Intended for healthcare professionals

Education And Debate For and against

Doctors and nurses should monitor each other's performanceFORAGAINST

BMJ 2000; 320 doi: (Published 15 April 2000) Cite this as: BMJ 2000;320:1070


  1. Tim Crossley, general practitioner
  1. Thornley Street Surgery, Wolverhampton WV1 1JP
  2. Walsall West Primary Care Group, Kingfisher Medical Practice, Willenhall, West Midlands WV12 5RZ

    “You used to work on ward 3. Do you remember me? I was on nights.” The nurse approached me at the end of year house officers' party; it was 1981.

    “I used to hate you,” she added. She poured a pint of beer over me. I was too startled by this informal appraisal method to reply suitably. Later, I learnt I had incurred her wrath by reacting to the incessant inhuman bleep by arrogantly snapping at her part in my misery.

    Only the minds, not the hearts, of the professions are behind being appraised. I am a general practitioner, and most of us cling on to “independent status,” best viewed as a kind of complex performance related pay, with certain small freedoms and certain obligations. Senior hospital doctors have different obligations and less freedom but still have the privileges of rank. Not, perhaps, a free car parking space but certainly team leadership, care of employees, and involvement in hospital developments.

    This aloof position that we hold permits serious appraisals to be seen as something to be done to others, not oneself. Indeed, status is a barrier behind which we cower.

    That the threat is perceived so deeply shows how unconfident we are as doctors. Yet what aspects of our work are important to appraise? We leap to thinking of technical …

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