Rapid Responses to:
|
|
Rapid Responses: Rapid Responses published:
-
![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
What doctors do privately is a very public affair
- Paul S McDonald (15 March 2002)
-
Why is it so difficult for doctors to put patients at the centre of their own care?
- Mark Halladay (18 March 2002)
-
Only the bad should fear
- Jay Ilangaratne (18 March 2002)
-
No symmpathy here!
- Albert Garib (22 March 2002)
-
Sir Denis' views deserve more respect than this
- James A Willis (22 March 2002)
-
Defining professionalism: the place of career development
- Adam J Poole (BSc MRCS) (23 March 2002)
-
Professionalism, transparency and public accountability
- John Hopkins, Darlington DL1 5LW (23 March 2002)
-
Controlling doctors?
- Roger M. Goss (29 March 2002)
-
A fair trial?
- Stephen Fava (5 April 2002)
|
|
|||
|
Paul S McDonald, Senior Lecturer (Research) University College Worcester WR2 6AJ
Send response to journal:
|
It was most stimulating to read the views of a most respected doctor and academic. The article is tinged with a sadness, a melancholic farewell to things that once were. It is perhaps understandable that the Government is seen as the agent provocateur, forcing through the pace of radical change whilst belittling the professional persona. Is it an 'unprecedented attack' or is it a necessary offensive manoeuvre ? Firstly, I would like to reassure the professor that, like most other patients, I will continue to treasure and have confidence in the consultations I may have with doctors. I know the matter of these consultations will remain protected. However, I must surely be aware that the possibility of harm will sometimes emerge. In the light of Bristol, Shipman, and others, can I be confident these harms will be adequately addressed by the profession alone ? Surely I must acknowledge that any such harm would inevitably become the business of others outside of the profession. At this moment in time there are many thousands of these private stories being scrutinised by complaints managers, service managers, practice managers, risk managers, medical directors, chief executives, convenors, trust boards, independent panels, advocacy groups, health 'watch dogs', public inquiries, solicitors and the media. The events and circumstances of all these once private histories have become common currency. The conditions that may predispose to care going wrong have been well documented in the medical research yet one could argue that the professional responses to these have most often been slow, secretive, insular and reactionary. Governance, of which lay participation and leadership is a foundation, is a political, managerial and very public response to these conditions and offers no favour. It has emerged from society's new desire to openly monitor and to avoid unnecessary harms. It reflects society's rejection of blind faith. In essence, it is coming to grips with those previously unspoken factors that contribute towards care going wrong. It is becoming inevitable that the content of those once sacrosanct private consultations - and all of the politics that surround them - have now become the business of others outside of the corridors of the GMC. For these reasons it may be seen as superfluous to hang on to the absolute sanctity of the profession. As a patient, I would rather see the GMC concentrate its efforts in preparing its doctors to practice in what are very challenging times for them. Help them to help us. |
|||
|
|
|||
|
Mark Halladay, Chief Executive New Possibilities NHS Trust Bridge. Witham, Essex CM8 1EQ
Send response to journal:
|
Why is it so difficult for doctors to put patients at the centre of their own care? you ask in your Lead editorial.
Perhaps one reason is because the medical establishment works so very hard to maintain its own voice as dominant at the centre of all medical matters. |
|||
|
|
|||
|
Jay Ilangaratne, Medical-Journals.com
Send response to journal:
|
An "unprecedented attack" on the independence of medical profession?- -I am not so sure.Changing legislature is aimed at creating greater transparency,accountability, and strengthening hitherto neglected rights of patients. That cannot be a bad thing,either for doctors or their patients.But changing old habbits is a difficult process, and indeed,could be very disturbing for some. When resisting change, it is natural to blame someone else;this is reflcted in the opening paragraph of Pereira Gray's editorial.However, there is no sound evidence for his allegation that patients' demands of doctors far exceed what they would expect of others.In fact, reading "Shame: the elephant in the room" by Frank Davidoff(BMJ 2002; 324: 623-624) would be far more useful for doctors, rather than addressing negative rhetoric, when the medical profession needs proportionate changes to survive another century.It is time that the medical dogmatists,the racists,the arrogant,the secretive, and the patient -unfriendly, leave the meidcal arena graciously,rather than obstructing fairness to a great majority. Competing Interest:None |
|||
|
|
|||
|
Albert Garib, Hospital Pathologist Huntington Beach, California, 92660
Send response to journal:
|
Dear physician members of the NHS. From what we read in the US, you strongly support the NHS. The government wants to "deprofessionalize" you and cortrol you. What else is new? What else do you expect from a government monopoly? Why do you support a institution that wants to enslave you? |
|||
|
|
|||
|
James A Willis, GP retired Provost Wessex Faculty RCGP 28 Borovere Lane, Alton, Hants, GU34 1PB
Send response to journal:
|
Professor Pereira Gray's leading article deserves more serious thought than it has received from the rapid responses so far. In an extraordinarily patronising commentary Paul S McDonald once again trots out the names 'Shipman' and 'Bristol' as though the two were in some way comparable, and as though they provided unchallengable, or rational, justification for the epidemic of officious regulation which is so damaging the standards of medical care in this country. Regulation may be a solution to something, but it is certainly not a solution to 'Shipman', nor is it the primary answer to the utterly-different circumstances commonly labelled 'Bristol' where, as I have argued* the problem was not a failure of detection, but a failure of action by those in authority. Jay Ilangaratne, again, repeats the simplistic cliche that 'only the bad need fear'. This is utter rubbish. The 'bad' are, as everybody with an ounce of experience knows, adept at ticking the boxes of official forms. The resistance to excessive regulation comes not from 'the bad', not from 'the threatened', but from thoughtful doctors, like Sir Denis, who could comply with the regulations standing on their heads, but who regard them as profoundly unwise. It is to be hoped that an article of such wisdom, coming from a doctor of such experience and seniority, will receive more considered attention elsewhere and contribute to a more understanding official view of the crucial issue of professionalism. James Willis * http://bmj.com/cgi/content/full/317/7161/811 |
|||
|
|
|||
|
Adam J Poole (BSc MRCS), Managing Director, Career Edge PO Box 19983, London N3 2ZS
Send response to journal:
|
I cannot but agree with Denis Pereira Gray that the medical profession is facing one of the greatest periods of flux in 150 years, with huge implications for professional representation and education. But to meet these challenges, it is surely better to up the ante and be more progressive than the reformers, to steer the course of reform and regain the initiative. The proposed MESB (Medical Education Standards Board) presents one such opportunity to shape aspects of professional training and career development according to doctors’ wishes. Nowadays the ‘professional doctor’ requires a broader skill set to meet the needs of the NHS and the challenges of a complex career pathway. As director of Career Edge, an organisation set up by doctors to address the lack of career support in the profession, I hear many comments about the lack of such training, most notably at the pre-SpR stage. That’s why we joined a coalition called D.O.C.S. (Doctors for Ongoing Career Support) and contributed to its submission to the MESB consultation. Signatories to the D.O.C.S. principle outlined below include Dr. Richard Taylor MP: 'Doctors' training programmes should place stronger emphasis on career and professional development training. Career skills of a broader nature would better equip all doctors to meet the needs of the NHS and the challenges of a complex career pathway.' Our contribution suggested that PGME (postgraduate medical education) schemes approved by the board should contain an element of career and personal development training. Further, the board’s Training sub-committee should incorporate representation of an individual / individuals who can contribute their expertise on the broader training needs of doctors. Furthermore, part one of the consultation document states that: “staff need to have effective continuing professional development opportunities to ensure they remain ‘quality assured’,” but we believe that equally important is the need for doctors to remain enthusiastic, motivated and committed to the NHS and to their own career. Given their experience in education, assessment and training the Colleges are in a prime position to collaborate and work with other experts to build programs which include career development components. Such innovations would demonstrate that they are more in touch than the reformers give them credit for and add can value to the services provided currently by each individual College. In considering what constitutes ‘professionalism’, let’s use any and all opportunities to get new, and important, items on the agenda, or we may have to wait 150 more years for another chance to do so. |
|||
|
|
|||
|
John Hopkins, GP Parkplace Health Centre, Darlington DL1 5LW
Send response to journal:
|
Dear Dr Smith, Denis Pereira Gray has spent his professional lifetime working to raise standards in general practice, not least in his work at President of the Royal College of General Practitioners. The Royal College of GPs is often criticised by general practitioners themselves for being academic and even elitist. Whatever the truth of those complaints, Pereira Gray is the last person in the world to be an apologist for poor doctors. In his editorial, he argues that organisations responsible for the training and regulation of doctors should be accountable to the public they serve, through Parliament, rather than to the Cabinet Minister responsible for the Health Service. That is a view that most doctors would agree with, our first obligation is to our patients not to politicians. To make that accountability effective we need to be transparent about the way we work. That puts an obligation on the way journalists report the result of audits and performance review. By definition, half of all doctors will be below average and a league table wouldn’t be a league table if it didn’t have a bottom place. If we are to be open about underperformance it needs to be done in a climate of support and education rather than “naming and shaming”. Yours sincerely, Dr John Hopkins |
|||
|
|
|||
|
Roger M. Goss, Director Patient Concern
Send response to journal:
|
LETTERS TO THE EDITOR 29 March 2002 Controlling doctors? Editor - Gray’s plea for retention of medical independence is wholly human. But it overlooks the reasons for the need to reign in the profession. Self-regulation, for that is what independence means, is the history of arrogance, secrecy and unaccountability. These features of medical practice would not cause so much harm and suffering if medicine were an exact science. Making decisions on the basis of “best interests” would invariably ensure welcome outcomes. But uncertainty is medicine’s defining characteristic. The profession needs protection from its own hubris as epitomised by Miss B’s doctors. They considered their ethical convictions justified trying to override her right to self-determination. Only genuinely independent regulation and ultimately legal restraints can thwart such attitudes. Roger M. Goss Director – Patient Concern (1) Gray D. Deprofessionalising doctors? The independence of the British medical profession is under unprecedented attack: BMJ 2002; 324: 627-628 (16 March) |
|||
|
|
|||
|
Stephen Fava, Consultant Diabetologist St. Luke's Hospital, Guardamangia MSD07, Malta
Send response to journal:
|
With the changes proposed in the constitution of the general medical council and the way it deals with alleged cases of 'malpractice', one wonders whether it can guarantee a fair trial. Most of those who sit in judgement have no legal training, are not autonomous and are often subjected to intense media pressure. |
|||