 | | | |
Harold Shipman may have killed up to 300 of his patients. That is no reason for other doctors to commit professional suicide. Yet this is the likely consequence of the measures of regulation and revalidation proposed in response to the Shipman case by the medical establishment - and enthusiastically backed by the government.
| Given the circumstantial character of the new evidence against Shipman - and the difficulty of securing corroboration - the estimates in the report produced by Professor Baker in the first week of January 2001 are crude approximations. While the scale of Shipman's perfidy is likely to remain uncertain, one thing is clear: he was not an underperforming GP. When he was first arrested many of his patients complained about the removal of their hardworking and conscientious family doctor.
| Yet leading figures in the medical establishment - such as Donald Irvine of the General Medical Council, Sam Everington of the British Medical Association and Liam Donaldson, chief medical officer - have taken advantage of the Shipman scandal to push forward their proposals for dealing with doctors who are idle, incompetent or otherwise underperforming. The problem with these measures, most of which have been under discussion for some years, is that they are likely to prove demoralising for doctors and damaging to doctor-patient relationships.
| The most palpable effect of plans to revalidate GPs is, according to Surendra Kumar, a leading figure in the Royal College of GPs, that they 'could help decimate GP services' (1). In fact, decimation is an understatement: Dr Kumar reckons that 10 percent of GPs could fail the tests, a similar proportion would opt for early retirement, and the whole scheme would require 15 percent of all GPs working full time to service it. In other words, over the next decade, when more and more is expected of GPs, the revalidation process will remove around one third from active service.
Perhaps even more important than the effect on GP numbers is the likely consequence of revalidation for morale. At a recent discussion of 'the real issues causing distress to us in general practice' reported in a bulletin of the Royal College of GPs, doctors complained about the 'corrosive influence of guilt' resulting from exhortations to improve performance and of 'a lack of confidence in our own competence' (2). The danger of revalidation is that it will exacerbate the medical profession's loss of confidence rather than alleviate it. 'I always worry about whether I have got the right diagnosis', proclaims Dr Everington in a spirit of self-abasement that might endear him to his friends in the government, but is unlikely to impress his patients (3).
| | The process of revalidation - pushed forward by Monday's announcement of a new National Clinical Assessment Authority - aims to consolidate a new style of general practice. This is less concerned with the care and cure of patients and more concerned with pursuing New Labour's social engineering projects - against teenage pregnancy and other forms of 'social exclusion'. One sceptical GP wonders whether 'we are squeezing out the fundamental primary role of the general practitioner - treating patients': 'I worry that in the process of creating this egalitarian, social, health, education, employment, entertainment, voluntary-private-public partnership care system, we are setting ourselves up to be all things to all people and inevitably fail to fulfil any of their needs' (4).
| With its democratic and egalitarian rhetoric, the new medical elite claims to be on the side of the patients. In reality, its proposals threaten to make the medical profession even more subordinate to the state bureaucracy and to push doctors into a more intrusive and authoritarian relationship with their patients. No wonder the government has so enthusiastically taken up the stick generously offered by the doctors' leaders to beat the profession into line. As with Shipman, the real victims are the patients.
| Dr Michael Fitzpatrick is the author of MMR and Autism, Routledge, 2004 (buy this book from Amazon (UK) or Amazon (USA)); and The Tyranny of Health: Doctors and the Regulation of Lifestyle, Routledge, 2000 (buy this book from Amazon UK or Amazon USA). He is also a contributor to Alternative Medicine: Should We Swallow It? Hodder Murray, 2002 (buy this book from Amazon (UK) or Amazon (USA)).
(1) Pulse, 13 January 2001
(2) London Calling, December 2000
(3) The Sunday Times, 7 January 2001
(4) Claire Gerada, 'Healthy Living Centres and the demise of General Practice', London Calling, December 2000
|
|
|
| | |
