Why are doctors so oddly thin-skinned?
25 July 2008
There will be more grumpiness than usual this week in doctors’ surgeries across the country. GPs, already wearied by the demands of anxious, needy members of the public, have another reason for discontent. They are not, as a profession, trusted quite as much as they feel they should be. Under a new scheme, they are to be appraised, of all humiliating things, once a year. Worse still, there will be tests once every five years designed to “revalidate” them. “I feel very upset,” Dr Satyajit Dasgupta told the BBC. To be asked, after 32 years’ in general practice, to take an examination to prove his worth was “insulting”.
Some might think that, if airline pilots are tested as a matter of routine, a profession which handles the health of a million people a day might accept occasional scrutiny but, as I discovered last year, the medical profession are extremely sensitive about such matters.
After it had been revealed that the average GP’s annual salary was now around £115,000, and that some make up to £250,000, I wrote a column in which I recounted my experience with a friend, later found to have a brain tumour, whose initial treatment at the hands of two doctors had revealed a shocking degree of idleness and incompetence. It was time, I suggested, that there was some way of holding hopeless doctors to account.
The reaction to my article was startling. A few readers and one doctor expressed similar concerns about the system, but the vast majority of emails were from angry GPs. One told me that, since my friend was going to die anyway, the way local doctors behaved was irrelevant. Another said that I must have invented the whole thing. A third, apparently from a non-medical member of the public, was so weirdly abusive that I Googled the sender’s rather distinctive name. He, too, was a GP. A couple of days later, on a website by NHS Blog Doctor, readers were told that what I had written was “outrageous … one of the most unpleasant, nasty articles I have read about British doctors”.
The extraordinary intemperance of these reactions confirmed, it seemed to me, a real temperamental problem within the medical establishment. Most GPs offer a good service, often under difficult circumstances, but a few, it appears, are affected by day after day seeing vulnerable, fearful members of the public, often having to make life-changing decisions. They go slightly bonkers and lose any sense of proportion. The most innocent of suggestions – that doctors should not be above criticism, for example – is seen as a foul, ungrateful slur on a noble profession.
This problem, caused by the extraordinary amount of real and psychological power wielded by doctors is that, for most people, personal health is such a fraught subject that they are simply afraid of complaining. In most communities, a GP has more direct power over the lives of individuals than any other authority figure.
Appraisals and revalidations will be useful, but in truth only doctors themselves can change their own attitudes. They have told us often enough that patients need to learn how to use the National Health System correctly. Equally important, it turns out, is a process of re-education, of learned humility, within the medical profession.
GPs occupy a respected and privileged position in society, and are justly well paid for what they do. But that does not mean that any criticism is outrageous or that a system of assessment is an insult. It is time for the doctors to be less easily affronted, more grown-up.
Here’s one I nicked earlier
The news that the singer-songwriter Paul Simon is suing a clock company for stealing one of his songs will be greeted with hollow laughter in some quarters. Down the years, complaints of this kind have normally flowed the other way.
During the 1960s, Simon’s version of “Scarborough Fair”, based on a medieval tune, was copyrighted to him and Art Garfunkel, upsetting the singer who had taught him the tune, Martin Carthy. The melody for another song, “American Tune”, was lifted, as he later confessed, from Bach’s St Matthew Passion. There were mutterings from African musicians about songwriting credits after the album Graceland was a global hit. Music can be a collaborative business.
* It was somehow inevitable that the grim, grinding culture of tests, targets and league tables would eventually reach what is virtually the last group not to be affected by it – children under five. The children’s minister, Beverley Hughes, has decreed that there is not nearly enough testing in the nursery. There will now be a statutory toddler’s curriculum, known as the Early Years Foundation Stage, which will establish a range of “development milestones” for children before they reach primary school.
Among the milestones will be a requirement to write simple sentences with punctuation and to solve problems using basic mathematics. Doubtless, Ms Hughes sees this miserable, sinister scheme as a great step forward for the nation’s children. The fact that many of them will, even before they go to school, have become habituated to failure, will be deemed irrelevant.