Human resources kindly invited me to join a recent ceremony to acknowledge long serving staff members, as part of the local health board's ‘Staff Recognition Programme’. This moment of affirmation was tinged with regret when I was asked to fill out a form attached to the invitation which included: “…..who do you report to?” Apart from preferring “to whom do you report?”—grammatically and phonetically—this question says much about 21st century hospital medicine. Most of us would prefer to answer ‘my patient’, rather than the managerial chain of command.

The organisation of healthcare delivery has never stood still but the reforms I have seen in the past 30 years have considerably reshaped our workplace landscape. In many cases physicians are less autonomous self-motivated individuals and more highly managed employees. We work to contractual volumes, answerable to multiple sources of internal and external monitoring. There is greater scrutiny by the traditional authorities of medical council and professional colleges, as well as exposure to public and patient advocate organisations and governmental agencies—for example, our Health and …