Forget ‘Am I a Good Doctor?’ I'll settle for ‘Am I a Competent Doctor?’ or, shall I put it another way ‘Could the RCGP do something useful for a change …?’
In my foolishness I once held the post of a parent governor at my child's school. The singularly most useful experience in the entire 4 years was the discovery of the following concept — that there are four states of competency/consciousness:
As a part-time GP of 15 years' standing (well, sitting down mostly, as my derrière can pay tribute to) a husband and three children to my credit, a home to manage and multiple interests outside medicine, I am able to say without any shadow of a doubt that I am most definitely unconscious.
But unconsciously what? Competent? Incompetent? A bit of both? Enough of one but not too much of the other? Who knows? Well, my appraiser would. My uncertainty and self-doubt would be eradicated once and for all.
As I looked forward eagerly to my appraisal date I started to suspect that such need for external affirmation of my competence may be singularly related to my proud ownership of two X chromosomes. Those peers less fortunate seemed really quite confident, felt in no need of monitoring and resented the idea of being scrutinised. Amazing what a difference one chromosome can make. But alas! No joy. The day came and went and I was none the wiser.
I enjoyed the process, though. I even found it helpful and supportive. But it didn't answer my burning question. Forget the ‘Am I a good doctor? I'll settle for the simple ‘Am I a competent doctor?’
Well, it seems revalidation is only around the corner so I guess someone wants to know. I keep glancing at articles here and there about ‘revalidation’ and ‘fitness to practice.’ I keep thinking ‘I must read that and find out what the official opinion is before I write this article’. But why? Surely my opinion is as important as anyone else's. After all, I am ‘the profession’. I'm not an academic or a political animal or anything special. Just an ordinary front-line regular ‘Jo Soap’ GP.
So how do I think are they going to find out about my competency?
Well, I only have the usual smattering of trivial complaints to my name. That must count for something. I've never knowingly made a major mistake. My colleagues are still willing to work with me (just!). Will someone publish quality markers of my clinical ability? You know the sort that says that 95% of all my asthmatic patients have had their peak flow recorded in the last year. Does that make me competent? Competent at what? Tapping buttons on the computer? Has anyone assessed my consultation skills in the last 15 years? Has anyone tested my knowledge base? Has anyone investigated if I know how to read a paper and evaluate the evidence with my own little brain. Umm … no!
But this time next year they will have.
And how? Well, I have elected (and paid £1100 to boot, since the College wouldn't reduce their exam fees for such a project) to re-sit the MRCGP exam in its entirety AGAIN. I passed it first time round 13 years ago. The aim? To prove to myself that I do have some measurable level of competency.
It still may not be the answer I'm looking for, but think of it another way. It is a well validated quantitative and qualitative assessment. It says so on the RCGP website. If I (we!!) all did it every 5 years that would reduce the bill to the NHS for appraisal and revalidation fivefold. Food for thought.
It might even be said that the RCGP were doing something useful with our subscriptions for a change …
Will Pandora succeed in her bold quest? Is passing MRCGP still possible in one's dotage? Can MRCGP tutors and examiners withstand the withering gaze of maturity. Or immaturity? To be continued …
