The appraisal system may not be perfect but it encourages GPs to be reflective, argues Dr Amrik Gill

I read with interest Dr Phil Hammond’s column on revalidation ‘Bring on the exams’ (Guidelines in Practice, March 2005, p. 64).

The whole question of revalidation has, unfortunately, got tangled up with the Shipman enquiry. It is important to tease out the issues and look at them separately.

At the moment, the appraisal system may indeed “involve little more than a cosy fireside chat”. However, that is not how it is meant to be. Real evidence is sought to show real achievements. The great benefit of the appraisal system is that it asks the participant to reflect and learn from experience ­ and it is bound to get tougher as time passes.

It is also an advantage that a medical colleague is asking the questions. Any GP who has had a non-executive director of the PCT come to discuss the patient satisfaction survey will know how hard it is for non-clinicians to understand the doctor-patient relationship.

This relationship will only tolerate so much bureaucratic accountability ­ at some point the patient simply has to trust his or her doctor.

How does an exam-based system actually prove anything? Even the medical schools have now realised (alas so late!) that having great exam results says nothing about a candidate’s communication skills.

Communication skills are the true cornerstone of medical practice ­ hence Phil’s suggestion to send in a video of our consultations. I have nothing against this idea and it might work well, but videos cannot reflect the whole truth.

The appraisal and revalidation processes will not necessarily pick up those doctors who are performing poorly, nor those who are sick.

By all accounts, Shipman would have come through any appraisal, revalidation, exam or video consultation with flying colours. His patient satisfaction survey would probably have been the envy of all of us.

One of the important issues raised by the Shipman case is what to do with doctors who are found to be abusing drugs or alcohol. This problem is not peculiar to medicine, but a wider societal issue. Do we give these fellow human beings a second chance or not? If we do, what form should it take?

What is peculiar to medicine is the special relationship that exists between the physician and his or her patient. Appraisal is a self-analytical exercise. Our patients put a great deal of trust in us. We owe it to them always to be self-critical, proactive in updating our knowledge, humble and transparent.

Dr Amrik Gill, GP,
Walsall,West Midlands

Guidelines in Practice, May 2005, Volume 8(5)
© 2005 MGP Ltd
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