The equinox has passed, Monroe is back, and so too is Dr No. It has been a quiet summer for medical bloggers. Hot Burning Coales got herself into hot water lately, implying that the Royal College of Caring and Sharing was a coven of homophobes, xenophobes and gynophobes, and Ben Goldacre has discovered publication bias, and served it up with Bad Pharma sauce, but the big event of the first half of the year, the passing of the Health and Social Bill into law, has given way, as did the outbreak of WWII, to a phoney war. No tanks piloted by Very Willing Cowboys have yet been seen overrunning hospital car parks; nor have any foundation trusts been bombed by even more willing hedge fund managers. It is, for now, as if the Act had not happened. Which is just as well, for now, because there is another big black cloud looming large on the medical horizon: the spectre of revalidation. What, Dr No wonders, would Stilton and his gang of goons make of Monroe?
Monroe is Dr No’s kind of doctor. Never mind that he chooses to operate on raspberry jam and porridge – Dr No always preferred operating further south, in the gumboots and Mackintosh territory of O&G – it is his approach and attitude that appeals. He is a surgeon who knows that the essence of surgery is as much about the cerebral activity of knowing when to operate as it is about dexterity, and that the best surgery comes about when the surgeon works as much with the patient as against the disease, for all surgery does is set the body up so that it can heal itself. Were Dr No ever – Heaven forbid – to develop Parkinson’s, he might just let Monroe wiggle his coat hanger deep in the recesses of Dr No’s brain. It worked for Monroe’s first patient, a car mechanic whose tremor stopped as sweetly as a car door opens when the coat hanger touches the spot.
But Monroe is a maverick unicorn with his horn permanently stuck in the tree of authority. The new series has helpfully embodied authority in the form of a timid surgeon turned manager with a forehead so broad that even a blind unicorn could not miss. To annoy Monroe still further, the manager has recruited a caring and sharing nurse practitioner sidekick with attitude who Dr No suspects may be Nurse Ratched on happy juice. Sure enough, once Monroe had put down his coat hanger, he and the surgeon-come-manager locked horns over whether to operate on a lad with a vascular malformation that had already caused a stroke, and which, despite the fact it could cause death at any moment, no less than two other surgeons had declined to operate on, on the grounds that it was too risky.
The lad, on the other hand, had other ideas. Notwithstanding a reckless habit of tapping the side of his skull right over the ticking bomb, as he called it, he and his pregnant wife had done their homework. Monroe was their man. They even had a nice line in surgical flattery stitched up: Monroe’s hands, said the lad, were craftsman’s hands. Monroe was powerless to resist. The operation went ahead, and, like the coat hanger trick, this being Monroe, was a great success.
But what if it had gone wrong? The surgeon-come manager had made it very clear that, while he might put up with Monroe’s coat hanger tricks, he had no truck with Monroe boldly operating where two previous surgeons had timidly failed to go. Monroe’s answer was that in all likelihood they were youngsters, moulded by today’s risk averse culture, but that does not alter the fact that, had things gone wrong, Monroe would have faced a bumpy passage through the Bolam test.
And what if – as likely would have been the case – the surgeon-come-manager had been Monroe’s Responsible Officer – the GMC’s on-the-spot goon charged with signing off Monroe’s revalidation? What would once have been merely a difference in clinical opinion suddenly becomes a ominous matter of management control. What if the RO, led by a timid nature and burdened with the awesome responsibilities of his post, believes, in good faith, that he cannot responsibly sign off Monroe’s reckless behaviour, for so to do would be to endorse that behaviour? Monroe would find himself in a sticky place from which he would need rather more than a coat hanger trick to escape.
There may be some things on which HBC and Dr No might not see eye to eye, but on revalidation they certainly agree: it is a Very Bad Idea. Ironically, the Royal College of Caring and Sharing’s presidential election a few months back garnered the College a pro-revalidation president, while HBC, also a candidate, bombed. HBC could do far worse now than focus her efforts on opposing revalidation, for she clearly believes, as does Dr No, that revalidation has nothing to offer us. Nothing, that is, but blood toil tears and sweat.