Professor Trisha Greenhalgh told the RCGP’s annual conference in Liverpool that the college needed to overturn the ‘unintended consequences’ of revalidation that was driving doctors out of the profession.
‘How many excellent GPs do we know who have thrown in the towel, in some cases five or ten years early, rather than do battle with the system?
‘To retain only those GPs with the inclination and stamina to play the managerialist revalidation game is an alarmingly powerful form of professional Darwinism.’
Professor Greenhalgh, from Barts and the London School of Medicine and Dentistry, warned that relationship based care was also threatened by the shift towards a marketised healthcare system where the sick patient is a customer.
‘In this market model, the doctor-patient relationship is accorded no special status, and good clinical practice is defined largely in terms of information sharing, transparency and an end to medical paternalism.’
‘In reality, most of medical care is not about making decisions. Health problems increasingly involve chronic diseases that require ongoing effort by both patients in the form of self management and professionals in the form of periodical check-ups, management of exacerbations and long-term support.’
Professor Greenhalgh also argued that the over-use of ‘unreal’ situations in medical education, such as simulated patients and standardised scenarios, was a threat to relationship-based care.
‘I know that a structured approach makes both teaching and assessment more consistent and reproducible. But I also know that what honed my own professional virtues was early and prolonged contact with real patients, suffering from real illnesses, real anxieties and real social situations, and shadowing experienced doctors caring for those patients.
‘As a college we owe it to tomorrow’s patients and tomorrow’s doctors to take a stand on the inexorable retreat of medical education from the messy, non-standardisable reality of illness and suffering.’
