Wednesday, 1 October 2008

Deadly doctors

Dr Shipman's actions have had a lasting impact on the medical workforce.

Training, regulation and scrutiny have all explicitly changed as a result of this. I'm sure there are other issues around trust and confidence and probity that have also been challenged through this.

Nowadays I have to go through an annual appraisal with a Medical Director at a neighbouring hospital, once a year. This is a significant and laborious process. I've said before how it ties up a full week of my time and a full week of secretarial/clerical time to do this. Unlike Dr Bacon's spurious website to rate doctors, I'm anonymously rated by patients, doctors, receptionists, clerical staff, nursing staff, physiotherapists, OTs, social workers, healthcare assistants, secretaries and managers in a structured and rigorous fashion, collated by the Royal College who then illustrate my ratings against a national benchmark, to see how I compare.

Masses of time, effort and expense is therefore invested in to annual appraisal. This is a subject dear to my heart at the moment since I've to generate my appraisal folder over the next couple months, a folder that will fill a lever arch file.

By unhappy chance, in the past I have been involved in the investigation of a number of complaints. One was around the practice of a Consultant Psychiatrist in another hospital. Looking at her case notes, standards of care seemed poor. Speaking with staff, standards of care seemed poor. Speaking with patients, standards of care seemed poor. Speaking with carers, standards of care were poor and their fury towards this doctor was palpable. Speaking with the service manager, standards of care, organisation, service delivery and teamwork seemed poor. Lots of complaints had been generated. 360 degree appraisal suggested the doctor was not good. Yet, this Consultant Psychiatrist had signed off annual appraisals.

Annual appraisal can only realistically appraise the evidence that is brought to the meeting. Even with a lever arch file of evidence, it's perfectly possible for a bad doctor to limp through it, presenting their practice as good enough.

I am quite certain that the current systems would not pick up or spot a doctor like Dr Shipman. Clinical audit could. Investing massive effort and confidence in appraisal seems to be missing the point.

3 comments:

Northern Doctor said...

Unfortunately the distinction between appraisal as an educational process and appraisal as a performance review tool seems to be blurring. Using appraisal for performance review completely perverts it.
There is no way that Shipman would have been picked up by appraisal or any revalidation measures that are being proposed. That is not to say we don't need some kind of revalidation - but we need to stop associating one with t'other.

Tainted_Halo said...

Remember the purpose of re-validation is for the governing bodies to demonstrate they *do* give a shit about the safety of patients; "really we do - see?" - and they're not just botching something together after being bothered by the discredit such slip-ups bring to the profession.
Re-validation by your peers - makes your peers responsible for your mistakes and not the governing body.
Then - after the next major embarrassment - they have to review the process and add another lever arch file.

DeeDee said...

This is not limited to the medical world. In the private sector in IT, we also have cumbersome annual appraisal processes that generate a great deal of paperwork, have absolutely sod-all to do with whether or not someone gets promoted or a raise (their boss decides that well before the process is completed), but do succeed in seriously pissing off about half of the employees every year. They exist for one purpose only and that is to protect the company from a tribunal, by doing the legal equivalent of holding up garlic and a crucifix and waving folders of paperwork at a bunch of lawyers.

Yep, our appraisal season (not to be confused with deer season or rabbit season) has started too...