Knowledge and approval - When is a will suspicious?
In October 2012 the General Medical Council (GMC) announced that each of the 230,000 doctors practicing in the UK today will now require regular monitoring in a bid to improve patient care.
This is welcome news in light of two scandals that have hit the NHS in recent months regarding ‘rogue’ UK doctors.
The first at the Solihull and Good Hope Hospitals, part of the Heart of England NHS Foundation Trust who employed surgeon Mr Ian Paterson. Mr Paterson was allegedly carrying out unregulated breast surgery on a number of women. Around 1000 women either had unnecessary surgery or underwent surgery (partial mastectomies) using a technique that was in breach of UK guidelines. In a stark contrast to many claims I investigate in Hospitals failing to diagnose breast cancer, this was a case of over treating women – women who for years thought that they had breast cancer when they did not or who underwent surgery which was unregulated. Many of Mr Paterson’s patients will want a thorough investigation into what happened and why and how they had, in some cases, years of negligent care by him.
Further stories were reported by the BBC regarding Obstetrician and Gynaecologist, Mr Robert Jones who worked at The Royal Cornwall Hospitals Trust. Mr Jones was suspended and a report by the Royal College of Obstetricians and Gynaecologists found that the number of surgical complications where he was involved was considerably higher than what would be expected. The report also found that he did not adhere to guidelines and did not write adequate medical notes in patient records.
Both of these doctors have been reported to the GMC who will follow their own robust appropriate procedures for dealing with incidents like this. However the question that is often asked when scandals like these make news headlines is why these doctors were not stopped earlier and how many women have received negligent medical treatment as a result. The reports in these two examples clearly show that they were not cases just a handful of patients, but actually over a thousand women and spanning many years.
The GMC was established as long ago as 1858. Not much has changed in the way doctors are regulated since then, but the GMC have now finally brought in a scheme which hopes to avoid allegedly ‘rogue doctors’ like those mentioned above from either continuing in practice at all, or continuing without improved training.
A new system of checks will begin as early as next month and will be known as ‘Revalidation’. Doctors will be expected to show that they are keeping up to date with modern medicine and modern methods and are fit to practise in the UK. The Revalidation process is likely to involve annual appraisals and information about a doctor’s work, including feedback from patients, fellow doctors, nurses and other colleagues. It will probably be the first time that patient feedback will be used in this way although I think it is too early to say how the feedback will be collected and which patients will be asked to participate.
This is no doubt welcome news to patient safety groups, however, the number of complaints to the GMC is still on the rise. The number of complaints increased from 7,153 in 2010 to 8,781* in 2011, a rise of nearly a quarter. Similarly the NHS has also seen an increase in the number of complaints made directly to them. The Health Service Ombudsman, the last resort after a complaint has been made received 150,859 complaints between 2011 and 2012 which is an 8% increase in the last year.
When things go wrong
We know that complaints are on the up but we have to wonder whether Revalidation is going to make a significant difference to the patient experience. Revalidation may just create more paperwork and overload doctors with form-filling and we don’t know how seriously it will be taken at the start. Poor communication is the subject of so many complaints and trust in the system seems to be at an all-time low. Revalidation may help to spot cases such as those of Dr Paterson and Dr Jones much earlier but there are times when, despite whatever the Revalidation procedure may bring, things go wrong.
It was reported in the Telegraph on 25 October that one in ten medical negligence claims involving cancer are from women with breast cancer as doctors are failing to examine women and not following up on abnormal test results. This may, in part, be due to the fact that breast cancer is on the increase generally, and delays in diagnosis may not always be negligent - poor communication seems to be a contributing factor but there are situations, different to Mr Paterson who is criticised due to over-diagnosing women, where delays in treating at all have led to poorer outcomes for patients.
If doctors are aware that patients will give feedback on their performance as part of the Revalidation process we might start to see improvements and the number of complaints start to fall but how much value will be placed on the feedback part of the process? We just don’t know. I hope that the Revalidation data is made available so that we can see whether doctors are failing to meet the required standards and whether there is a drop in the number of complaints as a result. In clinical negligence claims, it will be important to have the data so that patients have a full picture of why their care has gone wrong so reliance will again be placed on openness and good communication – factors which feature so heavily in complaints.
*The figures come from the GMC’s report, ‘The state of medical education and practice in the UK’
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