Dr Phil Hammond, GP and broadcaster

Shock! Horror! A survey of 200 newly qualified doctors has shown that a third aren't sure what to do with an unconscious patient, and only five know how to tell if the airway is blocked. Hardly a surprise to anyone whoÍs been a newly qualified doctor, but good to have it down in black and white for the Department of Health to ponder.

Alas, the DoH has decided to 'discuss the findings with the General Medical Council', whose track record in sorting out medical underperformance is hardly exemplary. It looks like weÍre in for a few more years dithering over the oxygen mask.

Surveys showing that doctors aren't all we're cracked up to be have surfaced periodically ever since I qualified in 1987. After a day or so of being a smug ginger git, I quickly realised that if I didn't get the nurses on side my life would be hell and my outcomes would be appalling.

Way back in 1993, the GMC's Tomorrow's Doctors promised us that newly qualified house officers would in future hit the wards running, having picked up all the requisite knowledge and skills needed to be competent – but alas it doesn't seem to be happening yet.

Why not? No-one would dream of turning out a pilot who wasn't sure what the throttle was for or how to get the landing gear down.

Some old-timers believe the new GMC-inspired curricula might even be making things worse, focusing more on attitudes and behaviour to the detriment of knowledge. It's all very well being patient-centred and friendly, but it helps to know roughly where the aorta is.

Personally, I think the lack of training of doctors at all levels has less to do with changes in curricula and more to do with changes in culture. Patients are much less likely to accept being practised on, and the old rituals like lining up students to perform unconsented internal examinations on anaesthetised women are on the wane (although still happening in some hospitals).

Add in the vast increase in student numbers, the lack of teachers due to the crisis in academic recruitment and service commitments and it seems today's students are even more likely to be left to drift in a 'see one, do one, teach one' manner.

On a brighter note, general practice is the one area that has really come up trumps in student teaching. Perhaps it's because we're anti-humiliation and pro-ignorance. As a student, I watched open mouthed as a GP teacher admitted to a patient he hadn't got the faintest idea what his rash was, handed out three dermatology atlases and said, 'First one to spot what it is wins a fiver.'

It was from GPs that I learnt great phrases like 'Half of what you learn at medical school will turn out to be wrong. Trouble is, we don't know which half.' With around 2 million bits of clinical knowledge kicking around the average doctor's brain, there's clearly huge scope for getting it wrong.

That we don't seem so good at is accepting technological help. I've no doubt that if all doctors had access to good decision support systems we'd make far better diagnoses and decisions, and involve patients a lot more. And if patients had access to the same system, they might not turn up with armloads of well meaning but dangerously wrong internet tosh.

As for new house officers managing emergencies – you may not have time to log on for computerised support as the patient expires in front of you. Ideally, you need to have simulated the situation in your training and rehearsed it as a drill.

Failing that, go back to the old ways: panic, and ask a good nurse for help.

Dr Phil is on UK tour this Autumn with '89 Minutes to save the NHS'. Details at www.karushi.com

Guidelines in Practice, October 2002, Volume 5(10)
© 2002MGP Ltd
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