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You don't fatten a pig by weighing it

Plans for patients to rate GPs online are wrong-headed and akin to fattening a pig by weighing it all the time, The Jobbing Doctor argues.

Plans for patients to rate GPs online are wrong-headed and akin to fattening a pig by weighing it all the time, The Jobbing Doctor argues.

Over the last few years, Jobbing Doctor has seen a great change in the way that we interact with government. No longer are we a profession that can expect to set its own standards and regulate them from within the profession. We are now increasingly expected to react to political pressure.

We have, at the moment, a target-obsessed culture, and this has moved throughout all areas of professional life. It is a belief that professionals cannot be trusted to behave in a professional way and somehow have to be monitored and measured. It pervades in teaching, as well as social work and local Government.

The problem is that the measures of professional working are crude and difficult to interpret in any meaningful way. As Einstein said: ‘Everything that can be counted does not necessarily count; everything that counts cannot necessarily be counted. '

Regardless, we have had a gradual drift towards a consumerist approach to medicine and the latest manifestation is a website that allows you to ‘rate your own doctor'. This has been going for around six months or so. Problems with it include a hopelessly out of date database, so people can rate doctors who aren't even in the country any more and also people who died months ago, and that all these ratings are anonymous.

One could more easily accept this kind of puerile nonsense if it had been developed by some entrepeneurial wunderkind. However, the evidence is that it has been put together by doctors. And this is the surprise, as one would feel they had the judgement to know that this is an ineffective and dangerously simplistic tool. As it is a very poor site, we expected it to fail, quietly and unmourned. However, it is now clear a number of senior figures in the profession either had a hand in its development, or gave tacit approval. This shows a surprising lack of judgement.

We can see now that it was a way government could test out sites like this prior to incorporating it into their own way of assessing GPs. The health minister, Ben Bradshaw, has likened such assessment of doctors to reviews on Trip Advisor or Amazon. However, unlike those sites, ratings of doctors and practices are put on anonymously and anyone can make an adverse comment that is libelous, or completely incorrect, without any chance of comeback.

So we as GPs face being compared on all sorts of spurious grounds with no real value to these judgements and no right of reply. This is a frequent problem with many of Government's initiatives (if that is not an oxymoron) - the law of unintended consequences. Nothing will demotivate a professional more quickly than being given a bad report that is untrue, when they don't know who has made it and they cannot do anything about it.

One would hope that some lay organisations would have a better idea, and would recognise the sterling work that goes on in primary care, particularly those organisations whose members are overwhelmingly dealt with in primary care. Say, a charitable organisation like Diabetes UK. But now their vice-president has climbed on this rating bandwagon, believing it will improve services. They are wrong-headed in supporting this chimera of a website.

You cannot fatten a pig by weighing it all the time. Constant assessment will not improve a service. And the perpetrators of this website should be ashamed of what they have created, and what will be done with it.

Badly done.

The Jobbing Doctor: you don't fatten a big by weighing it all the time The Jobbing Doctor

The Jobbing Doctor is a jobbing general practitioner in a deprived urban area of England. I tend to write about what I see and experience in primary care - the highs (and there are many of them), the lows (some of them as well), and many other things in between.


There is a long history of doctors who write. Whilst I would never put myself in the same league as almost all of them, there seems to be a compulsion to write down our experiences, as we are often the chronicler of the common man. Writing a blog is really a form of this.


Previous posts
Why being 'my GP' to a patient will secure our future March 10

"You can't fatten a pig by weighing it all the time. And constant assessment will not improve general practice." Fattening a pig

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