Dr Phil Hammond, GP and broadcaster

Lights! Camera! Scrotum! Yes, the camcorder has now become the leading must-have medical accessory for aspiring GPs. See yourself in action and you see what sort of doctor you are. Are you empathetic? Do you know your stuff? Where did you get that tie? Is that a piece of yesterday's lettuce stuck to your upper incisor?

Since the brave new world of consumerism kicked in back in 1998, all registrars have been obliged to demonstrate to 'independent assessors' that they don't all mumble into their beards and hide behind the computer. At least not while the camera's running.

And there's the rub. Everyone tries harder when they know they're being assessed, but whether we put in the same effort when it's just one man and his bunion watching is another matter.

Most of us have very little notion of the effect we have on patients and, aside from Christmas presents and complaints, we don't get any feedback at all. This isn't critical, but without any measure of patient satisfaction it's easy to delude yourself that you're doing a great job. A hundred years ago, a surgeon called Lord developed a technique to help people who found it painful to pass motions. He stuck ten fingers up their backside. And surprise, surprise - they never came back. They must have been cured.

So, are videos the answer? Taping the top end while doctors are delving around at the bottom is a tad unethical, but it would at least give us a chance to reflect on what it's like to be a recipient. Doctors who store their speculums in the fridge are usually far too busy trying to visualise the cervix to take in the grimace. Immediate feedback along the lines of "Warm it up or I'll scream!" would be just as effective, but most patients prefer to suffer in silence than trouble the doctor.

However, we have to seek consent to record a consultation and patients have the right to have the camera switched off and the tape erased at any moment.

Intimate physical examinations are excluded, although I once recorded a young farmer who was very up front about his botty boil and had it in the view-finder before I could hit the off-button. It was as fine an example of non-verbal communication as you could wish for.

Fortunately, I scraped through my training just before peep-show videos became the law but I was dismayed to hear of a registrar whose tape went AWOL on its way to the independent assessors. The Post Office launched an urgent investigation, found nothing and then changed its name to Consignia.

The registrar refused to go through the ordeal of trial by video again and decided instead to go and work as a GP somewhere else in Europe. Ironically, he will later be eligible to work in the NHS without having to repeat the video, courtesy of something called the 'European Union acquired right arrangements'.

As for the video, we haven't got the foggiest where it ended up. Maybe you can view it online now at www.dodgybunion.com (all major credit cards accepted).

And, as any lawyer will tell you, if a video made in confidence with the promise of erasure ends up on You've Been Framed we're talking six figures... per bunion.

One solution might be to ditch the video and panel of experts, and let patients judge our consultation skills. OK, she might not be sure why you've prescribed a fifth generation cephalosporin and he might not twig why you squeezed his testicles and asked him to cough. But patients know if it was done with care, and they know if they've been patronised.

Expert observers can be fooled by doctors who trot out "I know how you feel" or "What are your worries?" every time there's a pause in the consultation, but patients can't. They can smell fake empathy.

If we really want a patient-centred NHS, let them take over revalidation and write our references too. It can't be any worse than the status quo.

The new edition of Dr Phil's book, Trust Me, I'm a Doctor, is available at the discounted price of £8.99 to Guidelines in Practice readers; tel: 020 7381 0666. His new show, 59 Minutes to Save the NHS debuts at the Edinburgh Festival Fringe and is on UK tour in the Autumn.

Guidelines in Practice, Aug 2002, Volume 5(8)
© 2002MGP Ltd
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