This is DZ guide to government and managers at all levels on how to try and demoralise and demotivate the medical profession.
1) Make it plain that you believe they are lazy bastards, only to be found on the golf course, or in the private hospital. Use this as an excuse to impose a new contract paying strictly for the hours you put in. When this backfires on you and the doctors get, in effect, a huge pay rise because they are now getting paid for all that work they used to put in for free, encourage the view that they are all greedy overpaid bastards milking the system.
2) Gradually introduce an increasing number of guidelines, giving the impression that these are to assist clinicians in decision making. Then, when the opportunity arises institute disciplinary proceedings against individuals for not rigidly following those guidelines. In this way clinical decisions can be taken out of the hands of professionals, and put in the hands of non medically qualified managers. When this causes disasters hold the professionals responsible.
3) By means of managerial targets ensure that prioritising of patients is done on administrative and financial grounds, rather than clinical.
4) Screw their pension arrangements.
5) Keep them disorientated by repeatedly making massive reorganisations of the system. Never give them an opportunity to allow any administrative system to bed in. Never give them enough time to iron out the wrinkles and make it work.
6) Have them regulated by a body made up initially entirely of their peers, and use this as an excuse to make them compulsorily pay for it. Then gradually introduce non medical appointees so that it is no longer self regulation. Skew all the rules so that the regulatory body is all powerful, answerable to no-one and in effect, a kangaroo court. Enable this body to prevent someone working, not just for misbehaviour or incompetence, but for being unable to tick a few boxes on an arbitrary tick box form.
7) Introduce a system whereby selected individuals receive extra financial rewards. Make the criteria for selection as opaque, unfair and arbitrary as possible. Ensure that some specialities receive a disproportionate number of awards. Discriminate against women and ethnic minorities. This will not only demoralise, but divide.
8) Make it difficult for primary and secondary care doctors to interact. Introduce reasons and systems to make them compete. Introduce barriers to ensure that correspondence between the two is intercepted by non medical personnel with a view to preventing effective co-operation in patient care.
9) Introduce a new rule compelling them, on pain of regulatory action, to speak out in the event that they perceive circumstances that adversely affect patients. Allow employers to stamp on them when they abide by this requirement. Under no circumstances allow these people any access to any effective assistance.
Do any of these sound familiar? There are probably other good tips that have escaped me for now. In my next post I will comment on how I see these actions have affected the medical profession today.