Letters: Living up to the idealised version of being a doctor

I was very intrigued to read Chris Lancelot's piece on the imposter syndrome (GP, 10 July).

I think it is a very real issue for a lot of doctors, maybe because we often feel we don't live up to the idealised version of a doctor that the public still often holds.

I came across the 'syndrome' when doing research for my thesis in 1998 to 2002, looking at GP attitudes to appraisal before and after its formal introduction in the UK.

There is no doubt that although GPs are willing to embrace the concept of appraisal at a rational level, powerful negative emotions are still associated with the concept.

Appraisal raises fundamental questions of value and ability: 'Am I good enough?', 'Will I be found out?'

These fears are not, apparently confined to the doctors. High achieving professionals in many disciplines report similar feelings which have been described as the 'imposter syndrome'.

Until recently, all GPs had to do to remain in post after qualification, was to avoid any allegations of serious professional misconduct in terms of clinical or ethical responsibilities.

Appraisal brings a quite different complexion to bear on practising doctors - GPs have to prove, for the first time, on-going fitness to practise.

They have to prove that they are still up to date, knowledgeable, skilful, empathic, sensitive, that they can work in teams and communicate effectively with colleagues and patients.

Will appraisal reveal hidden fears and deficiencies? Will they be found wanting? It is these questions which encapsulate some of the deep-rooted concerns about appraisal which will impact on its introduction.

Dr Di Jelley, clinical lead for GP appraisal NHS North of Tyne and Northern Deanery, North Shields

RCN displays courage in assisted suicide ballot

The RCN has balloted its members on assisted suicide and has changed its policy to neutral, but neither the BMA or RCGP has felt able to trust its members to voice their own opinion.

Dr Martin Wolfson Surbiton, Surrey

Time to challenge some of the dementia myths

It is great that there are calls for more funds for research into how dementia occurs (Healthcare Republic, 21 July).

However, just as vital is funding for services for people who live with the condition, along with the will and passion to make life as active and enjoyable for them as possible.

It is also time to challenge some of the myths about dementia. When someone develops the condition, it doesn't have to mean it's 'game over'. Where support is strong and sophisticated, people with dementia can make a contribution to life.

Our joint guidelines with NICE are aimed at GPs, nurses, geriatricians, psychiatrists, social workers, care home managers and care staff. Interestingly, one of our calls is for care managers to ensure the co-ordinated delivery of health and social care services for people with dementia.

Just as important as the money is the quality of care, provided by a well-trained, well managed workforce that supports people with dementia in a professional way.

David Walden, director of adult services, The Social Care Institute for Excellence, London

The new primary care minister's mixed signals

Have I misunderstood the quote from Mike O'Brien, new primary care minister (GP, 10 July), or is he saying we are not giving patients enough of an incentive to respond to the survey? How much should I pay a patient in exchange for them giving the replies I choose for them? Is this advice condoned by the GMC? Oh, I forgot, he's not a doctor, he's a politician, so the GMC doesn't apply, silly me.

Dr David Church GP, who lost out because patients can see the doctor the same day, so they don't know if they can make an appointment more than two days hence because they never need to.

Machynlleth, Powys.

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