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I competed in a karate competition recently and found it a bit like surgery: you spend years perfecting technique and getting to know intuitively what might be effective with each person. The NHS needs to retain and value the experience and intuitive competence of doctors, other senior clinicians, and managers. Educating someone for autonomous practice and the ability to deal with complexity is hard. But other types of educating can sometimes be simple. Knowledge and skills are empowering for staff and patients, as are environments that welcome discussion. In an NHS with minimal money, time, and staff it’s hard to retrofit education and new processes alongside other work, but we can start by focusing on patient education and empowerment. Social media and advertising have changed how people absorb information, how cultures evolve, and what our “norms” are. The …

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