Intended for healthcare professionals

Rapid response to:

Reviews Personal views

I just wanted to be a doctor

BMJ 2006; 333 doi: (Published 10 August 2006) Cite this as: BMJ 2006;333:359

Rapid Response:

Medicine and its representation

Tara Hunt (1) captures a key dynamic in modern medicine. At all
levels we seem to have two jobs, firstly to do the job and see patients,
and secondly to prove that we have done this activity, and to an
appropriate standard.

Doing the job is actually the core reason for doctors to exist. It is
the hardest part of medicine. Meeting and dealing well with people with
all their pathology and their personal particularities is hard work. By
comparison with this going to meetings is far easier.

To get to do our core job doctors now have to jump through multiple
hoops of audit, quality assurance, clinical governance, appraisal, and now
revalidation. There is no evidence that these time consuming activities do
anything for patient care. There is no evidence that they measure what
matters, or reliably discriminate good practice from poor practice. Indeed
I propose that in their current form they could all be stopped and that no
patient would be any worse off.

However for Dr Hunt, and the rest of us, we currently need to throw
some salt on the Altar of Audit and worship the Idols of Clinical
Governance and Research. It is now quite possible to make a career doing
this, and so rarely see any real patients at all. But never mind the
numbers, feel the depth of the evidence based quality.

Meanwhile the discharge summaries do not get written on time, and the
readmission rate is going up.

Competing interests:
None declared

Competing interests: No competing interests

12 August 2006
Peter G. Davies
GP Principal,
Keighley Road Surgery, Illingworth, Halifax, HX2 9LL