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Detours on the ‘patient journey’

Forget QOF, home visits and actually seeing patients. This year Copperfield will be mainly 'preparing for revalidation'

I'm going to tell you something you already know. Something about the wacky world of practice in general and of the consultation in particular. But it will come as news to those who feel qualified to judge, mould or dictate our terms of engagement – like Daily Mail reporters, the authors of ‘care-pathways' and politicians.

It's this. A consultation isn't a clear-cut interaction between the ‘consumer' (that is, the patient) and the ‘healthcare provider' (that is, us). Those who write headlines, flow charts and terms of service think it is. They believe a patient walks in with a right inguinal hernia, is offered a choice of hospitals and is given a ticket for his ‘patient journey'.

If only. What actually happens is this. ‘Hello doctor, this hacking cough is doing my head in, can I have my inhalers while I'm here, I'm ready to try those nicotine patches, can you pop in to see my mum soon, her memory's worse, did you ever get my results back from the hospital, I must show you my manky nail, I'm due a blood pressure check, by the way, whenever I cough, I get a lump in my groin. Oh, and how about some Viagra?'

All this, of course, with phones ringing, QOF prompting, visits pouring in, the registrar asking my opinion about a ‘non-blanching rash' and a memo telling me I'm late for my time-management seminar.

In short, it's like trying to spin plates while someone hits you in the face with a plank.

At a conservative estimate, I reckon I handle around five distinct problems per consultation. The constraints of time and expertise mean I work to an 80% level of perfection – and I say that's good enough. Aiming for anything better requires disproportionate effort for minimal added patient benefit. But the GP critics and deconstructivists don't create order from chaos, like us; instead, they'd create five distinct consultations from that one interaction. A quintupling of time and cost, in other words, to improve care by, say, 10%.

You understand the principle of being ‘good enough', of course. You'd think the college should, too. But I've just received a copy of ‘RCGP proposals for the revalidation of GPs'. It contains a list of a dozen areas of supporting information we'll have to provide, like multi-source feedback, patient surveys and so on, stopping only just short of requesting that we convey the attributes of our practice in the form of an hour-long performance-art mime.

Bugger me. The only easy bit will be, ‘A description of my work', because, by then, it'll comprise, ‘preparing for revalidation'.

And here's the point: the college should apply to revalidation the principles of the consultation. Assess us GPs to the ‘good enough', 80% level: instead of the proposed full-on pantomime, just give us GPs a quick five-yearly MCQ, and subject only those who fall below a cut-off to electrodes-on-genitals scrutiny.

It's not perfect and it doesn't measure fluffy stuff like communication. But it would be a cheaper, simpler, painless and ‘good enough' proxy.

And those of us who do a good enough job might just have a chance to get on with it.