Dr Phil Hammond, GP and broadcaster

Why are doctors such doormats? From day one at medical school right up until today in the surgery, most of us have behaved like conformists, following the rules and allowing ourselves to be dumped on from a great height.

The most recent example I’ve come across is the thorny issue of appraisal. If it’s properly resourced and professionally managed and doesn’t impinge on our personal time, it might indeed turn out to be something of value. But, instead, some enthusiasts are offering to do it on the cheap, in their own time – and playing straight into the Government’s hands.

The minimum fee for the time, responsibility and effort involved in each appraisal should be £500 but some people are doing it for £100 or less, thus opening the door to emotional blackmail by managers: “If they’re dedicated enough to do it for a pittance, so should you.”

Others are planning Saturday morning ‘appraisal parties’. I know medicine is a vocation, but that doesn’t mean we should have to do all the donkey work for every new initiative that comes along.

Some GPs may be frightened that lack of appraisal will leave us open to much sterner GMC revalidation. But the NHS can ill afford to lose any doctors, and unless appraisal is given the protected time and resources it needs, I can’t see revalidation working either.

Medicine is a very conservative profession. We hate rocking the boat, and the system of patronage has instilled in us the importance of not upsetting the established order ... Or else.

There were no doctors in my family, and at medical school I made the grave error of voicing a few opinions of my own. I left with a stinking reference (“This student refuses to take medicine seriously – he does not deserve a St Thomas’s house job”).

But it was the best thing that could have happened to me. I got out of teaching hospitals and into humane district general hospitals, where it was considered OK to stick up for yourself.

So, as you consider what to do with the uncosted contract and the unspecified quality controls that they won’t even let you see the evidence for, my advice is to stand up for yourselves.

We can blame the politicians for bringing in meaningless reforms and the public for not wanting to fund the NHS, but the bottom line is that doctors are still their own worst enemies.

Many of us willingly bought into the culture of workaholism that has been so destructive to our professional and personal lives, and some of us are still doing it.

But unless we wake up to our professional worth and break this cycle of abuse, general practice will never recover.

Guidelines in Practice, January 2003, Volume 6(1)
© 2003 MGP Ltd
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