This morning, Yesterday had the Right Honourable Jeremy Richard Streynsham ’Unt, Secretary of State for Health, on the line. He was on to crack up revalidation, Stilton’s pet project to spear ‘under-performing’ doctors. Evidence Based ’Unt is new to health, and it showed, despite being interviewed by Yesterday’s laziest presenter, Justin ‘Um’ Webb. When EBH wasn’t saying well, um too, he squeezed out the usual tired toothpaste of revalidation rhetoric, about the need to ensure doctors were up to speed on the latest advances, and in so doing revealed he hadn’t a clue about Stilton’s real plans. Bored, Um moved on to evidence based abortion limits and evidence based homeopathy. EBH carried on as before, squeezing out colourless, tasteless, um, toothpaste. Yesterday had missed a trick: surely Wingnut, Um’s co-presenter, would have done better. He might even have managed to get evidence based toothpaste with a stripe in it. Instead, we had to put up with evidence based ums.
Well, um indeed. Quite why the Department of Health should choose a damp October Friday for the Ministerial launch of Conning Patients, Spearing Doctors is beyond Dr No. If ever there was a slow training coming, it has been revalidation. It has been grumbling through the back yards and branch lines for over a decade now, and yes, it does look set to be the biggest train crash in GMC history, but why was it on Yesterday today? Perhaps a glance at the Department’s press releases over the coming hours may give us the answer.
Meanwhile, only yesterday Dr No was lamenting the unholy mess the Royal College of Caring and Sharing and its ex Council member, Hot Burning Coales, have got themselves into. While there may be much Dr No and HBC disagree on, there is one thing they do agree on, and that is that revalidation is a Very Bad Idea. The reasons why revalidation is a VBI are manifold, and Dr No has covered many of them in posts passim, but what bothers him now is why the hell the profession at large and in general appears to be hell bent of prostrating itself on the tracks as the train bears down. In fact we might even say it is worse than that: the College, in ousting HBC’s presidential hopes, let a pro-revalidation candidate into the presidential cab. Unable to resist leaning on the revalidation throttle, he will will help to ensure that the crash when it comes will be spectacular.
The early effects of revalidation will be to trigger mass retirement, as competent experienced doctors refuse to suffer the indignity of jumping through Stilton’s hoops. This of itself will be a disaster, as the NHS loses many of its senior doctors at a time when the health service is shuddering from the dynamite of cuts and reforms so radical they can be seen from space. Upon this blasted barren landscape, stage two will be unleashed: the hell of McCarthyism, as packs of Stilton’s goons hunt the survivors, spearing at will. Is it really any surprise that doctors who have given the matter proper consideration want no part in this bonfire of the profession?
At its heart, revalidation deprofessionalises doctors, by turning them into little more than cars to be MOT’d, with brakes to be inspected and emissions to be measured. It is sham regulation, by external control. To stick, once again, with the motoring metaphor, we know that a car is only as safe as the driver at the wheel. No MOT test, however thorough, can account for the mind that controls the car. And so it is with doctors: the surest, safest and most professional way of ensuring doctors are competent and humane is to make sure the mind that controls the doctor is competent and humane, and that can only meaningfully be achieved by a process of internal regulation. It is also the path, and indeed the essence, of true professionalism: self-regulation; for without internal, self regulation we can no longer claim to be – indeed, have even given up the right call ourselves – a profession.