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Nailing Doctors

Posted by Dr No on 10 October 2012

fang_et_al_2.jpgA 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?

Meanwhile, the rising presumption of incompetence, and so the need for greater professional guidance and control, continues apace. The motorway pile up to come that is medical revalidation continues to cruise down the autostrada of fate. Chief bus drivers Fang and Stilton were up before Dodders and his Health Select Committee the other day. Fang and Stilton were in expansive mode, but Dodders was in heads-down no-nonsense mode. On being offered an effusive introduction, Dodders told Fang, in the best Parliamentary language, to cut the crap. Fang cut the crap, and much of what was left was about revalidation.

The GMC remain confident that revalidation can be, as Fang had it, ‘switched on’ by the end of this year. From later evidence in the (uncorrected) transcript, it seems likely that this will be more of a light going on in a cupboard under the stairs affair, than the Blackpool Illuminations. One in four doctors still do not have an annual appraisal that might meet even basic revalidation needs. Only last month, when the hearing took place, final notions of who might be a responsible officer, where they might sit and even how many there may be had not been settled. Getting on for half of all doctors are attached to organisations – their so-called designated body – that fall outside mainstream NHS structures. One can’t help worrying that if Fang does switch his infernal machine on later this year, a fuse might blow.

And indeed infernal machine it will be. Despite the familiar caring and sharing rhetoric about ‘supporting’ doctors who fall foul of the system, one or two questions gave Fang the opportunity to show his teeth. When it comes to revalidation, there won’t be any comfy chairs. Asked whether responsible officers will always be doctors, he replied yes, but the real interest lies in the reason he gave: “We want responsible officers. The clue is in the name, ‘responsible’. We want somebody that we can nail, quite frankly.”

We want somebody that we can nail.” At a time when GMC complaint inflation is running at over 20%, such that one in 64 doctors now face investigation, nailing doctors, even if they are responsible officers, doesn’t sound very friendly, let alone supportive. And yet, in this brief, almost flippant, remark, Fang has revealed the spirit and culture he has in mind for revalidation. RO’s – members of what Stilton notably called his ‘army’ - will live in constant fear of being nailed by Fang; and in turn they, fearful themselves of being nailed, will not hesitate to nail those for whom they are responsible, and whose standards they deem to have fallen short.

Talk of armies and officers, not to mention nailings, evokes a hierarchical, militaristic culture, and that is what we will get. Yes, of course we need to deal with bad doctors, of whom there are too many, but what works and is indeed necessary in the Forces and on the battlefield does not, Dr No believes, sit comfortably with the profession of medicine. All the more so, given that, as one of the committee astutely noted, the GMC is a one-club golfing-machine, and we then recall, as well we might, Maslow’s old saw that when the only tool in your hand is a hammer, everything looks like a nail.


Bloody hell, no wonder doctors are stressed if that code is anything to go by. Do they really think that it's only doctors in rural communities that may be friends with former patients? And do they really think that being a 'friend' on FB is the same as being a RL friend? Some of us have a few 'friends' on FB, but some have hundreds, depending on what sort of function FB has for them.

Maybe people at the GMC don't have any friends of either sort so they don't understand that the world doesn't end if us mere mortals dare to communicate with a doctor, even one who used to look after our medical needs, or vice versa.

Never mind, Dr No, you can set up a nice FB account where you pretend to be someone belonging to a profession with a less dotty body overseeing it. What about a pole dancer? They seem less inclined to think that coming within twelve feet of a disrobed body means something improper is going to happen.

The more Dr No considered this post after writing it, the more bizarre he found the situation it describes. On the one hand, we have the Royal College of Caring & Sharing infantalising doctors, or perhaps treating them as toddlers who need to be told they can drown in that nice enticing paddling pool, when the fact is that doctors are - Dr No shudders to say it - intelligent people who have been through a gruelling education and who should know, or if they don't, should make it their business to know, the ways of the online world. Dr No suspects the College's caring and sharing educators are behind the Social Media Highway Code, even if Clare Gerada, some might say a somewhat incontinent tweeter herself, has put her name to it. Dr No remains firmly persuaded that a world in which one chooses to communicate much of the time in chunks limited to 140 characters is an impoverished world.

Then, at the same time, we have Fang (Fang (as in Cardinal Fang) = Rubin and Stilton = Dickson, for those who are not familiar with Dr No's allocation of names) going on record with a 'throwaway' but nonetheless very revealing remark about nailing doctors. This world, Fang's hard cold world of nailed doctors, could not be more different to the cotton-wool wrapped kiddies' world of the College.

But then again, are they so different? Both Fang and the carers and sharers are, in their own very different ways, undermining professional autonomy, itself the handmaiden of not just confidence and competence, but of truly responsible professionalism. Both, in effect, are saying: doctors can't be trusted. The College has adopted a kids' TV 'lets have fun and be safe' approach, while the GMC has gone for the 'kick ass and take names' approach (and set up its own pseudo-Stasi to do this); but the underlying presumption is the same: doctors cannot be trusted.

These presumptions are very dangerous, because if promulgated enough, doctors themselves might even start to believe them. And who wants to be treated by a doctor who doesn't even trust himself?

I'm not sure where the GMC is coming from here. On the one hand, it's surprising how the net can bring out the inner 'pee-po-belly-bum-drawers' spirit in otherwise intelligent people. On the other hand, the internet is about the only channel left in which we can record what is truly going on in the NHS and it will not have escaped the GMC's notice how the likes of 38 Degrees acted as a rallying point for disaffected medics when the Royal Colleges couldn't get their act together on the HSCB. This is a medium that they haven't quite figured out how to control yet and long may that continue.

I was brought up in the original Medical tradition. Our Prof of Medicine is Scottish and knows his stuff, Dr Skilled and he warned us from day one that as the lowest form of live form on the war; Med. Students, we have to remember one thing: kindness alone does not cure diseases; medical skill might and that still ring true in my mind even today. My school friends when they have a medical problem, do not consult Dr Kind, they want Dr. Skilled, and that is the honest truth.

Gullible citizens are led to believe that all we need is a smiling understanding Dr Kind and not generally the one in hospital AS THEY ARE GOING PRIVATE AFTER BEING CLOSED.

If one day you need a stent, you will probably have to pay:that is Dr Skilled.

By the way , if people think and that includes those at the GMC think that they are going to catch out Shipman, think again, Shipman was too skilled at what he was doing.

What about Jane Barton? That is a whole different story. It is who you know!

Methinks you have hit the nail on the head Dr. No!

“Talk of armies and officers, not to mention nailings, evokes a hierarchical, militaristic culture, and that is what we will get.” And so you will.

Nothing stifles innovation, good practice more than an army of policies, procedures and protocols. Nothing stifles confidence more than the presumption of incompetence. Nothing stifles trust in the ?wise who operate in the higher echelons of medical Gestapo’s who gearing toward revalidation have not yet validated revalidation itself nor validate the opinions of their underlings.

I have always thought that something peculiar exists in the world in which health professionals live breathe and work, a strange kindergarten mentality that I never found working outside health…and as the power of the chief bullies rise and rise (under the guise of revalidation) God help those who, independent of mind and steadfast to their convictions of what is right and wrong fall outside of the ‘protection’ of responsible officers when they fail to toe the prescribed line…(Oh how personal vendettas can be meted out in this new arena..)

Nursing is not far behind, what was considered good practice changes as often as the wind – yet no-on informs you the wind has changed direction and God help you if you fail to notice...human error such as overlooking signing – it is so easy to become distracted in my work environment - a single entry on a MAR chart can lead to being struck off for-failing-to-give-medication-as-prescribed (Doesn't matter that you have given them.). And how insecure and full of self doubt you become when you are afraid to be open with regards to human error, how insecure and full of self doubt you are with every new decree…and revalidation will follow soon for us…and we will feel more stifled, insecure and damn it frightened!

Social media: I do so miss the medical bloggers who have transferred their loyalties to twitterland; I miss the informative posts and the interaction between docs and the general public – which I regard as healthy. That said Facebook is alive and kicking with excellent docs…

Well I will sign off now as I am depressing myself.

Leadership training by the army was deemed suitable for CEOs or Medical Directors.

On the other hand leadership training by Common Purpose was deemed suitable for lesser NHS mortals

Today all of us got trouble in our health due to food collapsion. An article can make a change of world 50% then it should be appreciable. Your article may cause a big change.

Dr No has had to turn new comments off. Please use twitter instead