Helping the General Medical Council

I was a trainee in cardiology in Bristol at the time of the events leading to the disciplinary action against two cardiac surgeons and the chief executive over the deaths of children after cardiac surgery. These events have questioned the role of professional self regulation and the General Medical Council (GMC) has developed new procedures to assess performance. I volunteered to pilot the procedures. I thought that, as I had been in post for 10 years, an independent assessment of my work could help me reassess how I do things.

The procedures help to identify the doctor whose performance is below standard so that improvements can be targeted. Before the team arrived on site I was asked to complete a detailed portfolio. I described what time was committed to teaching, training, and research, together with a full explanation of the clinical sessions I undertook in the NHS and in private practice.

I still do not know if I am a good doctor

There were questions about my attitude to patients, staff, and colleagues, and what support services were at my disposal. There followed a self assessment questionnaire in which I scored my competence in clinical skills in every medical specialty. It did not take long to assess my competence in bronchoscopy and shoulder joint injection. I had to assess my teaching ability, counselling skills, and ability to understand current problems faced by junior doctors and my ability to help them cope better.

Then the team of assessors, which included two doctors, one from the specialty concerned, one lay member, and a data entry clerk, spent two days at the hospital. I was interviewed at the beginning of the first day and invited to make comments relating to my own concerns about my practice or hospital environment. Members of the team then visited and inspected all areas of the hospital in which I worked. They had formal structured interviews with ward sisters, junior doctors, technicians, managers, and five nominated colleagues.

The clinical assessors studied 50 case records culled randomly from the past six months' activity, and on the second day I had a two hour viva on selected records. I was able to remind myself of these cases by reading the notes on the previous evening. I was closely questioned about my decision making, including what guidelines I used, and was challenged on their evidence base. I was asked what measures I took to correct the errors of junior doctors that were identified from the notes. I was asked about my referral practices, note keeping, letter writing, and personal philosophy of management comparing general medicine and specialty work. All members of the team sat in with me in an outpatient clinic and observed my ward round of inpatients.

At the end of the two day visit I was reinterviewed and advised that in the opinion of the team there was no need to proceed to further stages of the process, which involved formal assessment of my knowledge base and clinical skills. By this time I was relieved, but I was disappointed when I received no feedback about my performance as a consultant. My work as an NHS consultant requires me to routinely appraise and assess junior doctors. Who does this for consultants?

So what did I learn from the experience? I learnt that I had the support of my colleagues and, more importantly, the paramedical staff. From a personal point of view the case note viva was the most traumatic part as I learnt that I can make simple mistakes that I would not expect a junior doctor to make. In retrospect, I was amazed by the passive acceptance of my patients and their relatives, of the intrusion into the confidential clinical setting of an outpatient consultation and a ward round.

Other members of staff said that they had found the interviews stressful and intimidating. The one person the team did not interview was my secretary, who must know me better than any work colleague and who is best placed to know my clinical and personal faults. I thought that as I was a volunteer and had no concerns about my own practice I would not find the exercise stressful. I was wrong. The prospect of a two day inspection of every detail of your working life is intimidating.

I sympathise with our colleagues who will face these procedures for real, but I think that this new GMC process is exhaustive and fair. No stone was left unturned, and by the end of the visit the team had a clear idea of my workload, my clinical skills, and the quality of my care. They also had a sound knowledge of how the hospital is organised and what the tensions were between staff groups and even between neighbouring trusts.

The team was able to reassure me that even though it had identified some errors in my practice there was an allowance for human frailty. I still do not know if I am a good doctor. Perhaps the GMC is not the right organisation to ask the questions. I wonder what my patients would say.

See also pp 61, 69, and 122