Thursday, 20 March 2014

I'm Your Doctor, Can you Trust me?

  • Then came Doctor Death - or Harold Shipman. He was a General Practitioner or Family Physician who over a 30 year career murdered hundreds of elderly women with overdoses of opiates. He was imprisoned for life and a few years after imprisonment, he committed suicide, 

  • The fallout of the Harold Shipman affair led, as significant events often do in British public life to a very long and expensive Judge led public inquiry. It took more than 10 years for a new system of medical oversight to be devised. The General Medical Council (GMC) the body in place for registering and policing the medical profession since 1858 came very close to disappearing altogether. Vested interests such as the powerful British Medical Association, doctors' trade association in the UK and the government occupied contrasting stances. There was a lot of soul searching but after what seemed an age, a settled view of how doctors need to be regulated was reached. This is the Strengthened Appraisal I.e. an appraisal system that is obligatory and that needs to include review of evidence that the doctor was doing the right thing I.e. Practicing according to principles and domains set out in Good Medical Practice - the 10 Commandments of being a good doctor as laid out by the GMC. This uniquely includes feedback, not just from colleagues and workmates but also from an unselected group of patients.

    Doctors now need to be appraised annually in the new system if he or she wants to be re-validated and therefore retain the right to practice in the UK.

    Now that I am a trained appraiser and understand how the system should work, there is no doubt in my mind that this will help weed out the 'bad apples' (apologies for the mixed metaphors!) It does however need investment in time and money which at the moment is forthcoming - both from central government and from individual doctors whose registration fees have shot up over the past 5 years.

    The new system is excellent at assessing generic qualities a doctor must have, communication skills, quality improvement activities, mandatory training etc. One area where I think the new system is worryingly weak is test of knowledge - in essence there is none. You are not obliged to have an appraiser who is in the same specialty as you. All you have to demonstrate is that you accrue sufficient CPD (continuing professional development) points per year. This informs the appraiser that I 'attended' a course or meeting or that I 'read' a paper. A different approach is taken by American doctors who have had to re-certify in their specialty at regular intervals for a long time. This article in the Wall Street Journal as highlighted above reports how this recertification process is being strengthened. There is clearly a lot that British regulators can learn from our American Cousins. However when one remembers the lengthy and protracted course that led to the development of the strengthened appraisal system, I do not think there is any appetite for further reform - which is a great pity.