Posts tagged with Revalidation


Nailing Doctors

A hundred years ago, when Britannia ruled the waves, our language was high on a tide of nautical terms. Today, in the age of the automobile, it is to motoring that we turn for our metaphors. The complexities of nutrition are reduced to the simplicities of traffic lights. The rigours of medical regulation – revalidation – are simply MOTs for doctors. Latest on the bandwagon is the Royal College of Caring and Sharing, which has shared, on facebook of course, its Social Media Highway Code. There is, inevitably, a lot of caring, and even more sharing, but, for this reader the wheels started coming off the code when it likened today’s doctors to yesterday’s Wild West cowboys. Are today’s doctors really so feeble that they cannot for themselves work out how to behave online?

Well, Um

This morning, Yesterday had the Right Honourable Jeremy Richard Streynsham ’Unt, Secretary of State for Health, on the line. He was on to crack up revalidation, Stilton’s pet project to spear ‘under-performing’ doctors. Evidence Based ’Unt is new to health, and it showed, despite being interviewed by Yesterday’s laziest presenter, Justin ‘Um’ Webb. When EBH wasn’t saying well, um too, he squeezed out the usual tired toothpaste of revalidation rhetoric, about the need to ensure doctors were up to speed on the latest advances, and in so doing revealed he hadn’t a clue about Stilton’s real plans. Bored, Um moved on to evidence based abortion limits and evidence based homeopathy. EBH carried on as before, squeezing out colourless, tasteless, um, toothpaste. Yesterday had missed a trick: surely Wingnut, Um’s co-presenter, would have done better. He might even have managed to get evidence based toothpaste with a stripe in it. Instead, we had to put up with evidence based ums.

Blood Toil Tears and Sweat

The equinox has passed, Monroe is back, and so too is Dr No. It has been a quiet summer for medical bloggers. Hot Burning Coales got herself into hot water lately, implying that the Royal College of Caring and Sharing was a coven of homophobes, xenophobes and gynophobes, and Ben Goldacre has discovered publication bias, and served it up with Bad Pharma sauce, but the big event of the first half of the year, the passing of the Health and Social Bill into law, has given way, as did the outbreak of WWII, to a phoney war. No tanks piloted by Very Willing Cowboys have yet been seen overrunning hospital car parks; nor have any foundation trusts been bombed by even more willing hedge fund managers. It is, for now, as if the Act had not happened. Which is just as well, for now, because there is another big black cloud looming large on the medical horizon: the spectre of revalidation. What, Dr No wonders, would Stilton and his gang of goons make of Monroe?

Guidelines, Contracts and Revalidation

"Rules are for the guidance of wise men and the blind obedience of fools."

–attrib. various1

An editorial in the JRSM by the formidable Dr McCartney, who tosses articles as lesser Jockettes do cabers, helped crystallise some bitter salts that have of late been swilling around the vague stream of consciousness that passes for Dr No’s thoughts. The gist of it is that doctors have had enough of being pushed about, demeaned, and generally told what to do, all of which are anathema to the professional mind. For GPs straining to meet Quality and Outcomes Framework targets, the doctor-patient centred consultation has become the government-contract centred consultation. Hospital doctors no longer manage or treat their patients, they protocol them through pathways, all too often watched over by guidelines of not so loving grace. Juniors no longer routinely strive for excellence; instead, they slavishly strive for ticks in boxes. All through medicine, the opportunity for individual, creative, effective and satisfying practise has been flattened under the weight of rules, guidelines, pathways, contracts and targets.

How To Get Rid of Doctors

In a word: revalidation.

Amongst his medical friends, Dr No knows of two doctors who have already decided they will have no truck with revalidation. This is not because they are dodgy doctors, with dark secrets to hide – truth be told, they are very good doctors - but simply because the concept of the state deciding whether a competent, independent truly professional individual is indeed competent to practice is anathema, and a travesty of all that a true profession stands for. They would rather be out, than submit to state controlled ritual humiliation.

Revalidate! Revalidate! Revalidate!

Press News: For Immediate Release

General Dalek Council finds ninety-six per cent of dalek organisations believe revalidation will help daleks be better daleks.

Dalek HQ, London: An independent study of over 3000 daleks in ten pathfinder sites to test revalidation has found strong support from organisations that took part. A large majority concluded that revalidation will improve the dalek experience.

'It is encouraging that dalek organisations recognise the potential benefits of revalidation,' said Niall Dickson, Chief Dalek at the General Dalek Council.

Why Revalidation is Wicked

In 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?

British Professional Medicine: RIP 2013

Everyone, but everyone, is a professional these days. Even benefit scroungers like Dr No are professional benefit scroungers. Sociologists over the years have woven so many strands and threads through the social construct of professionalism that the term has become so broad and debased as to be meaningless. To borrow from a line attributed to the poet John Lydgate and later famously adapted by Abraham Lincoln, you can professionalise some people all of the time, perhaps even others some of the time, but you definitely can’t professionalise all people all of the time. If everyone is a professional, then no one is.

A Midsummer Day’s Madness

The doctors' strike, or ‘industrial action’, as the strikers prefer to call it, has happened. On the day after the longest day (2012 is a leap year), a smaller than expected number of striking doctors turned up for work sporting ARP style armbands declaring ‘I’m caring for patients’, which was a bit rich if you happened to be a non-urgent patient, and smugged their way through their day. As own goals go, it was a corker, more Rear Admiral Hamish McMayhem taking his entire fleet the wrong way up the Windward Passage, than a solitary cocoa bean going the wrong way up Bournville Boulevard. On the radio, you could hear Langho rubbing his hands with glee at the gift of anti-doctor propaganda, while the media at large took turns to shy coconut after coconut at the ‘my pension or your life’ protesters. If proof was needed that Dr No’s former colleagues had lost the plot, then this was that proof.

The Lies of Others

Twenty five years ago, the General Medical Council’s Annual Retention Fee for doctors to remain on the Medical Register was £20, and the “Blue Book” – the Council’s code of professional conduct for doctors – ran to some thirty pages. Today, the same fee is £410, and the code, which is now issued in several volumes, runs to hundreds of pages.