A hundred years ago, when Britannia ruled the waves, our language was high on a tide of nautical terms. Today, in the age of the automobile, it is to motoring that we turn for our metaphors. The complexities of nutrition are reduced to the simplicities of traffic lights. The rigours of medical regulation – revalidation – are simply MOTs for doctors. Latest on the bandwagon is the Royal College of Caring and Sharing, which has shared, on facebook of course, its Social Media Highway Code. There is, inevitably, a lot of caring, and even more sharing, but, for this reader the wheels started coming off the code when it likened today’s doctors to yesterday’s Wild West cowboys. Are today’s doctors really so feeble that they cannot for themselves work out how to behave online?
Meanwhile, the rising presumption of incompetence, and so the need for greater professional guidance and control, continues apace. The motorway pile up to come that is medical revalidation continues to cruise down the autostrada of fate. Chief bus drivers Fang and Stilton were up before Dodders and his Health Select Committee the other day. Fang and Stilton were in expansive mode, but Dodders was in heads-down no-nonsense mode. On being offered an effusive introduction, Dodders told Fang, in the best Parliamentary language, to cut the crap. Fang cut the crap, and much of what was left was about revalidation.
The GMC remain confident that revalidation can be, as Fang had it, ‘switched on’ by the end of this year. From later evidence in the (uncorrected) transcript, it seems likely that this will be more of a light going on in a cupboard under the stairs affair, than the Blackpool Illuminations. One in four doctors still do not have an annual appraisal that might meet even basic revalidation needs. Only last month, when the hearing took place, final notions of who might be a responsible officer, where they might sit and even how many there may be had not been settled. Getting on for half of all doctors are attached to organisations – their so-called designated body – that fall outside mainstream NHS structures. One can’t help worrying that if Fang does switch his infernal machine on later this year, a fuse might blow.
And indeed infernal machine it will be. Despite the familiar caring and sharing rhetoric about ‘supporting’ doctors who fall foul of the system, one or two questions gave Fang the opportunity to show his teeth. When it comes to revalidation, there won’t be any comfy chairs. Asked whether responsible officers will always be doctors, he replied yes, but the real interest lies in the reason he gave: “We want responsible officers. The clue is in the name, ‘responsible’. We want somebody that we can nail, quite frankly.”
“We want somebody that we can nail.” At a time when GMC complaint inflation is running at over 20%, such that one in 64 doctors now face investigation, nailing doctors, even if they are responsible officers, doesn’t sound very friendly, let alone supportive. And yet, in this brief, almost flippant, remark, Fang has revealed the spirit and culture he has in mind for revalidation. RO’s – members of what Stilton notably called his ‘army’ – will live in constant fear of being nailed by Fang; and in turn they, fearful themselves of being nailed, will not hesitate to nail those for whom they are responsible, and whose standards they deem to have fallen short.
Talk of armies and officers, not to mention nailings, evokes a hierarchical, militaristic culture, and that is what we will get. Yes, of course we need to deal with bad doctors, of whom there are too many, but what works and is indeed necessary in the Forces and on the battlefield does not, Dr No believes, sit comfortably with the profession of medicine. All the more so, given that, as one of the committee astutely noted, the GMC is a one-club golfing-machine, and we then recall, as well we might, Maslow’s old saw that when the only tool in your hand is a hammer, everything looks like a nail.