Who owns the consultation? I know who owns the pen I sign scripts with: me, even if it’s emblazoned not with my name but, ironically, with the name of some drug I will never sign a script for. I know who owns the building I work in: PropCo, or whatever they’re called these days. I even know who owns fairly abstract concepts such as the patient’s records: the Secretary of State for Health.
But, as I say, who owns the consultation? Not NHS England, even though they increasingly dictate its content via QOF, DESs and a variety of other intrusive annoyances. Not the DoH, despite all the talk about charging for DNAs or even for consultations themselves. Not even Richard Branson, at least not yet.
Patients, then? If this was an MRCGP viva, that would be the correct answer, but it isn’t, because a) There is no MRCGP viva, where the hell have you been for the last 20 odd years? b) It isn’t that simple.
Sure, patients have a degree of ownership sufficient to dictate whether extraneous matter (students, trainees, TV camera crews) impose on their consultation. Which means, I guess, they’re the ones who could veto whether the CQC and its huge f-off clipboard can cram into one corner of the consulting room as part of its ‘evidence-gathering’ exercise.
But don’t I get a say? Don’t I own at least a teensy weensy bit of the process I spend 90% of my professional life doing? Yes. Yes, of course I do. I say when consultations happen, when they start, when they end and, as much as I can these days, what they comprise. The consultation is my life and my life is the consultation.
So here’s a question for you: come the day, and my patient gives consent, am I obliged to let the CQC in on my precious consultation?
After all, the GMC Good Medical Practice Guide states that I should respect patients dignity and privacy, and that I must treat information about patients as confidential, and, no doubt, a whole heap of other things that aren’t compatible with the sound of boxes being ticked, or more likely, crossed, somewhere in the corner of my consulting room.
Or, to put it more simply to the CQC and the various other impositions on my working life: you have taken my self-respect, my sense of professionalism, my hope for the future. But you’re not bloody taking my consultation. It’s mine.
You can borrow my pen if you want, though.