26 November 2011

Vision for Vision for President of RCGP

Do we really want to go back in time
to the bad old days?
Over at Dr Una Coales's (@drunacoales) blog she sets out a vision for her bash at presidency of the Royal College of General Practitioners. I need to declare that I am not a GP, so I'm not in a position to vote on this. However, being a kindly soul, I am happy to offer Una some advice on how to present a vision that people can actually get behind. I'm posting this here because for some reason Una doesn't have comments enabled on her blog. I'm sure this is simply a technical oversight, and I hope it gets fixed soon.

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!]


  1. You mean this image?


    Or this one


    Or this one


    Or this


  2. The image I have used is taken from Una's own publicly available website; I assume she has obtained the necessary permissions for its use (and her YouTube channel camcorder recordings) from the BBC. At no time have I knowingly breached UK copyright on this website, and I have always acted extremely promptly to address any concerns that have been brought to my attention. Una knows this, and has all the evidence she needs to justify what I say. I would much prefer she discuss the issues that I have raised, because these are very serious indeed.

  3. You have not breached *ANY* UK or US law, she is just using cowardly bullying tactics.

    You cannot be sued in the UK for breaching a US law. Only a really stupid person could think this.

    Filing a false DMCA claim is illegal, so let her go ahead and try.

    She has several reproductions of copyrights material on her website, so she's probably comitted more copyright offenses than you.

    Please reinstate the link to the original photo. She cannot do anything about it as it's not illegal!

  4. Oh look, a copyright breach, 3rd photo down:


  5. It's not the copyright breach I am concerned about - legally I am on unassailable ground. This doesn't have to be personal (although I am aware of some things Una has said about me that are very unkind, and when she has time to reflect she will undoubtedly be a bit embarrassed by them); I don't hold grudges. My post is about this "vision" thing. The GMC has a lot of faults, but I for one would not want it restricted to the sorts of major systemic problems that only result in patient deaths. That is not what it is for, and I think it needs to be able to deal with much wider issues of competence. The photo issue is a flim-flam - that is why I took down the "copyrighted" photo and replaced it with one over which Una Coales does not have any copyright. The copyright for that belongs to the BBC. I have had no further communication from Una in relation to this, so I assume that she is now happy with this image.

  6. Maybe it was her time of the month which made her irrational and bitchy but I think the point about the image is relevant; should people who make baseless but potentially serious claims have such an influence on policy decisions which are a matter of life and death?

  7. Ooooh... Wayne. Naughty, naughty. The wife was nagging at me and I enquired whether it was "that time of the month".

    I'm still trying to find my left testicle to this day.

    These legal threats are becoming ever more vague and aggressive. People need to start realising that these legal threats are counter-productive.

  8. OK, the other BBC-copyright image has been removed. What are people's thoughts about GMC?

  9. It seems that Una has edited her blog post to remove the reference to the GMC that I discussed above. I'm not sure of the reasoning behind this.

  10. I think it is fair to say that Dr Coales' blog posts are a fluid work in progress. She revises some of them frequently. Possibly this is in response to other blogs, possibly it is her refining her vision of her candidacy. Her Twitter feed is similarly edited to remove tweets.

    It is a shame that it is not possible to debate the future of the RCGP and GMC with her. Various arenas for discussion are now off limits. I hope she will engage here.

  11. Of course it's perfectly reasonable to revise blog posts as one goes along; indeed I would be really grateful if she would do a bit of pruning so that we can see exactly what she is saying in the post I refer to above. It's not all bad by any means.

    Wrt the GMC thing, she does have a longer post on her blog which goes into her ideas for the GMC in a bit more detail, with local boards handling general competence issues, and a stripped down sort of "higher GMC" to handle serious negligence cases, but I think there are significant problems with this model, and am not sure that it would protect patients or support doctors adequately, as it would inevitably mire the whole process in red tape.

    I would be delighted if Una came on here to discuss these things, and maybe we could see if there are nuggets of gold hidden deep in there. I would hate for the poor literary style to be masking any issues of real substance that deserve wider debate.

  12. Agree with your view on GMC's role. Would welcome more transparency in how justly it delivers it.