I can no longer "ration"

Abstract

Ten years ago I wrote a personal view about how I gave patients dates for their gynaecological operations at the time of their outpatient consultation. As well as helping patients plan their lives this helped me to plan the surgical training of the junior staff. To ensure that no patient really in need of surgical investigation or treatment waited more than a few weeks I indulged in what would now be called rationing--that is, I restricted surgery to the patients in most need and to the most effective interventions. There were problems, but it seemed good NHS practice at the time. A decade on my system is just about extant, but surprisingly incompatible with a changed NHS. One of the most specific requirements of the patient's charter is for every patient to be seen within 30 minutes of the appointment time. Making a good job of arranging operation dates in the clinic can be time consuming. The most appropriate phase of the menstrual cycle, the patient's other commitments, what else is already on the operation list for that day, preoperative investigations, and treatment all require consideration. It takes only one or two more patients than average to need an operation and either the requirement of the patient's charter or something else has to be sacrificed. Communication and clinic procedures, such as …