Cost-Conscious Medicine: A British orthopedist recently lost his job because he objected to some of his hospital’s cost-cutting measures:

During a hip replacement operation a scrub nurse offered the dessert spoon to Mr Charnley in place of the sharp curette normally used to scrape cartilage from hip sockets. "On several occasions I was offered the dessert spoon and rejected it. It was later alleged I threw it at a nurse, but that is not true. I simply lobbed it away hoping it would never be used again." He said nurses joked about the incident and later came into an operation with plastic spoons attached to their facial masks.

Mr Terence Lewis, the hospital's medical director, said spoons were widely used in surgery at Derriford and were extremely useful. Hospital management arranged for an example to be brought before the tribunal by motorcycle courier. "I use one myself in cardiothoracic surgery. The spoon this tribunal was shown has saved a number of lives and is used to lift the sternum when we are stitching a patient."

I suppose there’s nothing wrong with using a sturdy spoon as a retractor, but I’ve never seen a dessert spoon with an edge sharp enough to scrape cartilage from a joint socket.

But this is about more than just substituting spoons for surgical instruments. The orthopedist got in trouble for failing to manipulate his patient lists to meet government targets. He wanted to operate on patients according to the urgency of their needs rather than their position on a waiting list:

Mr Lewis acknowledged speaking to Mr Charnley about waiting lists. He said: "We had access to between 2 million pounds [$3.2m; 2.9m] and 2.5 million pounds, which would not be received by any trust which breached the target. It was a huge amount of money which the trust needed, and it was being put at risk by his threat not to cooperate in meeting targets."

Mr Charnley's evidence was supported by his former secretary Rachel Payne and by Dr Rhona MacDonald, the editor of the BMJ's Career Focus section, who spent two months secretly interviewing staff at Derriford at the end of 2000. Her investigation followed the publication of a critical report into waiting lists at the hospital.

Dr MacDonald said that management were "so driven by waiting list targets they did not have time for anything else, like quality." People who spoke out, she said, "were told to go on gardening leave, which was a euphemism for suspension."

Ahh. The joys of government-run medicine.