Regulating doctors and medical practice


The Witchdoctor’s colleague thinks “about 50%” of his working time was wasted.  This sounds to me like a more productive career than most.  For many people the work they did that was useful to others could be an order of magnitude smaller.

I store and then dispose of numerous glossy reports.  Most are now unglossy pdfs which contain so much work that might have been useful…but never was. Many people put months of work into these before they sat around for years en route to the bin.  It used to be called Bureaucratic Unsolicited Mountainous Paper Heap (BUMPH).  Computerisation enables bureaucracy to grow in complexity.

The tsunami of regulation and consultation was a key characteristic of the command and control government of the 2000s.  It continues.   The reasons have been clearly described by John Seddon, but I think there is a lot more to be told, particularly in the health sector.  The bureaucracy Professor Parkinson described was much less before computerisation and the growth of the state.   Systems Thinking in the Public Sector: The Failure of the Reform Regime.... and a Manifesto for a Better Way

At a recent GMC Revalidation: The Way Ahead roadshow it was said that over 80% of doctors were submitting to the latest layer of regulation.

While I stand to be corrected, I have seen no sign that revalidation came directly from the ISO inspection cartel.  Perhaps someone will correct me. Perhaps similar ideas simply permeated the Civil Service in various forms and were absorbed by doctors and others who, needy for compliance, saw them as the only way to assure quality.  At their core the two hoaxes share the same bait and switch tactic:

Bait And Switch

Proxies for quality to impersonate quality.  Historical data to supposedly assure against future outliers.

How would a patient assess quality?  Not a patients’ lobbyist, a patient.  How many patients get cured? Something like that.  However, it is another imperfect indicator skewed by several important factors like the case mix and how sick the patients are.  Maybe measurement is not very useful at all.  Maybe it’s an undiscovered form of hyperactivity disorder.

How many patients would assess the quality of their doctor by the doctor’s compliance with collecting the required paperwork?  None, I expect.  Although many could be convinced of its value by marketing, just as many doctors might be.  Could so much work really be of no value?  Or of negative   value?

The GMC is redesigning revalidation to be as simple as possible, it says.  But to comply with revalidation requirements fewer patients will be seen.  Fewer locums will be able to fill posts at smaller hospitals if they are not bang in the middle of their validated competency.  More departments will be centalised to the mothership hospital.

Government “consultations” with industry involve the biggest companies in the industry.  Therefore legislation tends to force out smaller businesses that are less able to comply with new regulations.  Big government and big business feed off each other to the detriment of competition between more innovative businesses.  Each uses the other to limit competition.  Each offers jobs to the other when they have failed in the other sector.

Is all of this regulation and accreditation not just a meta-medicine for Medicine?  An alternative therapy for conventional doctors?  Unproven by any measure outside itself.  Plausible, but bogus.

Real quality can be done so much better that patients and relatives might notice.  This article describes how Steve Allder improved stroke services using systems thinking – rather than record collection.  Here is Benjamin Mitchell’s description of why it’s so difficult in the NHS:

“It won’t work without a cast iron mandate

It is difficult to explain Systems Thinking to others. Steve has had this with most of the NHS.  Steve talks about Flatland from “The Happiness Hypothesis” about a sphere visiting ‘flatland’ and everyone sees the sphere as a circle, getting bigger and smaller, but the two-dimensional square can’t understand the third dimension (“thickness as well as height, you say?”).  The sphere yanks the square out of flatland into the third dimension and feels sickened and unnerved.  When the square returns to flatland he can’t ‘preach the gospel’ to the other two-dimensional shapes.”

Those visiting Westminster rooms have spent too much time with people who live in Flatland.  The visitors have bought the t-shirts…and the certificates.  They’ve chosen to live in Flatland themselves.  Where everyone speaks the same language of Regulation. Everyone wants to be loved.

[Flatland title page image]

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This entry was posted in Bureaucracy, Computing, Management, Medicine, NHS, Politics and tagged , , , , , , , , , , , , . Bookmark the permalink.

One Response to Regulating doctors and medical practice

  1. Pingback: Well??!!! Eh? « The Witch Doctor

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