DZ wasn't going to comment further on appraisal but an article in today's Guardian made him reconsider.
Yet more evidence that standards of care are falling in the NHS has come to light, making very disturbing reading. The report doesn't once mention appraisal, nor is it suggested that the fall in standards is down to poorly performing staff.
Instead what is highlighted is inadequate resources, understaffing, delays in treatment. Hardly a surprise to front line staff. It is estimated that the NHS is short of 10,000 doctors alone.
So when the NHS is so short staffed how can we possibly justify taking what staff we have away from patient care to spend significant amounts of time on a pointless tick boxing and navel gazing exercise. An exercise reviled, ridiculed and regarded with utter contempt by the staff who have to endure it.
Appraisal is a process which achieves nothing whatsoever but to irritate, annoy and demoralise, and is a dubious luxury we can not afford. Without a doubt it has failed utterly in its aim to flag up problematic staff, as detailed here. I'll repeat what I said in my last post. It is a failed experiment.
One of the frequent excuses behind the imposition of appraisal is that it would "prevent another Shipman", though no evidence exists as to how the process achieves this. It has to be remembered that the medical profession has not supplied the only serial killer in the NHS, and perhaps this is why appraisal is now rolled out to blight the working lives of all healthcare workers.
Well it appears that in this one and possibly only justification it has failed. The news report does not elaborate about what sort of health care worker is involved here, but it is clear that appraisal has not provided the safety net claimed. Another Shipman/Allit has been at work and gone undetected for some time. I don't suppose for a moment that she was exposed by appraisal. Perhaps she should have mentioned it in her personal development plan.
So if, as I said in my last post, it has not demonstrated that it improves standards, and it does not pick up the psycopaths in our ranks, then what is it for?
Not long ago I posted on the utter waste of time that is "Mandatory Training". I pointed out that the obsession with this bollocks takes doctors away from their patients for a not insignificant period of time, to learn stuff, much of which is of no relevance to their profession whatsoever.
In similar vein I thought I'd look at that universally reviled, ridiculed and disrespected process of annual appraisal.
As Doctors we are used to the concept of examining potential therapies for our patients on the basis of how the potential benefit balances against the potential downsides. We look not only at the expectations of therapy, but also the possible adverse effects, and, ideally, present these facts to the patient, to ensure truly informed consent. We also consider cost.
So how does appraisal stack up using this approach?
1. Benefits of annual appraisal.
This of course is going to be difficult to objectively assess. The GMC approaches this difficulty by not even trying. Their concept of "success" seems to rest heavily on compliance rates. Almost all doctors are now participating in the process and that alone is considered success. But participation is not enough. There is little reason to believe that this man should not have been able to comply and retain his license to practice. The GMC would have considered that a success
Although it is claimed that there is evidence that the profession has a very positive attitude to the process, this appears to be based entirely on surveys. Try getting research published where the database consists entirely of surveys and see how far you get.
The claim is that appraisal and revalidation will identify underperforming doctors and thus raise the standard of practice. Really?
So how come that, as the GMC admits, complaints made to the GMC about doctors have doubled in the last 4 years? Doesn't speak of a raising of standards does it?
How about claims against the NHS for clinical negligence? In 2004/5 there were 5609 such claims, in 2015/16 there were 11000, and in 2016/17 a staggering 17338. The numbers are rising steadily and apparently inexorably. That doesn't support the idea that standards have risen since appraisal came along either does it? Excess hospital deaths show the same trend.
Let's face it, the assertion that appraisal and revalidation improves standards is not supported by evidence.
So Benefits? Zero!
2. The downsides.
GMC propaganda would have you believe that doctors are warming to the concept of appraisal. Odd... I have yet to meet a single doctor who has any respect or regard for the process at all. Indeed there is evidence that most find the process demoralising to the point where it is a significant cause of doctors taking early retirement. Or deserting the UK altogether.
The BMA estimates that annual appraisal takes the typical doctor about 40 hours, a full working week, to prepare for and endure. There are approximately 250,000 fully registered medical practitioners in the UK, so that means that total doctors time spent with patients is reduced by 250,000 weeks every year to accommodate appraisal. Assuming 6 weeks annual leave a year, plus 2 weeks study leave a full time doctor will work 44 weeks per year. So appraisal causes the effective removal from the NHS of 5681 full time doctors..............and a part timer. Put another way, if appraisal was abolished tomorrow the NHS would benefit with an effective rise in clinician numbers of 5681, without cost!
Whichever way you look at it, appraisal and revalidation for doctors is a failed experiment. One that virtually no other country has sought to emulate.
DZ has long felt that corporations in the UK seem to have precious little concern for the rights of their customers, seeing them only as walking cash machines. Over the past few years he has had a number of occasions when various companies have tried to weedle out of their responsibilities.
Such as "petplan" trying to avoid paying out for a dog's vet bills by claiming, falsely, that the medical condition occurred less than 2 weeks after the commencement of the policy. A period when, despite you having paid the premium cover is not provided. It gave DZ immense satisfaction to prove them wrong and eventually present them with a bill for £8000.
Or Apple, trying to claim that a cracked screen protector (with an intact screen underneath) invalidated the warranty and therefore the defective battery could not be replaced. Could anyone explain how, even a cracked screen could damage the battery. They seem not to care about the fact that warranties "do not affect your statutory rights".
Whirlpool informing me that there is a product recall on a tumble dryer, because they burst into flames, and then offering to SELL me a new one at a discount.
These people rely on people not having the tenacity to pursue them, paying up because it's less trouble.
Probably the worst offenders here are the car parking companies, which operate many hospital car parks. Typical are UKPC who have in the past been caught out altering photographs, changing date stamps, making stuff up and blatantly lying to screw people out of exorbitant "penalty" charges. In the world of industry this is not considered bad behaviour. UKPC have on their website the statement "UKPC is very proud to be identified in the London Stock Exchange Group's "1000 Companies that Inspire Britain" 2017 report" I think that says it all about modern Britain
In my post "DNA" I used one of my favourite bits of film. The film of Buzz Aldrin giving Bart Sibrel a very well deserved punch in the face. But what I like most is not the actions of Buzz or Sibrel, but of the lady accompanying Buzz, who is his daughter.
In this more extended version of the incident you can see that she makes a number of attempts to separate the two men and keep them apart. It might seem that she is trying to protect her aged father from the unwanted attentions of that prick Sibrel. But I think nothing could be further from the truth. I think it was the other way round. When the words "coward and liar" come from Sibrel's mouth just see her reaction. She's getting out of the way. I think she knew exactly what his reaction was going to be. She is as much of a star as her dad.
No sooner was the ink dry on my last post than I came across this article in the Guardian. The article itself is bunk and illustrates exactly what I was saying about the dumbing down of the British public, who are increasingly falling for this sort of thing.
My faith is restored because the article also illustrates that there is hope for us in the form of two different groups of people.
1. The practitioners of this therapy.
These people are almost certainly aware that their IV high dose vitamin therapy is total drivel. But they at least are making money out of the gullible and the uneducated. Cynical possibly, certainly unethical, but not without a degree of calculating intelligence. A fool and his money are soon parted. You may not admire these people, but I don't think you could call them stupid.
2. My real respect though goes to the vast majority of those who have made very appropriate responses to the article in the comments section.
It appears that a lot of people out there have had a decent education after all.