My experience, as an RNID volunteer who meets people seeking help with issues around hearing loss, is that GPs do not seem to recoil from deliberately imposing ordeals on our patients. In his briefing this month our Editor cogently explains the way in which healthcare systems often harm patients.[1] I must, however, disagree with part of his final sentence. 3 Munro KJ, Giles TC, Smith-Howell C, Nazareth I. Ear wax management in primary care: what the busy GP needs to know.