Twenty five years ago, the General Medical Council’s Annual Retention Fee for doctors to remain on the Medical Register was £20, and the “Blue Book” – the Council’s code of professional conduct for doctors – ran to some thirty pages. Today, the same fee is £410, and the code, which is now issued in several volumes, runs to hundreds of pages.
This colossal increase in regulatory demand has arisen for a number of reasons. Firstly, it simply reflects the general increase in regulatory interference by the state in its people. Secondly, over the last decade or so, there have been a number of high profile cases of exceptional failings by doctors, and these failings have generated a need for the Authorities to be seen to be “doing something”. And finally, according to the Authorities, there is a crisis in public trust in the profession; and this crisis can only be met by yet more intrusive regulation – by introducing revalidation for doctors.
There is much to be said about revalidation, and none of it is good. However much the Authorities may cant on about it being worthy and necessary, the fact is that most jobbing doctors consider revalidation to be unworthy, unnecessary and an unjustifiable intrusion into professional practice.
Revalidation reverses the normal contract between a doctor and society. It replaces the idea of a contract built on trust which assumes that the doctor is capable until proved otherwise with one that says the doctor in incapable until proved otherwise: that the doctor is untrustworthy until he or she has proved that they are trustworthy. It creates a state of affairs in which the default position is one of suspicion and mistrust.
A state in which the default position is one of suspicion and mistrust has more in common with a police state than a liberal democracy. Could it be that, far from being a “good thing”, revalidation is in fact nothing more or less that the Stasification of the profession? That the medical profession will, in effect, become a police state within the state?
If one looks closely, there are in fact compelling similarities between the organisation of a police state and the developments the Government intends to impose on the medical profession.
Firstly, we have a Department of Health – the Party – that is increasingly seeking to dictate what the profession should and should not do. We have the development of a state apparatus for policing the profession – the General Medical Council – the Stasi – which is now less accountable than it has ever been (except to the Party), and is to be granted greater powers to regulate the profession than it has ever before had.
Much of that control will – if we do not act to prevent it happening – be exerted through revalidation. Doctors will be required to give an annual account of their professional activities to the state to a degree previously unimaginable. Local officers of the Stasi – the so-called “Responsible Officers” will scrutinise these accounts for irregularities, and doctors found wanting will be “terminated”. Behind the scenes, shadowy apparatchiks known as “GMC Affiliates” will organise these executions. These shadowy officers will be beholden not to the people, or to the profession, but to the Stasi, and so to the Party.
To some, such an analysis might seem fanciful. But perhaps it is not. History tells us that truth is the first casualty in a police state: lies, propaganda and disinformation takes its place. Is there any evidence that the Party is issuing material which isn’t quite what it says it is? That could, in fact, be disinformation?
Well, in fact there is. Obersturmführer Marshall, writing in an editorial in last month’s British Journal of General Practice, describes revalidation as “a professional imperative”. The use of the word “imperative” is itself interesting. But far more telling is the content of the editorial.
The thrust of Marshall’s argument is familiar (another police state characteristic: propaganda is repeated until it is believed): the world has changed, and now doctors must change in response. The change is that the public no longer trusts doctors (this is itself disinformation: what evidence there is suggests the opposite is true – see here) and, as a result, doctors must undergo revalidation. It is, indeed, a “professional imperative”.
Let us look for a moment at what is behind this editorial. It cites ten references. Interestingly, only one of the references appears to be a conventional research paper (and that only touches on a small technical point). Of the nine others, four come from the State, one from the immediate past President of the Stasi and two more are diktats from one of the academic arms of the Party. There is also a reference to “The New Politics of the National Health Service” which, since it was published in 1998, probably isn’t so new anymore. The editorial relies not on research, but on the Party’s own direct and indirect propaganda to make its case.
Self-referent grandiosity is of course to be expected in such an editorial by an apparatchik. More sinister is the misuse – by misrepresentation – of the writing (or in this case the transcript of lectures) of others to bolster the apparent weight of the ideas expressed.
Never mind the fact that the Herr Dr (and the BJGP) has misspelled the name of the author of the reference (it is O’Neill, not O’Neil), for that is just careless (but nonetheless discourteous). What matters more is that Marshall has misused the reference. In his editorial, he uses the reference to imply support for his notion that the concept of implicit public trust in the profession is dead, and that instead a form of explicit checking – that is to say revalidation – must replace it.
It never does any harm to check whether a reference actually supports what an author says it does. As it happens, O’Neill – who’s writing carries some weight, because these are the transcripts of the 2002 Reith Lectures – does not support Marshall at all. In fact she says exactly the opposite: that the crisis in trust, far from being certain, may be a myth, and that the kind of intrusive, over-bureaucratic revalidation processes proposed by Marshall and others in the Party may just turn out to be what we do not need:
“We say that we want to end the supposed crisis of public trust, and we’ve tried to do so in part by making many professions and institutions more accountable so that they are trustworthier. In these lectures I have queried both diagnosis and remedy. We may constantly express suspicion, but it is not at all clear to me that we have stopped placing our trust in others: indeed that may be an impossible form of life. We may constantly seek to make others trustworthy, but some of the regimes of accountability and transparency developed across the last 15 years may damage rather than reinforce trustworthiness. The intrusive methods that we have taken to stem a supposed crisis of trust may even, if things go badly, lead to a genuine crisis of trust.” Source
Some might say that such misuse and misrepresentation of the writings of others is small beer, even trivial. But it is not. A boundary that should not be crossed has been crossed. A step that should not be taken has been taken. Truth has been bent.
Film buffs will recognise the image at the top of this post is from the film “The Lives of Others” (for those who have not seen it, a superb film about the harm that arises from State surveillance of it’s people). Yet this post is called “The Lies of Others”. This is not a typo. Instead, it is a reminder that, in the process of creating a police state, truth is the first casualty. That process has already started.