We never talk any more Comment from the pages of the British Medical Journal, offered completely unedited, which makes the point, just in case you'd missed it, that all is not well in the British health system! By James Owen Drife, professor of obstetrics and gynaecology, Leeds Our local theatre, the West Yorkshire Playhouse, is adjacent to one of the national offices of the Department of Health (DH). My only appearance onstage at the Playhouse, so far, has been to give a lunchtime talk to DH staff. One of them had organised a series of lectures in which consultants explained what our jobs involve. It went reasonably well, as I recall, but it's hard to remember. It was a long time ago. In the 1990s direct contact between civil servants and doctors was a novel idea. Today it is unthinkable. Taking time out to understand what doctors do would be regarded as a distraction from the job of reforming the health service. Communication between the NHS and doctors is now unidirectional. "Top down" messages have become public relations exercises. We receive flashy documents, sometimes fronted by a medical celebrity, featuring trite quotes and mawkish photographs. Doctors, who have no time for falseness, bin them. Those who run our working lives feel that they know about medicine because they have been to a general practitioner, visited a hospital, or had a baby. Sometimes this, too, was a long time ago. If they want to catch up with modern practice they commission a survey. Or they speak to a medical member of a quango, who will see things as they do. Genuine dialogue could give the great and good a reality check. It might help them recover the credibility they have lost by instructing general practitioners on when to open their surgeries, telling hospital doctors what to wear, announcing that hand-washing is a great new idea, and compelling trainees to write creative fiction in job applications. Can we persuade the DH that there is intelligent life in the medical workforce? It's a tough assignment. You can talk to people only if they want to listen. We could start surreptitiously by persuading the cleaning contractors to leave copies of the BMJ in the coffee rooms. Then, who knows? Someone might arrange some more lectures. Doctors could tread the boards at the Old Vic (also adjacent to a DH office). But civil servants will point out that all targets and innovations now come from Downing Street. No problem. There's a playhouse nearby which used to be called the Whitehall Theatre. It's fondly remembered as the home of British farce. BMJ 2008;336:280 (2 February), doi:10.1136/bmj.39470.566389.59