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A substantial proportion of the contacts requesting support from the CMA during 2010 to 2011 have come from healthcare professionals and managers under pressure to lower standards on probity.

Despite the very wide range of professions involved in healthcare and chaplaincy work, and the equally wide range of levels of experience, the underlying themes are few and fundamental.

Is it all right to lie on request forms to gain an earlier investigation for your patient when resources are in short supply? How far can you go to embroider the clinical truth to get what you (or the boss) wants, preferably yesterday, or at any rate before the weekend?

Is it acceptable to protect my job by pretending ignorance when my colleagues are falsifying data for clinical audits because of time pressure? Does the pressure to create audits for their own sake - with little confidence that findings will be implemented - make my silence less culpable?

I’m a new GP and the partners in my practice appear to be lax about how we maximise our income in terms of how we reach our targets.

Patient care appears to be a low priority and I am expected to ignore their real concerns to reach QOF or the latest other government dictated targets. I’m wondering whether a doctor is needed for this job or a state-employee to input data to the detriment of individualised care.

When I started in this practice, I was a little suspicious of the style of advice I received from the practice accountants. I don’t know enough yet, but what if I’m right and we are all investigated by the Inland Revenue or the VAT man? I may be embroiled in corrupt practices because of our financial interdependence without even knowing it.

My colleagues are helping themselves to anything they can ‘borrow’ and then ‘lose’ from other departments because our budget is in’ meltdown’. It’s for the patients’ sake in the end but I’m expected to lie about the whereabouts of expensive pieces of equipment when those who lent them in emergencies come looking for them. Everyone knows I don’t agree with it and if I ‘whistleblow’, there will be a way found to get rid of me as they will know that it was probably me.

Overall, the experience of those in clinical and managerial practice for some years is that whilst the target culture may have become an idol to the point that colleagues and groups will become corrupted by degrees, it is far easier at the beginning of your career to become known for a sensitive conscience. Eventually, people will stop approaching you to ask you to collude with them because they know the answer they will receive. Once you are experienced enough to stay in one placement for any length, your radiology and other requests will meet with more co operation when you can look specialists in the eye and tell them “You know I don’t mess you around. This is what the patient has said or I have found on examination”.

The alternative approach will make you popular in the short term but demoralise you and wear you down in the long term. It isn’t worth it spiritually to pretend to yourself that you can bend and twist to corrupt norms until you look and feel like a pretzel as you try to please others and eventually it will damage you, your family as you arrive home seething with resentment and your patients as the system conceals problems which need addressing. Do ask members of the CMA for support as this is a complex and stressful area.