentience. Can this then be countered by modern packaging of ancient wisdom and practices? Is this our wisest approach?

[53] A day in the life (2014)
Man Overboard! A brief autobiographical cross-section

[54] NHS England 2014: Vichy France 1941: The old ghosts in our new NHS machine
Governmentally prescribed schemes to increase democratic accountability in Welfare are easy to intend, yet very difficult to implement. They can easily backfire to unanticipated forms of oligarchy or totalitarianism. How does this happen?

[55] Our unravelling humanity: do we need more regulations? (2014)
To its credit the government seems to now be understanding the importance of lost human connections. The response, though, is predictable: it is to add to Healthcare’s already massive regulation. This may add rather more to our problems. How?

[56] PBR, PBC, PCT, CCG, CMHT, CBT, NICE, QUOF: NHS Alphabetti spaghetti? A guide for the perplexed: a critical glossary (2014)
What do the plethora of NHS institutional terms mean? Why are they important to understand? And what is their relationship to one another? Can this help explain our current malaise in healthcare? Here is a critical glossary.

[57] Mass-produced Mindfulness for Common Mental Health Problems: The awkward dance between managed systems and human meaning (2014)
A greater and calmer sentience is key to much of our better health and life-experiences. Can we mass-produce methods to achieve this?

[58] Our Welfare is ill-fared by yet more strictures and structures (2014)
Surely, all Welfare professionals should forever be more strictly appraised and registered? Here are some reasons why not.

[59] Six Suicides and One Homicide. The catastrophe of jettisoned personal containment in healthcare (2015)
Care and treatment are different though synergistic. The increasing trend to executise treatment over care destroys this critical complementarity. The consequences show us how important are such balances.

[60] Healthcare's Hole in the Heart : Can we have value for money and not lose our humanity (2015)
Efficiency has now become cardinal in healthcare management. Increasingly methods from competitive production industries have been adopted. Yet the results are often paradoxical and demotivating. Why is that?

[61] Appraisals: how do we assure safety without asphyxiation? (2015)
‘We can’t carry on like this!’ is now a familiar cry of impotent frustration throughout Welfare services. Clearly we need challenges to our dysfunctional order. Yet our officials’ responses are often redolent of the last gasps of Empire: draconian authority with officious nervousness. What is happening?

This example – of General Practitioner Appraisals – is a telling microcosm.

[62] A Fortunate Man: the vulnerability of vocation. A major work revisited (2015)
A Fortunate Man – a searching portrait of a country GP by essayist and novelist John Berger – was first published in 1967. It projected a highly personal view of medical practice: one undertowed by rich human complexity. Nearly fifty years later, what does this anciently pioneering book offer us?

[63] Rick and Ajita: How may we reconcile systems of healthcare with our subtle humanity? (2015)
Systems – our ordering of commonalities – have contributed greatly to our treatment of structural disease. Elsewhere systems are much more problematic. Rick and Ajita show us how and why.

[64] Evidence from Professional Appraisals? We learn more about the governors than the governed (2015)
Professional Appraisals have become often absurdly complex, cumbersome and remote, and then blindly authoritarian. Now they obscure and destroy more than they can assure. What, then, do Appraisals tell us?

[65] Off-piste: only fresh tracks lead to fraternalism in healthcare (2016)
Care Pathways – executively designed systems for all – can easily displace the nourishment of our healthcare from fraternalism. What is that? Two intimate vignettes illustrate.

[66] From Balint to Square-bashing. Fifty years’ experience of General Practice (2016)
Our healthcare’s increasing employment of complex technology is often accompanied by a disinheritance of our human complexity. This inverse relationship is undesigned but ever-more important. A personal history of the culture explains.

[67] Preventing Overdiagnosis? Yes, but what kind? Part 1: Geography (2016)
‘Preventing overdiagnosis’ should be an undeniable call. Yet even to agree a definition will prove impossible. To understand why it requires us to look far beyond the workaday tenets of our professional practice: the hinterland is vast. This is the first of two parts.

[68] Preventing Overdiagnosis? We need fewer systems and more philosophy Part 2: Geology (2016)
Contemporary medical practice now harvests two new and increasing tranches of diagnosis: first, subjective experiences of discordance, disturbance or distress; then symptomless but risk-linked biometric anomalies. These have led to a massive medicalisation of areas of life often better otherwise understood.

[69] Revitalising Holism. We need literature of wit and grit more than piety and idealisation (2016)
‘Holism’ can easily become a politically correct, liberal healthcare catechism. A recently published book of sterling values,
The Snake in the Clinic, illustrates the problem. Here is a review.
Published in
Journal of Holistic Healthcare. Vol 13, Issue 3, Winter 2016

[70] Our ailing profession. We need more than resilience and replenishment (2016)
The malaise among NHS healthcarers is akin to the patient dying from an internal haemorrhage: oral replenishments, or even transfusions, may be very inadequate.
A recent day conference parried this perspective.

[71] Can Art’s courageous experiments also be accessible? A review of a brief work of brilliant obscurity (2016)
Sometimes art and philosophy tantalise us with ideas or experiences we can never quite ‘get’. Sometimes, we may suspect, this is the author’s intent. Can this, nevertheless, enrich us?
Published in
Journal of Holistic Healthcare. Vol 13, Issue 2, Summer/Autumn 2016

[72] How and Why Do We Retire? Ill omens for younger doctors (2016)
The nature of our departures from our work often tells us much about what kind of problems are being left behind. The individual may escape, but what about the wider community?

[73] Introductory note to Death by Documentation (2016)

[74] Death by Documentation: The penalty for corporate non-compliance (2016)
Our organisational efforts to assure fail-safety, uniformity and probity can easily – in excess – turn destructive beyond anyone’s wish or anticipation. This tale tells how such ‘mission creep’ happens and how it is sustained.

[75] General Practice is the Art of the Possible: but we are turning it into a tyranny of the unworkable. Reflections on our inspections regime (2016)
There used to be a tacit assumption that healthcare (and welfare generally) was mostly imperfectible, but that practitioners would generally do their best. All that has been replaced by something very different. This long letter – to an NHS inspection manager – shows in detail how we lose our professional trust, identity and integrity.

[76] CQC Inspection and closure of my NHS General Practice. Farewell from a long career
Letter to Chief Medical Inspector of Care Quality Commission,
November 2016

[77] The Proof of the Pudding is in the Eating: Actual and virtual realities: how our inspection culture unhinges, (2016)
What’s really going on? How do we know? Who do we listen to: the participants or officially designated inspectors? This response to a contended official report – that rapidly closed down a small and very popular GP surgery – portrays our difficulties.

[78] Is expedience the death of our professional spirit? What our colleagueial utterances are telling us (2016)
Short-term adaptations to survive may – longer term – have the reverse effect. How can this be? This short dispatch, from an ailing frontline of our NHS, explains.

[79] Too Big to Talk About. Organisational momentum: its paralytic wake (2016)
Corporatism often enlarges and entrenches itself by increasing demands for compliance. Eventually though, unchecked, this will sicken any organisation. Such is now evidently ailing our NHS. A brief glimpse from a small conference provides a sample.
BJGP Blog, February 2017

[80] I, Daniel Blake. Industrialised humanity: why and how should we care for one another? Fraternal wisdom from a film maker (2017)
How do we best assess the complex needs of others? Are these best served by always increasing systems – now particularly computerisation and proceduralisation – to determine our human contact? A recent film
I, Daniel Blake, cautions with courageous wisdom.

[81] When is Compliance Necessary for Public Safety? The policing of Welfare: a personal story (2017)
Imposing managerial order onto some aspects of our natural human complexity is far more easy and attractive to design than to sustain. Our misplaced and excessive efforts can lose us far more than we gain. Here is one salutary story and a broader analysis of social control.

[82] Holism is less about eliminating root causes than tending our many branches. Reflections on causation in healthcare (2017)
Attributing causes to human behaviour and predicaments may seem often essential and sometimes easy: it is frequently tricky. With the pursuit of ‘root causes’ this is especially so – the greater our efforts, the more we are likely to miss. An intimately observed example explains.

[83] Abolishing the NHS Internal Market. Too big to talk about? (2017)
Our healthcare culture is now largely controlled by notions of commerce, ubiquitous surveillance and micromanagement. The inevitable depersonalisation is increasingly disliked by both healthcarers and patients. Nevertheless we seem unable to reverse these effects. What is happening? How do we respond?

[84] When is Change Progress? Are we throwing the baby out with the bath water? (2017)
Risk management and quality assurance must always be good, surely? Not necessarily. More of something good is not always better. Sometimes we can add more problems than we take away. A complex public event and two private dialogues illustrate.

[85] David Zigmond: Biography for Centre for Welfare Reform (2017)

The End?

Section Contents Copyright ©; Dr David Zigmond 1976, 2017          

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