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November 27th 2003

Career focus BMJ 2003;326:S162 (10 May 2003)

The way I see it

Consultant appraisal is trying to achieve too much

I wrote this critique of the consultant appraisal process for a medical readership. The process --introduced as an NHS initiative less than 2 years ago - has already been hi-jacked by other groups. One of these is the General Medical Council (GMC), the medical profession’s regulatory body, which plans to use it as a basis for the forthcoming 5-yearly renewal of every doctor’s licence to practise (“revalidation”). It probably would not have done this if the medical profession - in the guise of the British Medical Association (BMA), the doctors’ professional association - had not first told the NHS that it would only accept annual appraisal if every medical practitioner were to be appraised by another medical practitioner.

The GMC is currently grappling with the problem of how to “revalidate” all doctors, including those who work outside the NHS (in public health, in occupational medicine and in the private sector) and recognizes that it needs additional input from patients, peers and colleagues. However, since no medical practitioner’s appraisal will count for revalidation unless it is conducted by another medical practitioner, it is easy to see how the process is likely to be distorted by the profession’s control over it. In this way, the GMC has colluded with the BMA, and an opportunity has been lost for a more open-ended review of what it really means to practise medicine effectively, and how this can best be assured in the interests of practitioners, patients and society as a whole.

As Freidson wrote in 1970:

[Self-regulation] “develops and maintains in the profession a self-deceiving view of the objectivity and reliability of its knowledge and of the virtues of its members. Furthermore it encourages the profession to see itself as the sole possessor of knowledge and virtue, to be somewhat suspicious of the technical and moral capacity of other occupations, and to be at best patronizing and at worst contemptuous of its clientele.”1


1. Freidson E. Profession of Medicine: A Study of the Sociology of Applied Knowledge. New York: Dodd, Mead, 1970.

Wendy Riley, Development officer, Department of Education and Professional Development, University College London,
London WC1E 6BT

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