Thanks eDoc for your explanation. I agree that the word "guidelines" was too narrow/loaded a description of what happens; nevertheless, there are constraints on doctors' prescribing, such as BNF, individual drug data sheets, other pharmacological literature, what your consultant likes/dislikes, what NICE will permit and so on and so forth. That range of constraints is what I carelessly subsumed under "guidelines". Should you consider them negligible? I am a bit bemused myself that you, in turn, assume a lack of depth knowledge on the part of other professional specialists. Indeed, this is the whole point of specialised technicians and nurse practitioners: they do have detailed knowledge and extended training, but of necessity within limits; and within their specialist areas, believe it or not, they may well have considerably more knowledge and expertise than, dare I say, your average SHO, even if s/he did get trained at a University. As to the protection of doctors' club, the derivation comes from over 20 years observation of the phenomenon while working in the NHS as a nurse and technician. I did not say, nor wish to imply, that all or even most doctors are idiots with a soft job - after all, if it was that easy we'd all be doing it, wouldn't we? Nor do I wish to imply that it is the medics who take their errors lightly, on an individual level. At least, the young lady who recently prescribed a patient of mine 400mg frusemide was very grateful to have the amount queried. I have seen many an incident - and no, I can't supply you with published references, since publicity was the last thing anyone involved wanted - when the sequel to errors involving both doctors and nurses/technicians resulted in the former continuing to practise unhindered at the same time as the latter were suspended, officially investigated, and in some cases penalised.