Margaret McCartney: The false god of appraisal
BMJ 2015; 351 doi: https://doi.org/10.1136/bmj.h4982 (Published 21 September 2015) Cite this as: BMJ 2015;351:h4982All rapid responses
Rapid responses are electronic comments to the editor. They enable our users to debate issues raised in articles published on bmj.com. A rapid response is first posted online. If you need the URL (web address) of an individual response, simply click on the response headline and copy the URL from the browser window. A proportion of responses will, after editing, be published online and in the print journal as letters, which are indexed in PubMed. Rapid responses are not indexed in PubMed and they are not journal articles. The BMJ reserves the right to remove responses which are being wilfully misrepresented as published articles or when it is brought to our attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not including references and author details. We will no longer post responses that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
Out of the twenty-one respondents, only ONE (Dr Archer) has sought to defend this scandal - and he is financed for his research by the noble(?) DoH.
I assume, fairly, I hope, that about 95% of doctors feel that their time and emotional energy is being wasted.
Clearly, the doctors' leaders who should have sought to dismantle the programme failed to do their job. Thereby they failed the medical profession and they failed the patients.
Solution? A mass non-cooperation movement by the registered doctors.
If anyone has a better idea, please tell us, the patients,
Competing interests: As a patient I want the doctors to spend their time on treating patients.
Dear Editor
I read with interest the View and Review of Margaret McCartney as I read with interest her weekly posts, too. I will discuss details with my appraiser, who is a very good listener and adviser and I believe this is the good part of the process.
I sympathize too, it is a very time consuming exercise, especially when one has to fill in the same information every year, then add the new one.. In my case I have to fill in the CPD information twice.
I add to the facts, that for independent professionals or self-employed doctors, like me, there is a twofold aspect which most doctors, who are 'in the system' would not go through: 1) an appraisal is the 'lifeline' of my activity and of my forthcoming set of activities; it's like a compass and I need the interaction because most of my work has been at European level and there is not a European set of standards for appraisals or PDPs and 2) without an annual return, despite the fact that I am not in 'the system' I cannot revalidate under the GMC's rules; this goes in a completely different territory and I will spare the readers those details.
My impossible task on the appraisal remains the 360 evaluation, again I spare the details, but I am yet to convince my appraiser that given my role remit as a self-employed consultant I usually cannot get a 360 feedback, but I get the recall for work as an independent contractor. I believe that if someone calls you back to work, that is sufficient 360 feedback.
However, if we doctors want to alleviate our symptomatic pain from this exercise I can share this non-medical podcast with readers. It certainly made me feel better:
http://podtail.com/podcast/listen-to-lucy/it-s-time-to-sack-job-appraisa...
Yours sincerely
Andreea Steriu
Public Health Doctor
Competing interests: No competing interests
I too have placed this wonderful piece in my appraisal folder. I have wasted time thinking about it and gazed at my navel several times. Sadly I cannot claim "impact" as the appraisal process is still in place...
Competing interests: No competing interests
Thank you so much for this article. I have placed it in my appraisal documentation and look forward to reflecting on it with my appraiser. It will be my final appraisal as I am taking early retirement, largely due to the attitude to the profession shown by the appraisal process and so perfectly described in this piece.
Competing interests: No competing interests
I wish to congratulate Dr. Margaret McCartney for her recent article regarding the current appraisal process. (BMJ 2015;351:h4982) From my experience it echoes precisely what most doctors feel about appraisal, even though there are some, at least in this area (Lancashire) who seem so positive and enthusiastic about it that they are almost evangelical!
I have often wondered what the cost of the appraisal "industry" is to the NHS. Taking into account appraisers' fees and the cost of supporting staff at CCG level, I would not be surprised if it were about £1000 per doctor. Now there are about 60,000 GPs in the UK (gmc-uk.org) so that works out at in the region of 60 million pounds! Can this expense really be justified?
I hope the "Comment" column in your publication continues to question such matters with this type of common-sense approach.
Competing interests: No competing interests
I note that the responses thus far have been supportive of the article and negative towards appraisal. This is rather different to my experience a few years ago when trying to question the value of the proposed system at the time the system was being proposed!
I guess the phrase chickens come home to roost springs to mind.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1115392/
Kerr, D., 1999. Is appraisal the answer to ‘dodgy docs’? Employing Medical and Dental Staff, 15, pp. 10-11
Competing interests: No competing interests
Now please can some one tell us the names of the doctors who created this GOD?
For, this god cannot have simply appeared under a gooseberry bush.
Competing interests: I like doctors to do doctoring.
Dear Editor
How wonderful it was to read in the last few BMJs (most recently Margaret McCartney BMJ 2015;351:h4982) sanity concerning the behemoth that appraisal has become. At last the boil has been lanced. I have not met a colleague in the last decade who feels that the uncritical amassing of endless ‘paperwork’ is anything but a stupid, hugely time-demanding waste of energy. It seems that seeing, diagnosing and treating patients is no longer the priority in medicine that it should be. Instead doctors have to justify their existence by completing data that nobody ever reads. The system is profoundly flawed and it is no wonder that doctors retire early or emigrate.
It is high time that our medical representatives, the BMA, the GMC and the Royal Colleges, addressed this ridiculous situation by reducing and simplifying the current over-burdensome appraisal system.
Yours sincerely
Michael G Davies (thankfully retired consultant)
Competing interests: No competing interests
Thank you for your last 2 published statements on the subject, and for being vocal when so many have withdrawn their judgement over the past years, for fear of the intimidation from the royal Colleges. Great stuff !
Thanks to you something may unfold and hopefully lead to the complete abolishment of revalidation and appraisals. The police and the CQC have to do their own jobs, and ours is to see, to listen to patients and sort them out. Regards.
Competing interests: No competing interests
Re: Margaret McCartney: The false god of appraisal: What's the BMA's Position?
I agree with Dr Anand's suggestions. As the overwhelming majority seems to acknowldege McCartney's view, isn't it time that the BMA took up this issue with the relevant authorities without delay? Abolition of frequent appraisals will also save a considerable sum of taxpayers' money and Mr Hunt, too, might be pleased about it (assuming there is no gain for him).The BMA must accept their members' views rather than the opinions of its committees which sit in the BMA House. If the BMA does not take any constructive action in this regard, then the others will have to lead. Extreme measures, as suggested by Dr Anand, might be the fastest way to resolve this matter.
Competing interests: No competing interests