Two days ago Dr No got another fun email from the GMC. Unlike the recent email from O Chair – ‘I’m Terry, and I’m your buddy!’ – the latest email is GMC News, March 2015, e-bulletin edition. Dr No passed on the email’s ‘Forward to a friend’ link – if friends are forwarding GMC emails to you, you need to check out who your friends are, and if you are forwarding GMC emails to your friends, you need to check out whether you’ve actually got any friends. He also declined to click the link offering Dr No the opportunity to check his registration online, on the grounds that he already knew his registration status. He learnt, from the GMC News e-bulletin headline, that there was ‘Strong support for proposals to improve patient protection and public confidence in doctors’, which turned out to be another eight out of ten cat owners who replied story. He also learnt that the theme for this year’s GMC conference, hashtag #GMCconf for those who can’t – perhaps because they are busy forwarding GMC emails to friends – make the regulator’s annual gangbang in person, is ‘creating a culture of openness, safety and compassion’. Coming from an organisation which, at least in the conduct of its fitness to practice procedures, is known for its opacity, recklessness and indifference, this struck Dr No as a bit rich.
It’s a matter of conjecture whether Stilton wants more complaints to the GMC. Last year, he was all for it. The GMC’s State of the Profession report for 2014, published on 8th October 2014, noted ‘regulators…are seeing a rise in complaints…much easier to raise a complaint. This is all to be welcomed…’. The ellipses cover many words but the meaning is unaltered. By 11th February 2015, only four months later, writing in BMJ Careers, he said ‘We do not “welcome” the huge increase in complaints’. It is not clear why “welcome” is in quotes but that aside the two positions seem rather at odds with each other. Perhaps they have the heating at GMC Towers set rather high, and Stilton is starting to overheat. Or maybe it’s complaint blowback, be careful what you ask for. Welcoming complaints, the GMC got more than it bargained for.
The annual metronome to British public service broadcasting, the Reith Lectures, have begun this year’s tick, with Dr Atul Gawande doing the tocking. A smooth tocker with hints of George W Bush style pulsing rising enunciation, today’s first lecture – the first of four, we should note – asked ‘Why do Doctors Fail?’. Master of the personal anecdote, Gawande told the tale of a certain Baby Walker – not the contraption, but his son – who survived despite being born with an aortic abnormality, while the baby in the next cot with the same condition did not. The answer, by and large, was systems failure: Baby Walker ended up in the right place at the right time, while Baby Maine next door did not: the right place, perhaps, but too late. Walker walked, Maine died.
Dr No made no secret of the fact that Dropping Like Flies was a quick and dirty assessment of whether the apparently very high number of deaths among doctors subject to GMC Fitness to Practice investigations was something to be concerned about. He concluded it certainly was, because on that crude assessment – crude because there was no attempt to adjust the figure for factors that might influence the death rate – it appeared that these doctors were at least fifteen times more likely to die than ordinary members of the working age population. The ratio of fifteen to one was, he believed, an approximate answer to the right question rather than a precise answer to the wrong question. It was, he argued, so gross in scale as to make it very unlikely, though not impossible, that the finding had arisen either by chance, or by a sufficient number of unadjusted for factors, such that being caught on Stilton’s prongs was not one of them.
Ploughing through General Turkey Council Fitness to Practice data with a tractor ever more bogged down in numerical mud, Dr No got distracted by another question: what do ‘erased’ – the chilling term used by the GTC in place of the plebeian ‘struck off’, chilling because where the plebeian leaves a name albeit with a line through it, erasure effects obliteration, total obliteration, for not even a name remains – doctors get erased for? In the past, one was encouraged to suppose it was the three As, alcohol, advertising and adultery, a supposition borne out by the General Medical Council’s, as it was then, 1965 ‘Blue Book’ guidance, which does indeed list the three As (alcohol comes under splendidly archaic ‘Offences Indicative of Tendencies Dangerous to Patients’ heading), along with other examples of ‘infamous conduct’ likely to bring a doctor to the Council’s attention. But over time, as two of the capital As have become, so to speak, of lower case severity, we might suppose that ‘gross neglect in diagnosis or treatment’, the 1965 heading for clinical failings, might have risen in prominence, such that today most doctors are struck off for substandard treatment. But what are the facts?
It is a truth universally acknowledged that a regulator in possession of a dodgy report must be in want of a cover-up.
–Attr: Austen, Miss J.
Yesterday on Newsnight, the Chief Stoat was worrying another victim, on this occasion the Chief Pongo for the time being at Can’t Quite Cope, the body charged for the time being with keeping an eye on the quality of health and social care in England. The story is that CQC had given a certain NHS Trust a green light when it should have flashed a red. On finding the error, senior staff at CQC ordered all lights off, all shredders on, and folk who should have known better started wall-papering their arses. But wall-paper is no match for the brown stuff. As the skid marks appeared, the CQC leadership panicked, turned to its lawyers, and received the extraordinary advice to hide behind the Data Protection Act. It was the absurdity of this advice, not to mention that it was followed, that caused Paxo’s eyes to enlarge in visible increments. Mr Behan, the Chief Pongo for the time being at CQC, responded for the time being by talking up his leadership, but the vigour his assertion was compromised by the fact he spent most of the interview looking like a goldfish about to lead the escape from a wet paper bag.
Paul Corrigan, whose posts show a worrying trend towards titles so long they stand as posts in their own right, has declared himself a friend of FFT, the punter-friendly friends and family test based on asking patients at or soon after discharge whether they would recommend the unit they have just left to friends and family. The test is popular with government for its apparent simplicity, resented by managers for the real extra burden it imposes, and derided by front-line staff, for whom the test might be better known as the Flying F*ck Test: the punters don’t give a FF about responding, and we don’t give a FF about the results. Although first announced last year, FF testing was back in the news last week after friendly we’re all in this together Dave announced plans to extend FF testing to general practice. The news got a cool response from senior GPs; others went further. One called the test ‘meaningless’; another dubbed it ‘trite’.
Everyone, but everyone, is a professional these days. Even benefit scroungers like Dr No are professional benefit scroungers. Sociologists over the years have woven so many strands and threads through the social construct of professionalism that the term has become so broad and debased as to be meaningless. To borrow from a line attributed to the poet John Lydgate and later famously adapted by Abraham Lincoln, you can professionalise some people all of the time, perhaps even others some of the time, but you definitely can’t professionalise all people all of the time. If everyone is a professional, then no one is.
Dodders, late of the Worsted tendency, chugged on to the Today programme this morning. There was a hiss of steam as the old tank engine settled on its axles. The topic of the moment, aptly enough, was whistle blowing. Dodders and his Health Select Committee have been asked to look into the General Medical Council’s pernicious habit of feeding whistle blowers into the firebox, instead of listening to their concerns. Humph did his best to get up a head of steam. There were shunting noises as Humph and Dodders went back and forth over the rails. But they remained stuck in the sidings, puffing platitudes. Delivering professional obligations, puff. Professionals responsible to their regulator, puff. Much good work being done but still too many examples where standards aren’t being delivered, puff puff!