Target centred medicine: why it is essential to cheat

Editor—D'Sa et al are wrong to believe that only patients are cheated by target centred medicine¹: we are all cheated, including any gullible members of the public (or politicians) who believe the figures.

For various reasons we have not put our outpatient bookings for our rehabilitation multidisciplinary clinic through the hospital's patient administration system—until we realised that our chronic overload, with out-patient waiting times of up to six months, was not being “seen” and was thus not creating the usual hysteria over “breaches.” So we arranged to abandon our personalised booking system and put the appointments through the hospital computer. On discussing this with the relevant managers we discovered that this would make no difference.

Of the 22 patients waiting for an appointment (mean waiting time 23 weeks), only one was from a general practitioner and the rest were tertiary referrals. We were told that only general practitioners' referrals were counted for 17 week wait statistics and tertiary referrals were not. As it happened the general practitioner's referral was to be seen in 16 weeks, so we were not “breaching” at all.

As most tertiary referrals are specifically targeted, often quite serious, and in rehabilitation practice almost the norm it is ludicrous that they can effectively wait indefinitely and no action need be taken, however long they might wait to be seen. It is equally absurd that our service overload is invisible.

So we will cheat. I have written to all our usual tertiary referral sources, asking that they copy the referral letter to the patient's general practitioner, and ask the general practitioner to write a parallel referral.

What a waste of time for the general practitioners. But if it's the only way to show the true picture, then this is what we must do.