David Zigmond is a London based GP, psychiatrist and psychotherapist. He has written extensively on the corrosive effects of the industrialisation of healthcare. He blogs regularly on his website and BMJ Blogs. His book, "If you want good personal healthcare - see a Vet" is available online. 

This article first appeared in BMJ Blogs

Current appraisal systems sacrifice more of value than they can assure. Clarifying why and how this happens gives us wider insights into our ill faring welfare systems.

“The more laws, the less justice”
German Proverb

Some healthcare management axioms seem incontestable: all our healthcarers should have a good standard of human and technical competence; these should then be held within a firm frame of moral probity. Therefore we need systems for professional appraisals, then validation.

Such is the easy rhetoric, but the meaningful implementation is proving much trickier. Generally, only those who administer the current appraisal system talk with conviction about its relevance or validity: the captive practitioners talk instead of obstructive rituals of submission, of unwisely prescriptive authority, and of a growing culture of forensic mistrust, even pre-emption.

This is not what was intended. What has happened and why? This decade spanning portrait may clarify.

Despite being delivered in dull bureaucratic speak - the media release was headlined, “Continued slow growth in health spending” - the latest report on health costs by the Australian Institute of Health and Welfare (AIHW) contains valuable information.

One key finding is that individual spending is the stand-out area of non-government sector expenditure.

The AIHW is a major national agency set up by the Australian Government to provide reliable, regular and relevant information and statistics on Australia's health and welfare.

Doctors for the environment is a voluntary organisation which is affiliated with an international organisation of the same name . It works to address the diseases-local ,national and global- caused by damage to the environment, such as health problems relating to climate change and pollution .

It has recently been focusing on the potential hazards of unconventional gases eg fracking. It provides scientific evidence to government and industry to influence policies highlighting the medical importance of the environment around us.

Doctors have a good understanding of the science behind emotive issues and as respected members of society have the potential to have significant impact on local and national opinion on environmental issues.

In further bad news on smoking, a British study has found smokers far more likely to experience depression and anxiety than non- or former-smokers (those who have quit for 12 months or more).

The study, the first of its kind, found that 18.3 per cent of smokers experienced symptoms of depression and anxiety, compared to 10 per cent of non-smokers and 11.3 per cent of former smokers.

The findings have prompted the conclusion that quitting tobacco helps improve both mental and physical health.

The British Health Foundation said the study refutes the notion that smoking alleviates anxiety and stress: the temporary feeling of relaxation is soon replaced by withdrawal symptoms and cravings, leaving the underlying causes of stress untreated.


Prevalence of current tobacco smoking among Australian adults, 1945–2013

newly published study* on the linkage between tobacco consumption and mortality has shown that up to two-thirds of deaths in Australian smokers can be attributed to the habit.

Further, current smokers are likely to die a decade earlier than non-smokers.

“Cessation reduces mortality compared with continuing to smoke, with cessation earlier in life resulting in greater reductions,” the research team* concluded.

The report drew on data contained in the milestone 45 and Up Study involving 204,953 NSW residents aged ≥45 years who joined thd study from 2006–2009.