This (‘Meaning and the Nature of Physicians’ Work’, NEJM 275;19:1813-5) is one of the best things I have read in a long time. It is right on some big issues, and is only depressing if you think positive action is not possible. The article speaks to the dehumanisation of the practice of medicine, and what happens when there is a gulf between those who practice, and those who think that a summary of practice is the same as actual practice. Tacit knowledge doesn’t fill cells in Excel spreadsheets. It is of course, not just medicine that is changing this way, but other professions — look at what has happened to schoolteaching and the bogus politics and ‘common sense’ that masquerades as evidence in education.