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Why Revalidation is Wicked

Posted on 02 March 2010

trust.jpgIn its proper form, the doctor-patient relationship is not unlike a marriage. It is founded, above all else, on trust.

The essence of trust is an implicit assumption of the benevolence of the other. Good marriages do not rely on annual appraisal folders, multi-source feedback or revalidation to stay on course; instead the partners simply trust each other. Indeed, the very concept of needing to re-establish trust periodically would be laughable. Why then do the medical revalidatchiks – the Obersturmführer Marshalls of this world – insist that we must replace implicit trust with explicit checking; and that revalidation is now a professional imperative, a ‘core professional activity and responsibility’ that we doctors ignore at out peril?

It cannot be because trust in doctors – with of course notable exceptions - has failed. Year on year, doctors come top in trust surveys – according to the latest MORI poll, more than nine out of ten adults trust their doctors. Nor, we are told repeatedly, is it about preventing the next Shipman. In fact, despite an extensive search, Dr No has been unable to find a satisfactory answer to the question: why do we need revalidation? The ‘what/where/when/how/who’ questions are variably answered, but the answer to the ‘why’ question – arguably the most important question of all – remains elusive.

The reason for this ‘missing’ answer is simple: the revalidatchiks do not want us to know why we ‘need’ revalidation, because the answer is a dark and sinister one. The truth is that we – doctors and the public, that is - do not need revalidation. Instead, it is the State, the Stasi – the GMC – and the revalidatchiks who need revalidation: because they are determined to control the medical profession, whatever the cost.

And what a cost that is going to be. Not only in time and money, but also, far more gravely, in damage to that sacred relationship between the doctor and patient. For just as sewing the seeds of distrust can destroy the best of marriages, so corrupting the customary trust between doctor and patient can only lead to great harm.

That is why revalidation is a wicked project. It must not be allowed to succeed.


“Why revalidation?” One reason seems to relate to targeting doctors who refuse vaccination. Something like this, which at face value seems sensible, has great “Creep” potential not just for the medical profession.


Just like HIV testing:


WD - Exactly the point I was making. Revalidation is about controlling doctors. There is no evidence that public trust is declining; in fact, according to MORI polls is has actually increased over the last 25 years. All that guff from Count Rubin and his henchmen about needing to maintain trust through revalidation is arrant nonsense.

What our dearly beloved rank and file colleagues don't get is that the shift from a default position of staying on the register to one where you get removed unless you revalidate to imposed standards is going to mean that the revalidatchiks can force us - on pain of losing our livelihood - to do what they want. Creep towards contentious vaccination is a good example. Who knows - even wearing the wrong coloured socks may one day be seen as 'bringing the profession into disrepute' and result in failed revalidation.

"revalidatchiks can force us - on pain of losing our livelihood - to do what they want."

That is why WD for a decade now has put together a detailed Plan B which she keeps to herself. She advises all junior doctors (and seniors too) who come her way to do the same!

Some day they will say she was a wise old witch!

Plan B for the Rhett Butler moment - very apposite from a wise old witch!

It doesn't matter how many arses you have to kiss, you can always wash your face.

As true now as it ever was.

Treat revalidation with the contempt it deserves. Lie and tick the boxes.

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