Doctors are hated but feared (by the government) and to be eliminated altogether as soon as possible

Taken from Second Opinion, by Theodore Dalrymple

ANYONE WHO DOUBTS that, at least from the cultural point of view, the Soviet Union won the Cold War in Britain hands down should attend a conference organised for doctors about impending organisational changes in the National Health Service (and organisational changes are always impending in the NHS).

There he will be convinced that every doctor will soon have a political commissar working alongside him to remind him of his wider responsibilities to government and party.

Doctors in Britain are now roughly in the position of Tsarist generals, scientists and ‘specialists’ in the first phase of the Russian Revolution: necessary but distrusted, hated and feared, and to be eliminated altogether as soon as possible.

The British revolution, however, has been carried out neither by the proletariat nor in the name of the proletariat: it is, rather, the revolution of the ambitious but ungifted, of whom there is a gross oversupply.

For everyone is persuaded these days that there is only one thing worth having, and that thing is power.

Last week I attended, for the sheer fun of it, a conference about some forthcoming changes to the NHS.

One of the lectures was given by a lady apparatchik from the Department of Health whose grimacing attempts at smiles, and whose bodily writhing as she tortured the English language with neologisms, acronyms and platitudes in the service of evident untruth, made Gordon Brown’s bonhomie seem like a model of spontaneity.

She knew what the assembled doctors thought of her, so in a sense she was being brave; at one point in what I suppose I must call her ‘presentation’ there was a single guffaw of contemptuous laughter.

It was an illuminating moment, a flash of lightning in a moonless night-time landscape.

For a moment I felt almost sorry for the speaker: you could see the panic on her face, a fear lest a hundred and fifty doctors turn on her and demand explanations in comprehensible language.

Alas, doctors are far too well brought up and chivalrous (or is it pusillanimous?) to humiliate an ambitious dimwit in public; and so the ambitious dimwits live to plot their revenge and increase their power.

Once in the Equatorial Guinean capital of Malabo I spent a very happy afternoon counting the number of aid agencies whose white Land Cruisers passed me in the street (the only vehicles there were).

I counted twenty-seven agencies in all, which goes to show that corrupt dictatorships are the boon of aid agencies.

And I had a friend who played a game of special cricket in his mind whenever he was in the company of an eminent but notoriously self-obsessed colleague.

A run was scored every time the colleague said ‘I’; there was a wicket whenever he uttered a sentence without mentioning himself. Needless to say, no innings was ever completed.

In like fashion, I spent the conference counting the acronyms.

I may have missed a few after lunch, when my stomach was full of soggy quiche and a banana.

Here is a list, probably not exhaustive: RIA, BIA, HEI, ASW, PQ, GSCC, IMCA, MCA, DOLS, PCT, LA, CSIP, AMHP, NWW, CPA, MDT, MHA, LPA, SCT, EMI, ECHR, EPA, SHA, AC, RMP, CRMO, NR, CTO, SOAD, RC.

The best acronyms, of course, should provide no clue as to their meaning, and yet be bandied about as if the meaning were known to all. Once their meaning is known to all, however, their bureaucratic utility declines: for acronyms are to modern bureaucrats what incantations are to ancient shamans.

British slang converter for overseas readers:

Not so much a slang conversion, actually, but a brief explanation of Dalrymple’s cricketing metaphor.

Cricket is played between two teams of eleven, each taking it in turns to bat while the other bowls.

The aim of batting is to score as many ‘runs’ – almost but not quite analogous to points – as possible.

The aim of bowling is to dismiss each batsman (‘get him out’, or ‘take his wicket’), in order that he retires from the field and can score no more runs.

Each innings has ten wickets (one batsman is left ‘not out’ at the end); thus, when Dalrymple writes that ‘Needless to say, no innings was ever completed’ he means that a sentence lacking the word ‘I’ was uttered fewer than ten times.

If that’s not clear, try this.

I knew, he knew I knew, I knew he knew I knew, and he knew I knew he knew I knew.

EVERYONE KNOWS WHAT doctors do: they diagnose and treat illness.

First, a patient comes to the doctor and complains of symptoms.

Then the doctor examines him and perhaps performs some laboratory or other tests.

Finally, having arrived at a diagnosis, the doctor applies the correct treatment, be it pharmacological or surgical.

From the purely abstract point of view, it is all rather simple and straightforward.

In practice, however, complications sometimes arise.

For example, last week there was a patient in my ward who told me that he had been off sick from work for the past year.

‘With what sickness?’ I asked.

Normally in these circumstances this question produces puzzlement, as if it were a complete irrelevance. But this particular patient was well prepared.

‘Backache,’ he said. ‘I’ve got severe pain in my back.’

I confess I was surprised.

He looked a fit young man to me, and he moved around with perfect ease, not like a man crippled by back pain.

Moreover, he had a number of cuts and bruises on him, the result of having been beaten up by a gang of children who had tried to mug him in the street and whom he had unwisely chased.

People with back pain are quite often mugged, of course, but they rarely run after their muggers.

Perhaps this man was emboldened by the fact that his hobby was martial arts: again, an odd choice of pastime for someone with incapacitating backache.

I telephoned his general practitioner with my suspicions, thinking that perhaps he had been deceived by his patient into signing him off sick.

I told the doctor my grounds for suspecting that his patient’s backache was not as bad as he claimed. It turned out, however, that I was telling the doctor nothing he did not already know.

‘Yes,’ he said, ‘he has never struck me as having been in much pain.’

‘But he has been off sick for the past year,’ I said, my voice tinged with outrage.

‘Yes,’ said the doctor, ‘but the last patient whom I made fit to work when he didn’t want to return to work picked up my computer and threw it at me. We ended up having a fight on the floor.’

I understood at once.

It isn’t only sick notes that are procured by threat, of course: round here all mind-altering substances – tranquillisers and antidepressants – are prescribed not for the patient’s sake but to forestall an attack on the doctor, who gives that patient whatever he wants to remove him from his presence as quickly as possible, before the patient spits at or punches him.

Things are a little better in the prison, I’m glad to say.

There the doctor is free to do what he thinks is best for the patient, thanks to the proximity of several very large men at his beck and call.

Last week, a patient arrived in the prison, a fit (though presumably not very skilful) young burglar.

‘Are you on any treatment?’ I asked him.

‘Yes,’ he said. ‘DF 118, diazzies and amitrippiline.’

An opiate analgesic, an addictive tranquilliser (diazepam) and an antidepressant (amitriptyline).

‘Why?’ I asked.

‘Backache,’ he replied.

‘Ah, a burglar with a backache.’ I said.

He smiled at me, and I smiled back.

Then we had a good chuckle together.

I knew, he knew I knew, I knew he knew I knew, and he knew I knew he knew I knew.

‘Nice one, Doctor,’ he said as he left the room, in excellent spirits.

British slang converter:

‘Sick notes’ – notes provided by a doctor to a patient excusing the patient from work and enabling him to claim statutory sick pay or other benefits.

‘Nice one’ – an expression used to indicate happiness or agreement.

Taken from Second Opinion: A Doctor’s Dispatches from the Inner City

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You’re Not Me

RECENTLY WHILE TRAVELLING on the London Underground, the opening words of Marx’s The Eighteenth Brumaire of Louis Bonaparte ran through my mind like a refrain:

Hegel remarks somewhere that all great world historic events and personages appear, so to speak, twice. He forgot to add: the first time as tragedy, the second time as farce.

Why, you might ask, did this passage insinuate itself into my brain on the District Line between West Brompton and Earl’s Court?

Standing opposite me was a young man badly dressed in black, on whose baseball cap was inscribed the word ‘Victim’.

On his black T-shirt were the words, ‘I wish I could be you’, which implied self-pity on an industrial scale.

On his right forearm (from which, Sherlock Holmes-like, I inferred he was left-handed) were a series of parallel scars from self-inflicted injury.

On his right forearm was tattooed a simplified reproduction of a picture by Gustav Klimt. All paintings appear twice: the first time as art, the second time as kitsch.

Reaching my destination, there was an announcement over the public address system. Because of the hot weather, it said, passengers are advised to carry a bottle of water with them while travelling, and passengers who felt unwell were advised to seek assistance.

Who, I wondered, would help me with my profound sense of irritation?

I was on my way to lunch with an old doctor friend. He was in a lather of indignation, as usual, against the administration and its Newspeak. He was particularly exercised by the term ‘quality assurance’, the locus standi of yet another layer of bureaucracy.

‘The problem is,’ he said, ‘that no one can be against quality.’

Then we started to utter slogans by turns.

‘Down with quality!’

‘Down with equity!’

‘Down with easy access!’

‘Down with world-class!’

‘Fewer patients, more paperwork!’

‘Shorter consultations, longer lunches!’

The other customers in the restaurant of the Royal Academy – for that is where we were – must have thought we were lunatics with delusions of medical qualifications who had been let out for the day.

Later that afternoon, I waited for my wife at a pub near a well-known railway station. It was pleasant to sit outside with a drink, even if most of the other drinkers had shaven heads or pony-tails, or (in one case) both. The only woman around, before my wife arrived, was also a man.

He was clearly in the throes of the sex change, for he dressed like a woman, and had breasts, but spoke and behaved like a man.

I wouldn’t have mentioned this had he not spoken so volubly about something called a ‘gender assignment certificate’.

Here indeed is a new field for bureaucracy to till. I suggest such certificates be made compulsory, like identity cards. There will be errors, of course, but such is the cost of progress.

I accidentally knocked an empty plastic bottle off my table and it fell at the feet of another drinker. I bent down to pick it up. ‘I wouldn’t bother if I were you,’ he said.

‘But you’re not me,’ I replied.

And then I thought of the man on the District Line: ‘I wish I could be you.’

Then I wouldn’t mind wading through rubbish as I walked down the street.

Taken from Second Opinion: A Doctor’s Dispatches from the Inner City

Available in trad book form here with free postage and packing worldwide, or here at

Also available as an eBook at (and other relevant Amazon sites)