Saturday, 29 October 2011

Revalidation of UK doctors by the General Medical Council should be scrapped writes Dr Helen Bright

30-10-2011. Click on the photo to read article in Pulse about the study on revalidation.
For years we have been saying that proposed Revalidation of doctors is a seriously faulty concept and unnecessary in regulation of doctors. While we agree that doctors should keep up to date, the system of Continuous Professional Development is sufficient for that purpose.
Administrative management of doctors is a completely different matter. It is something that is done locally, at place of work. Structures exist for those doctors who work in such managed work environments (NHS or private hospitals). We have heard of permanent difficulties of doctors (system) not meeting health demands of population, funding / financial restraints in healthcare, management problems etc as well as expectations that doctors keep quite in such a system. Revalidation could be seen as yet another tool to impose compliance with status quo. Doctor who is critical of colleague(s) could be very easily removed from medical practice without having to use the proposed Revalidation. Medics do know already how to gang up, use Old-Boy network and GMC's Fitness to Practice Procedures to get rid of annoying colleagues. However, Revalidation is extra sweet for psychopaths who do inhabit medical world, as it, really, is free for all and there is no responsibility whatsoever for making false or prejudiced statements about doctors' practice anonymously.
There are doctors who are entirely self-employed. If they could not manage themselves they would have no business. Not everybody needs to be managed by others. Unhappy, private clients do not pay their bills.
Now, surprise, surprise, when re-testing GMC Revalidation it is found by GMC funded study that certain groups of doctors would be subjected to unfairness: for example, locum doctors the majority of whom are of ethnic minority origin. So, patients and colleagues can be racist in how they appraise those of ethnic minority. Again, this is something we noticed long time ago, but GMC would not believe us. Indeed, some of us have been labelled paranoid when we complained of discrimination against locum doctors.
What about opportunistic stab in the dark? Surely, anonymous feedback can do just that. People do have nasty streaks in them.
Proposed Revalidation process breaches Human Rights of doctors. For example, there would be no right to correct wrong allegations and from unknown persons whose credibility cannot be questioned. Laws of Natural Justice are breached too.
Revalidation should be abandoned. Revalidation is bureaucratic torture aimed at the population (doctors) who are by their very nature already more conformist than the most of the population. Administrator Anxiety about some doctors' performance must not be used to control and extinguish excellence of other doctors. This is reminiscent of how those afflicted with Anxiety neurosis can behave: dominating and controlling one minute and submissive the next. Who invented Revalidation?

Click on the photo below to read more on Anxiety Neurosis and treatment.
There are other treatments such as psychoanalysis.

And the smaller pilot study reported on the General Medical Council website is different from the one reported in Pulse:

New research supports the potential for using patient and colleague questionnaires in the revalidation process

Press Release

03 Jun 2008

New research, commissioned by the GMC and published today, has confirmed that patient and colleague questionnaires may offer a reliable method for assessing the professional performance of UK doctors.

New research, commissioned by the GMC and published today, has confirmed that patient and colleague questionnaires may offer a reliable method for assessing the professional performance of UK doctors. The pilot study, led by Professor John Campbell, Foundation Professor of General Practice and Primary Care at Peninsula Medical School, involved 541 doctors, who were assessed by their colleagues and patients using standardised questionnaires developed by the GMC.

The patient questionnaire focused on gathering the views of patients on a doctor's communication skills, ability to explain conditions and treatments and to involve the patient in the decision-making process. The colleague questionnaire asked that colleagues give their views on a number of key issues such as a doctor's clinical knowledge, teaching skills and prescribing.

The White Paper on the regulation of Health Professionals, published in 2007, confirmed that patient and colleague questionnaires would become a key element in the revalidation of doctors in the future. This new research confirms that patient and colleague questionnaires, developed by the GMC, have potential as a means of collecting information regarding doctors' performance.

This is an important study as it is essential that any such tools used for assessing the professional performance of doctors, as part of the revalidation process, are adequately researched and validated.

The GMC has now commissioned the research team, led by Professor Campbell, to undertake more in-depth testing of the questionnaires across whole organisations and in different clinical settings. The outcome of this further research piece will help underpin work on evaluating the professional practice of doctors as part of the revalidation process.

Professor Campbell said, 'The revalidation of UK doctors is an important development in the regulation of the medical profession. Only by adopting processes thoroughly grounded in research evidence can patients, society, and the medical profession have confidence in the evaluation of a doctor's professional performance. This study provides that initial confidence. And, in line with aspirations recently expressed in the Government's White Paper, 'Trust, Assurance and Safety', these tools appear to offer doctors the possibility that they can provide real evidence in relation to their clinical practice. Our current work will provide further evidence on the utility of feedback obtained from patients and colleagues in identifying those doctors whose performance might require further scrutiny'


Scrapped Princess, is a Japanese novel as well as manga (comic). It starts with a fantasy that one of the twin princesses according to prophecy would destroy the world. Based on this superstition/prejudice she is scrapped (thrown from a cliff) in order to prevent apocalypse. The scrapped Princess survives the fall from the cliff but is no good at protecting herself. A number of adventures follow including encounters with Peacemakers who have for 5000 years held back the cultural progress of humanity. Presumably, this is representative of pathological avoidance of conflict, neurotic submissiveness and similar. Eventually, of course, the truth comes out that Scrapped Princess was not danger to the world but exactly the opposite. In real life, we do know that some people never get justice and that patients do die because of that. Click on the comic picture below to watch some of Scrapped Princess.


Anonymous said...

“Systematic bias” in patient and colleague feedback on doctors
By Mike Broad - 28th October 2011 9:50 am
Official assessments of doctors’ professionalism demonstrate systematic bias, a study reveals.
The researchers, from the Peninsula College of Medicine and Dentistry, in Exeter, warn that assessment involving feedback from patients and colleagues should be considered carefully before being accepted due to the tendency for some doctors to receive lower scores than others, and the tendency of some groups of patient or colleague assessors to provide lower scores.

The research investigated whether there were any potential patient, colleague and doctor-related sources of bias evident in the assessment of doctors’ professionalism.

It is particularly relevant because the GMC is set to introduce a new system of revalidation for all doctors next year and it is likely to involve the use of multi-source feedback from patients, peers and supervisors as part of the evidence used to judge a clinician’s performance. The results will contribute to a decision on whether doctors are fit to continue practising.

The researchers used data from two questionnaires completed by patients and colleagues. A group of 1,065 doctors from 11 different settings, including mostly NHS sites and one independent sector organisation, took part in the study which has been published on

They were asked to nominate up to 20 medical and non-medically trained colleagues to take part in an online secure survey about their professionalism, as well as passing on a post-consultation questionnaire to 45 patients each. Collectively, the doctors returned completed questionnaires from 17,031 colleagues and 30,333 patients.

Analysis of the results that allowed for characteristics of the doctor and the patient to be taken into account, showed that doctors were less likely to receive favourable patient feedback if their primary medical degree was from any non-European country.

Several other factors also tended to mean doctors got less positive feedback from patients, such as that they practised as a psychiatrist, the responding patient was not white, and the responding patient reported that they were not seeing their “usual doctor”.

From colleagues, there was likely to be less positive feedback if the doctor in question had received their degree from any country other than the UK or South Asia. Other factors that predicted a less favourable review from colleagues included that the doctor was working in a locum capacity, the doctor was working as a GP or psychiatrist, or the colleague did not have daily or weekly professional contact with the doctor.

The researchers say they have identified “systematic bias” in the assessment of doctors’ professionalism.

They conclude: “Systematic bias may exist in the assessment of doctors’ professionalism arising from the characteristics of the assessors giving feedback, and from the personal characteristics of the doctor being assessed. In the absence of a standardised measure of professionalism, doctor’s assessment scores from multisource feedback should be interpreted carefully, and, at least initially, be used primarily to help inform doctor’s professional development.”

The GMC, which commissioned the research, said it wanted to understand more about how feedback can play a part in improving doctors’ practice.

Niall Dickson, the Chief Executive of the General Medical Council, suggested that feedback still had an important role to play in revalidation despite the findings.

He said: “This study found that feedback doctors receive may vary depending on a variety of factors, such as the specialty they work in or where they qualifie.......

Doctors4Justice said...

and where they happened to find themselves

Anonymous said...

Whistleblowers in general and Black and Ethnic minority doctors in particular,will be at the receiving ends.They will never receive satisfactory feedback and the NHS Trusts will refer them on spurious complaints to the GMC, and the Council will energetically take up these complaints as stream 1 and the conventional Defence Unions hardly support rather in most case mislead ethnic minority doctors while protecting the interests of the Trusts and the GMC.

Sadly, the situation is gloomy!!!!!!!!

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