|Do we really want to go back in time|
to the bad old days?
Well, the post is a bit of a mess. It's far too long, and doesn't help the reader make an assessment of what Una can bring to the important position of President of a major medical Royal College. It meanders all over the shop and contains numerous platitudes and pointless anecdotes that add nothing to the overall thrust (if there is one). There are also some alarming aspects that certainly raise my eyebrows, for example:
I reiterate the U.S. policy that the GMC should ONLY deal with proven cases of medical negligence, i.e. when a patient dies unnecessarily, when a death could have been prevented but occurred due to negligence.I am something of a cynic when it comes to the General Medical Council. I agree with Una that many of its systems and processes are long and harrowing, and that the GMC can be abused as a weapon against doctors by people with a grudge. However, to restrict the GMC to dealing with "proven cases of medical negligence" is a very very strange thing to say. The "i.e." implies that a patient has to die before anyone gets pulled up on their practice; I charitably presume that Una meant "e.g." here (I hate it when people misuse these important little abbrevs), but if this is meant to be a bar indicating the severity of malpractice meriting a referral to the GMC, then medicine really will be in trouble. What about inappropriate sexual advances to a patient? What about financial pressure, or coercing patients to write the doctor into their will? What about grossly incompetent surgery where the patient doesn't die, but ends up disfigured or in pain? Surely no competent doctor would wish to see the GMC restricted to dealing only with patient deaths, but wants to have a regulator that upholds standards of excellence in patient care, right the way down to ingrowing toenails or accurately assessing and communicating risk (important in my own specialty of Genetic Medicine).
And then we need to ask what constitutes a proven case of medical negligence? Who does the proving? In the UK, that is generally the GMC, so Una seems to have hit a bit of a Catch-22 here; if the GMC only deals with proven cases of negligence, and for a case of negligence to be proven, that requires a GMC adjudication... You can see the problem. Certainly Una is right if she's saying the GMC should not pry into people's personal lives, religious beliefs, sexuality etc. if the doctor nonetheless practices excellent medicine without fear or favour. But in matters of medical practice, it has to be the GMC that decides what constitutes negligence or incompetence (these are not the same thing). Una is of course also correct in implying that the processes need to be sped up to weed out vexatious referrals or complaints where there is no case to answer. The GMC is not and must not be a grievance body.
What do doctors (and patients) really need in a president of the RCGP? Vision is one thing; clarity of vision is another. I suggest they need grit and determination (Una certainly has these in spades), but also a commitment to practical everyday excellence, constructive engagement, and the development of a truly responsive and equitable health service. In order to avoid over-lengthiness and meandering I'm going to leave it there for now; do have a read of Una's post, and perhaps we can discuss further in the comments below (which I allow on my blog).
[UPDATE - Dec 2011: Image changed because of threat of legal action to the tune of $150,000!]
[UPDATE2: 1/3/2012: Previous still image from Mentorn Media's production for the BBC "The Big Questions" (broadcast 12/2/2012) has been removed after a request from the company. I wish it to be clear that this was completely voluntary and amicable, without coercion of any kind.]
[UPDATE3: 1/3/2012: Keep an eye on the blog for the latest!]