How to deal with immigration from the EU - make everyone pay - a lesson from the General Medical Council.

In 2008, a locum GP doctor injected David Gray, a patient with typical excruciatingly painful kidney stones, with a fatal (10 times normal) dose of morphine. This act was not intentional but a tragic mistake and it occurred because the doctor who was a German national and whose command of the English language was not good, for want of a better description, screwed up - badly.

Mind what you wish for!

Cardiothoracic Surgery in the UK is, as far as the General Medical Council and the Colleges of Surgery are concerned, a single specialty.

The Effect of Feminisation of Medical Training

As honorary senior lecturer at the University of Sheffield,  I am often involved in the assessment and examination of medical students.
I was recently attending a refresher course on OSCE (Observed Structured Clinical Examination) assessment of medical undergraduates.  This formal instruction for examiners is, we were told, now mandated by the General Medical Council .
The talk together with demonstration videos of how to and how not to carry out a proper valid OSCE assessment was very helpful and informative.
The speaker was a medical education specialist from the medical school. Many of her senior colleagues are also women. It struck me as I listened to her presentation that, in addition to a steep increase in the number of female medical graduates, there has been a gradual feminisation of medical training in the UK. I suppose that this should hold no surprise to anyone as the number of academic medical women involved in designing curricula and assessments has inevitably increased. This, I hasten to add,  is no bad thing. On the contrary, it is to be welcomed. Feminisation of undergraduate medical training has led to an increase in patient centredness of what is expected from modern doctors  (what old timers used to call the touchy feely bits!) - a quality hitherto lacking in medical training.
Whether this approach to medical training occurs in all of the countries of origin of the large numbers of foreign graduates who work in the NHS is debatable. This should be a matter of some concern if the predominance of foreign born doctors who fall foul of the General Medical Council is to be reversed. There is no doubt that this new approach to undergraduate training is extended into postgraduate training and foreign graduates who come to the UK for their postgraduate training learn fast. The doctors who are at risk are those who do all their training elsewhere and come to the UK for their tenured job. It is this group who require an intensive and prolonged induction prior to entering medical life in the UK with all that British society expects from its doctors.

I'm Your Doctor, Can you Trust me?

How Qualified Is Your Doctor? - WSJ.com

• The Appraisal process for doctors in the UK is now pretty comprehensive. It was not always thus - up till one or 2 years ago, the process itself was poorly organised, most appraisers were not trained and most doctors just did not bother - the fact that it was not compulsory being one of several reasons.

• 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.

 

 

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Walking a Dodgy Tight Rope!

Doctor found guilty of gross negligence manslaughter
I do not, in anyway condone  what this surgeon did or rather failed to do - but being charged and imprisoned for delaying surgical treatment seems excessive to me.
This quote is straight from the legal website

"The test for gross negligence manslaughter is as follows:

1. Did the defendant owe a duty of care?
2. Was that duty of care breached?
3. Was that breach SO GROSSLY NEGLIGENT and showing such disregard for the life and safety of others as to be worthy of a criminal conviction?"

Answers to the last 2 queries can be very subjective.  I can think of a few cases of imperfect clinical management I have observed over the years that could be interpreted by a judge on a bad wig day as grossly negligent behaviour deserving of a criminal conviction. 

I am assuming that this doctor's case has gone through the GMC as according to the GMC website  he is suspended.  I also assume that it was the man's family (or a rival for his private practice!!) who was the driving force for the CPS to bring formal charges against him.

It is also possible that what has been reported does not fully reflect this man's actions.

Nonetheless, as I reminded an F2 doctor recently, as professionals we are walking a very tight rope every day and can never know where the gust of wind that will knock us over will come from.  There for the grace of ...... #PHILOSOPHICAL  

Will Revalidation be Victimless?

Jumping through the hated hoops to revalidate
Since December 2012, in addition to being on the medical register of the General Medical Council, all doctors in the UK have to have a Licence to Practice. This has to be renewed every 5 years and this renewal will require an annual strengthened appraisal.
 I read quite recently that several thousand doctors who were expected to have had an appraisal by now still had not.
I am an appraiser as well as having to be an appraisee. I still find the whole process of collecting and collating supporting information, organising an appraisal together with the additional steps one has to take every revalidation cycle to be quite burdensome.
We are all very busy and many doctors are quite disorganised when it comes to organising things that do not relate directly to patient care.
How many of us for example have taken every day of leave owed to us?
How many of us have claimed every mile driving to and from clinics or MDTs?
This article in BMA news is an account (the first of many I suspect) that  not learning the art of box ticking and suffering bouts of procrastination could now prove to be seriously painful indeed for many doctors.
Will it all be worthwhile ? Are patients now less likely to be harmed by the medical profession? Probably not! It may still all be worth it  if we all end up organising ourselves, claiming every penny and every day's holiday owed to us and setting clinical work aside to find the necessary 7 or so hours to get appraised.
Aaah, I can see now why we need 7 day working!!

Professionalism and the Francis Report on the MidStaffordshire Hospital Scandal

I came across a link to this page on Twitter recently. I have mixed feelings about this. Acting, when one sees poor practice is part of Good Medical Practice, a set of codes, published by the General Medical Council of the United Kingdom, that define Medical professionalism. Legislating for professionalism (which is what this e-petition is asking for) always makes me uncomfortable. It undermines the whole concept of professionalism when certain behaviour is enforced through the letter of the law.
I have a sneaky suspicion that something like this may very well be the end result (or part of it at least) of any legislation that results from the Government's response to the Francis report. This report is the product of the independent public inquiry that was initiated by this government to investigate the terrible things that happened at MidStaffordshire Hospital in the English Midlands. Its publication is long overdue, April, then June, now October and it is inconceivable that new legislation will not result from its publication.

Is there a Doctor on the Plane? ID Fraud and the GMC

I was recently flying back from the Mediterranean on RyanAir. Being posh and rich ;) Matron B and I had booked seats and we were sitting in the front row. A third of the way through the flight, I noticed the air hostess (are they still called air hostesses?) run into the galley, grab a handful of sick bags and ran back to the main body of the fuselage.