Posted by: Nicholas Ramscar24 July 2013
I recently had my attention drawn to a post by Steve Kell, a GP and Clinical Commissioning Group chair, on his blog. He describes a patient about to undergo an operation, who asks which surgeon would be best suited for her needs. We’ve all had this question, and his advice – that any of the hospital’s surgical consultants would be able to deal with her problem – won’t have anybody sitting bolt-upright in their seat.
This is a persistent patient though, because rather than accepting his reassurance, she wants a more detailed answer. And she is obviously persuasive as well as persistent; in the course of their discussion, Dr Kell decides to publish his revalidation survey. As a CCG chair, he sees her enquiry as an opportunity to make a statement about the value of transparency in clinical care, and laudably decides to start with himself.
So, should we all be doing this? It would certainly fit the zeitgeist. The surgeons started releasing their mortality data earlier this year, and you might recall that variability of inpatient death rates has recently attracted a modest amount of media interest. In any case, we’ve done the work already - we are already appraised and revalidated, so why not publish and let the public admire the results of our box-ticking?
An objection to publishing the surgeons’ data was that it would create a drive away from more difficult cases, and that younger trainees would opt for specialties with naturally lower death rates. This wouldn’t be such a problem in general practice – there’s no way of predicting how complex the case is going to be until the patient’s in the room (or sometimes until they’ve already stood up to leave, and mention the central crushing chest pain from halfway into the corridor).
But at least the surgeons’ data measured something concrete and unarguable - death. Our feedback is usually fuzzier than that, focusing on listening ability, clarity of explanation, and whether you remembered it was appraisal time and bought the receptionists a box of chocolates the previous week. As Dr Kell says, good medicine and popularity are not the same thing. A doctor who makes a correct but unpopular decision might score lower than one who wanders down the path of least resistance. Feedback from patients is important, but it is incomplete data – perhaps it should be cross-referenced with benzodiazepine prescription rates, and quantity of sick notes dispensed.
Whatever the arguments for publishing revalidation data, I cannot see it garnering much immediate support from GPs. I cannot imagine GPs will think that their data will be viewed dispassionately, objectively, and free of political agenda. Certainly not whilst they are used to working twelve, thirteen, or more hours a day and then reading how lazy they are when they get home. They will suspect that this kind of candour would be whittled into another stick with which to beat them. Sadly – because the public deserve to know what they’re getting for their taxes, and because most of the data will be excellent – I suspect cynicism will get the better of transparency for a while yet.