It’s no secret that I’m not exactly finding general practice a breeze at the moment. The daily misery, the relentless increase in workload (much of which I believe is in no way in the interests of the patient), the approach of revalidation, the fact that after five static years we’ve had to give ourselves a 10% pay cut this month, and the fact that my blood pressure doggedly refuses to come down to a sensible level, all means that – even after going part time recently – I am not having much fun here.
Revalidation? I am just not facing up to it at the moment. I get emails, which I don’t open. There was a letter in the post this morning from the GMC, and I quote from the outside of the unopened envelope: ‘Ready For Revalidation -> Starts 3 December 2012.’ That’s in a couple of weeks! I don’t intend to open the letter until I’m a fair bit drunker than this. Maybe later tonight.
I am struggling to see the point of either annual appraisal or revalidation, for one main reason; it seems obvious to me that bad, incompetent or even frankly criminal doctors (of which there are undoubtedly more than a few) would barely break their stride in hurdling the obstacles that these processes would put in their way. It is an oft-repeated canard that Harold Shipman would have sailed through not only annual appraisal but 360-degree patient and colleague feedback. And if these processes are not designed to find people like him then what are they for? What are they actually for?
‘Kafkaesque menace’
I will concede that it is marginally more sensible for our profession to organise these hoop-jumping exercises ourselves, rather than allow some outside agency to have an aggressive poke at us at random, but I’m not impressed by our efforts so far.
I’d like to quote the medical intellectual giant Dr Theodore Dalrymple at this point: ‘In obeying directives not because they are right but because they are directives, doctors lose their self-respect, their probity and their intellectual honesty. Gogolian absurdity can result – with a hint of Kafkaesque menace and Orwellian linguistic dishonesty.’
And he wasn’t only talking about revalidation.
I’ve had a somewhat arm’s-length relationship with annual appraisal so far, since I discovered it wasn’t a legal requirement,but revalidation is different; it is a legal requirement, or what passes for legal in GMC-world, so I’ll have to play the game.
My impression is that appraisal and revalidation are all about reflection; the constant re-evaluation of how we practise and what we know.
And here’s the rub; that’s exactly what I do. I live and breathe general practice, I bore myself to death with the amount of time I spend thinking about this vocation and those patients directly under my care. I wish I could bloody well stop, but all I can do in reality is to divert my obsession into these fortnightly articles. I genuinely doubt that there are more than a few GPs more obsessively reflective than I am.
So that’s my plan. When it’s my turn for revalidation, I’ll walk into the room, tell them that I’ve not had a clinical complaint in 15 years, and lay 20 photocopied Pulse articles on the table. That should be enough, shouldn’t it? And if not, why not?
Dr Phil Peverley is a GP in Sunderland
