Editor,—Duthie and colleagues (Gut1998;43:711–14) have confirmed what we hoped, and wanted to believe, namely that properly trained nurses perform flexible sigmoidoscopy safely and effectively. This result offers the hope that we will be able to cope with increasing service demands but also addresses other important issues.

There seems to be a curious difference in our attitudes towards nurses and doctors in the performance of practical procedures. For the same patients and the same procedures we demand that nurses undergo formal training and assessment but do not insist on this for doctors. Where is the validated, agreed programme for …