Just an everyday observation. Awhile back I sat through two hours of what can best be described as a project management meeting. Twenty people or so reviewing pages of protocols, adding a bit here and there, but seldom taking anything out. The process stretches forward over a timeframe of months or years. A central (but unspoken) problem being that the attempt to capture clinical encounters, involves formalisation and summarisation, resulting in few participants actually knowing what the clinical context will be. All laudable work, all designed to improve things.
When I returned to base I could observe the environment one single doctor found themselves in. One harried ‘junior’ doctor, literally running between a room full of students whom the doctor was attempting to teach; an on-call phone that kept going off; an on-call patient being seen at the same time in another room; a simultaneous polite query about drug dosage via pharmacy; and doctor acting as porter and nurse wheeling patients from one room to the next. Model that.