Salisbury has made a timely corrective to the opprobrium heaped on managers.1 But the elephant in this particular room is the blizzard of guidelines, rules, employment law, health and safety regulations, and plethora of stuff that makes their work essential.Jerry Muller in his book The Tyranny of Metrics outlined the self-perpetuating appetite of the US education system for ever more data of debatable value to the effective delivery of teaching.2 In the UK in general, and the NHS in particular, there has been a relentless piecemeal accumulation of administrative imperatives, which have occupied more and more of my time from 1978 onwards running small diagnostics departments in and outside London.Unless there is a critical rethink of what is utterly necessary to deliver clinical services to citizens, this legislative grit will continue to grind down the cogs of the machinery that we as clinicians use every day to fulfil our commitments.
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