Management of sickle cell disease in the community

The Peter principle, named after Laurence J Peter, who first enunciated it, describes a common problem inherent in the ways in which individuals perform their allotted tasks within a hierarchical system: “In a hierarchy every employee tends to rise to his level of incompetence.” The problem is unavoidable. Pseudopromotions, such as kicking an employee upstairs or sideways are ineffective, as are several other strategies. In medical practice, working in teams may help to mitigate the effects, when competent juniors protect their incompetent bosses, but not when an individual works alone. The best strategy is prevention, by considering, through benefit:harm balance analysis, why one should not seek or accept promotion. However, once incompetence sets in, the affected individual loses the ability to understand the problem.