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Medicine and the human factor
  1. Piotr Szawarski
  1. Anaesthesia and Intensive Care Medicine, Wexham Park Hospital, Slough, UK
  1. Correspondence to Piotr Szawarski, Consultant in Intensive Care Medicine and Anaesthesia, Wexham Park Hospital, Frimley Health NHS Foundation Trust, Slough SL2 4HL, UK;Piotr.szawarski{at}

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All life is precious, but it seems that the lives of NHS staff are disposable as long as targets are being met.

Clare Gerada1


The great William Osler once said, ‘The practice of medicine is an art, not a trade; a calling, not a business; a calling in which your heart will be exercised equally with your head.’2 Unfortunately, healthcare is increasingly seen as an industry rather than art and the emotional aspect of medical practice is more and more ignored, to the detriment of both the patient and the doctor. Aside from clinical excellence, safety quite reasonably became one of the goals of modern-day medical practice. Borrowing from the industry, a human factors approach is increasingly being applied to improve the reliability of performance, reduce the number of errors and improve safety. This essay is about the lynchpin of any complex human venture, the human. The venture in question is delivery of care in particularly complex, potentially stressful environment. In the attempt to improve safety and in the face of growing complexity, increasing attention is being applied to the process of care delivery, the efficacy and the reliability. This may erode the traditional values treasured by doctors that include autonomy, creativity and personal experience leading to disillusionment or disenchantment with the practice of this great art.3 The resulting emotional exhaustion, depersonalisation and reduced professional efficacy have been termed burn-out. The diagnosis of burn-out as an occupational phenomenon has been acknowledged by the International Classification of Diseases 11th iteration of classification of diseases.4 A mental health problem, however, is not a label a physician would seek voluntarily and for good reasons. The establishment discriminates against a sick doctor.5 This is apparently justified by the need to protect the public, but is the public not better …

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  • Contributors PS conceived, researched and wrote the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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