Agreement: I AgreeBody: Dear Editor On the basis of the limited information to hand - this is both a sad and a baffling case. No clinician, whether of Olympian professional stature or merely part of the primary care PBI, can claim an unblemished diagnostic record. In the instance in question there seems to be a number of potentially confounding factors, not the least of which may be a multiplicity of GPs involved, remote consulting taking precedence over proper consulting and, I infer, electronic records. The literature showing the benefits of personal doctoring is extensive. Unfamiliarity with the patient and vice versa is a definite hazard. The drive toward the impersonal in medicine harms both patient and clinician and, more perniciously, is part of the proletarianisation of the professions. Toward the close of my career I was obliged to undertake increasing volumes of phone consulting. Thus, from personal experience, I formed the clear opinion that this approach is of very limited virtue and brimming with risk. There is a mass of minor problems and questions needing quick answers that may be amenable to such a style but for everything else there is no adequate substitute for face to face and hands on consulting. For most of my career my practice offered, and mostly succeeded in providing, same day appointments for all - unless the patient wished otherwise. This is possible - QED. Waits of days or weeks or even months for an appointment seem to have become normalised in places and I struggle to understand how. How does a contemporary GP spend their day? Starting in the early '80s digital records were useful as electronic filing systems, limited only by the fact that most competent typists could type many times faster than the machine could process the input. Processor speed is no longer a rate limiting factor but the fundamental nature of the electronic patient record, its structure, processes, presentation of data, and outcome is of growing concern. A couple of days ago I had a coffin dodger's MOT- routine bloods and lifestyle questions. The extent of the digital record of the simple consultation amazed me when I viewed it later Neither patient, nor clinician, nor practice benefits from such an approach to data - but data trawling commerce, managers, lawyers and, of course, those preparing to send the bills in our soon to be privatised NHS do. Current software is the trojan horse for privatisation. AI enabled transcription of consultations is going to cause major problems unless every entry is immediately verified as correct by all involved. Substantial amounts of the speech of both patient and clinician is redundant and will merely obfuscate the record. The errors in transcription and the horrors perpetrated by autocorrect are merely cherries on the cake. Where does liability for error lie in such situations? Not all old approaches to the practice of medicine are as redundant as some seem to believe and our freshly minted digital nirvana is actually the rising tide of commercialisation. Yours sincerely Steve Ford No competing Interests: No competing interestsThe following competing Interests: I have not undertaken any medical work since 2008 and my GP training was in the late '70s. I am definitely out of date.Electronic Publication Date: Tuesday, September 23, 2025 - 12:44AI use: No, I have not used AIHighwire Comment Subject: Jess’s rule: GPs urged to use “three strikes and rethink” approach to prevent patient deathsWorkflow State: ReleasedFull Title: Re: Jess’s rule: GPs urged to use “three strikes and rethink” approach to prevent patient deaths Highwire Comment Response to: Jess’s rule: GPs urged to use “three strikes and rethink” approach to prevent patient deathsCheck this box if you would like your letter to appear anonymously:: Last Name: FordFirst name and middle initial: StevenEmail: stevenduncanford@outlook.comAddress: Haydon BridgeOccupation: Retired GPBMJ: Additional Article Info: Rapid response