Dame Janet's disappointments

Editor—Firstly, can we put Harold Shipman aside?¹,² What he did was horrible, but basing a system of revalidation on the actions of a psychopathic mass murderer is absurd. No matter what system is put in place, it will not stop the psychopath, just as all the fences in the world will not stop a suicide bomber.

The whole problem with keeping an eye on one another is no one knows what we are keeping an eye on. What is a “good enough” doctor? We can all enumerate the qualities of a “good” doctor—compassionate, knowledgeable, in possession of clinical skills, and dependable with a healthy dose of common sense, for starters. But can we define the doctor who needs to be struck off? That is a whole different story. Sadly, and I am not surprised Dame Janet doesn't get this as I suspect she inhabits the black and white world of the law courts, medicine is rarely black and white but a confusing number of shades of grey. For example, if a diabetic patient has a blood pressure of 140/80, am I a bad doctor, a good enough doctor, or a good doctor? What if said patient's other indices are spot on? What if the blood pressure is a lovely 120/80, but she feels terrible and only keeps taking her pills because I insist? What if the blood pressure is 160/90, 200/100?

I teach and struggle with just such dilemmas all the time. When should a student or resident be failed? Do I fail them for always being late? Do I fail them because they show up but don't seem particularly interested? Do I fail them because their clinical knowledge appears to be a bit less than their peers? I don't know. If anyone else does, I would love to hear from them.