Revalidation

I am behind the times. Jobbing Doctor and Mental Nurse are ahead of the game and already have blogged comprehensively about the scrullious IWGC site that notionally informs folk on a doctor's performance, and the process of formal revalidation as a mechanism to oversee doctors' performance.

Although I've not blogged about the IWGC website I've commented on various blogs. For the record, my thoughts are that Bacon's site is unhelpful. It's not balanced or representative or useful views that enable patients to make informed choices. It's a place to rant and, from a position of anonymity, damage named individuals who can't respond to or explain or give their side of events. I work with families who are abusive to my patients. This month alone, and we're only 3 weeks in to it, has generated 3 referrals to me of patients who are being seriosuly abused by their relatives (with police involvement) and a few others where malign care (but not criminal) is an issue. These patienst are incapacitated and will not comment on web sites about me. The families see me as mean and 'orrible, stopping them having the house/punch bag/money/sex they want. They no doubt see me as meddling and obstructive and unhelpful. They are in a position to be vocal and look to apportion blame, without looking too hard at themselves.

In mental health this issue is particularly relevant. I often do what's unpopular with relatives.

This month I had a family who want their mum bundled in to a care home, the CMHT and I (and their mother) feel she should be managed in her own home. She's given support and she's in her own home, where she's more oriented, and happy. But I'm the nasty doctor who leaves her in her home even though she's getting worse and worse.
I think I've done a good job of patient centred care.
Family could say I don't listen and I do nothing.

This month I had a family who wanted their mum to stay in her house so she wouldn't go in to care and the house wouldn't get sold to pay for it. She was wandering at night, getting lost and wandering around half naked trying to find family at 2.00am. She doesn't live in the sort of area where you want to leave your door open and wander around on a Friday or Saturday night at 2.00am. Risks are unmanageable, she's had, "negative life events," she's lost valuable items, most of her money and is covered in bruises. She's accidentally set things on fire a few times, not attending to risks that her cigarettes pose, including setting her clothes on fire once. She has dementia and is incapacitated with respect to considering her needs, risks and deciding on future care. No donee, no deputy, no LPA, no advance decision. Best Interest meeting is held. Outcome : 24 hour care. Care home found, she's placed, she's happy there.
I think I've done a good job of patient centred care.
Family could say I don't listen and I don't let them care for their own mum and I bundle people in to homes without giving them a chance.

Often in mental health I address what people need. Invariably they're happy with this and oddly I've had no complaints but have had verbal and written compliments recently, but this perplexes me since I'm frequently not doing what they want. And there's the crux. In health care, we address clinical need. This is not always the same as addressing what people want.

My post on Jobbing Doctor's comments summarises my feelings on revalidation :

Appraisal takes me several full days, job planning another full two days, so a week a year of my time is pretty much tied up in this bureaucracy as it is. Also about 2 days of my secretary and about one day of the neighbouring hospital's Medical Director. 2 clerical staff spend 2 full days pulling records of every clinic attendance (and non-attendance), every referral, every admission, calculate length of stay, every home visit, all work done.

At present the system's pretty excessive, to my mind.

Revalidation will add to the time necessary to collect the data. If a lot of multisource feedback is sought (e.g. from a representative sample of patients) then the time invested necessarily increases further. Then, to gather a portfolio of evidence for good practice, which will be copying and pasting most of my annual appraisal file but will still need additional material that's in other areas such as CPD peer group records and the like.

I won't get paid for doing this revalidation. None of my staff will get paid for supporting this process. The opportunity costs (of erroding clinical time) are, as you suggest, substantial.

A lot of time and money will be invested.

How will it benefit doctors?

How will it benefit patients?

If health management had to be even half as evidence based as health care delivery, my world would be such a better place.