Do you fancy being a 'GMC affiliate'? It's a new role, proposed by Sir Liam Donaldson, for local doctors to monitor the performance of their colleagues and report back to the council.1
It's the kind of job that might have appealed to Harold Shipman as an ironic cover, but it does seem to put a lot of responsibility on the shoulders of a few assessors, particularly now the burden of proof required to ruin a career may be downgraded to 'balance of probability'.
But don't worry,you won't be alone; affiliates will buddy-up with mem- bers of the public. I've got several patients who delight in asking awkward questions and would relish policing the profession. One came in last week with a pain in his foot which, when I suggested might be 'metatarsalgia', he said: 'No, its proximal to the metatarsals, just here. Now what bone would that be doctor?'
It was less of a consultation and more of an anatomy viva, and to be honest, I'm not sure I ever learned the bones of the foot. Neither do I lug around a copy of Gray's Anatomy for just such an occasion. 'That's your navacular,' I said, with utter confidence. 'You mean navicular, and anyway, it's just distal to that I think you'll find.'
Fortunately, I've recently stumbled across something called firstname.lastname@example.org,2 which settles all body part disputes at the click of a mouse. For some reason, looking up facts in books makes you look incompetent, but doing it online looks like research. In 10 seconds I had a beautiful model of the bones of the foot on view.
'It's probably your intermediate cuneiform with a hint of navicular. Either way you haven't broken anything so get lost and leave me alone.'
I'm sure such rudeness would get me struck off under the new rules, but then none of us likes having our knowledge-base challenged.
Unfortunately, in the future our knowledge is likely to be challenged at regular intervals, and if you're like me,your memory is slowly morphing into a large lump of Swiss cheese. I've got gaping holes in most disease areas, even though I try to brush up on them regularly. The potential curriculum of general practice is just too vast for any mortal to hold in their head.
The older I get, the more I find myself relying on online decision aids. GP Notebook3 is the one I use at present, not least because it tracks all your queries and gives you a print out to prove that you have at least tried to stay in touch.This would have been very useful for my annual appraisal, had it not just been cancelled due to lack of funding.
Am I a good doctor? I rarely get complaints: I'm a good talker and an OK listener, but I have to look up a lot of things.
Revalidation should test our ability to do our jobs with the resources we normally have to hand, like online decision support. Without it, a lot of us would probably fail a widespread knowledge test.
So here is my definition of a good doctor – someone who doesn't know everything, but he knows where to look for information, when to ask for help, and can do it quickly enough without appearing incompetent. Well, it works for me.
(1) Department of Health. Good doctors, safer patients: Proposals to strengthen the system to assure and improve the performance of doctors and to protect the safety of patients. A report by the Chief Medical Officer. London: DH, 2006.
(2) www.anatomy.tv OR www.univadis.co.uk