Letter: Pilots work with machinery; the GP's role is more subtle

Dear Editor 

So now we have it. After prolonged gestation, the CMO for England has produced his report on revalidation, 'Good Doctors, Safer Patients'.

Sir Liam is to be congratulated for his efforts, but I feel a few caveats coming on: Shipman would have sailed through each and every 'knowledge test'. The way to avoid a reprise is to improve death certification.

But who could object to knowledge tests for GPs? Of course GPs must be up to date or how else can they treat patients successfully? After all, Airline pilots have their competence to fly tested 100 times in the course of a normal career. Why not GPs?

Much of what a GP does is related not to knowledge in the abstract but to how it is used.

Even the most gifted individual could only remember a fraction of what might be relevant. Instead GPs develop ways of accessing information when it is needed.

Much clinical work is associated with understanding patients' problems and helping them to cope with them. More is concerned with support and reassurance, often over years.

In many ways the personality of the GP is more important than the extent of their knowledge base. Continuity and experience still count.

Airline pilots have relatively simple, though skilful and important, jobs with a large but finite number of potential problems. They interact with systems and machines, rather than with troubled, confused, duplicitous or aggressive individuals. For that reason alone this comparison is invalid.

I do not believe that the public has serious worries about the quality of GPs, although perhaps sometimes they should have. Knowledge tests are more appropriate for testing basic cognitive abilities than mature medical skills. To be valid they would have to be set at such a low level as to be meaningless.

I accept that the public have a right to be assured that their doctors are decent and competent.

I would be happier to accept Sir Liam's proposals if there was some evidence to suggest that they were likely to achieve their aims.

Most doctors just want to do the right thing.

Dr Lewis Miller, Belfast.

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