The point being Charles is that we are not given "guidelines" for things like measuring BP pre GTN. We are given 5 years of full time undergraduate training followed by years of postgraduate training. We are expected to know the pharmacology of the drugs we give, the pathophysiology of the conditions we are treating, and then to treat as appropriate. If the medication or treatment we administer causes side effects, we are expected to know how to deal with them. And I really do not know where you get this impression that there is still a doctor's club where the incompetent are never punished- http://www.the-mdu.com/Search/index_title_0.asp?usertype=studentm http://www.gmc-uk.org/concerns/hearings_and_decisions/fitness_to_practise_decisions.asp not to mention numerous legal proceedings. I think this disparity that you perceive in treatment of nurses/techs/other paramedical staff vs doctors belies a misunderstanding about roles. The very fact that protocols exist for drug administration by ambulance service staff, nurses etc, is because those that are giving them are not trained to understand the entire pharmacology, interactions, contraindications- therefore there HAS to be a tick-box process to make the process as safe as it can be. Taking the GTN example again- ambulance staff must follow their protocol (measuring BP) or risk, as you say, being 'hung out to dry'. Doctors, on the other hand, knowing the exceeding short half life of GTN, coupled with the ability to treat hypotension effectively should it occur, know it makes bugger all difference whether or not they measure the BP first, but know they do it anyway at some point as part of their diagnostic process. And to Paula- I am not a troll, and I apologise all round for the flavour of my first post, it was a little excessively sarcastic. However I find it incredibly frustrating that the world and his wife think that being a doc is an easy job, half of us are idiots anyway, and hey- even if we do kill a few people, the old boy network will protect us ! Medicine is NOT tick box, protocol-driven, 'test x means this is diagnosis y' despite what the government will have everybody think. Diagnosis and treatment are difficult, and for every decision you see a doctor make, be very sure there were multiple other thoughts and options they considered before making the choice they did.