Liam Farrell: Using the P-word - is there a protocol for that?

Sarah Palin was the subject of derision when she used the word refudiate (obviously she got mixed up between refuse and repudiate, understandable in an American presidential candidate) in one of her publicity statements.

 She defended herself by saying that William Shakespeare had done the same thing, thereby demonstrating that she cannot tell the difference between genius and illiteracy.

Words are like living creatures. They change, they adapt, they coalesce. They can be dangerous, and we GPs have suffered from this. Power and point on their own are harmless, but put them together and they mean thousands of terminally bored GPs.

Audit used to be the remit of accountants and tax inspectors, but once it made the leap from management-speak into the medical world it became an instrument of torture. Like introduced animal species (grey squirrels, zebra mussels, black swans) which cause mayhem in the environment, these transplanted words have been a disaster.

But audit was just a premonition, the sound of distant thunder at a summer picnic; there was worse to come, much worse. The most sinister change of all has been protocol. When I was a lad, protocol was about what to do when you met royalty or were invited to the ambassador's party. For example, only speak when spoken to, bring a big box of Ferrero Rocher.

But now protocol has morphed into a monster. It is beloved of bureaucrats, as it gives them something to count. It stifles innovation and squashes intuition, and makes no allowance for individual variation (patients are inconvenient that way).

We have protocols for everything now; management of hypertension, washing hands, using the bathroom, chopping your own head off; at every practice meeting, no matter how trivial the subject, someone will ask: 'Have we got a protocol for that?'

But protocols really hit the jackpot with the swine flu outbreak; everyone was writing them, it became a very competitive industry, destroying great swathes of the rainforest in the process. We were getting protocols from Uncle Tom Cobley and all, frequently followed by new protocols with instructions to ignore the previous protocol. And someone, somewhere, I'll bet, is developing a protocol on developing protocols.

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