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How do you rate your appraisal?

Pericardial rub

Doug Grave

Monday, 28 April 2008

While musing over what should be the topic of my first blog for OnMedica, I have had to keep myself in check for fear of deteriorating too quickly into a sort of medical Victor Meldrew while still fulfilling my brief to write about some of the crazier things that pervade a consultant’s working life, and drive us all to distraction.

This week I have chosen the much loved process of appraisal. Consultant appraisal was imposed upon us as a reaction to the highly publicised maceration of patients by a few rogue surgeons and following the Bristol heart surgery fiasco. In our uniquely British way, and of course egged on by the blood-crazed tabloid press, all consultants were immediately assumed to be incompetent Texas chainsaw butchers or clones of Hannibal Lecter. This was manna from heaven for the politicians who at last saw a chance to drag us down to their own level of contempt in the eyes of the public.

So every year we have to prove ourselves. Now, I have no problem with keeping up to date or proving that I have kept up to date. Nor do I have any problem with my procedure numbers, mortality rates and complications being in the public domain. That is right and proper. The rest of the documentation however is largely a waste of both time and of rain forests worth of paper. In particular the section on management activity has absolutely nothing to do with one’s fitness to practice (one might say it is inversely related).

For example, we are asked to comment on relations with patients and probity. Who in their right mind is going to write "I find several of my patients a right royal pain in the rear" or "I never talk to patients on the telephone unless threatened with a meat cleaver by my secretary"? So we write bland comments such as "I don’t mind if my patients use my first name" (usually a lie!) or "my patients send me thank you letters" (usually true). When asked about probity, nobody writes "I have only nicked two NHS paperclips this year" or "I have, on occasion, posted a letter in an NHS envelope". We write that we occasionally accept thank you gifts such as a cake or a bottle of supermarket wine (which our Trust discourages) but to refuse appears churlish.

Asking us to comment on our own perception of probity is about as daft as the questions asked on some landing and immigration forms on arrival in the USA.

Are you a terrorist?
Have you been convicted of genocide?
Are you carrying arms or weapons of mass destruction?
Do you intend to overthrow the government?

Anyway, once the form is signed off by your equally bored appraiser, who on earth actually reads it? Probably nobody. The process, not the content, is what counts and that makes it even more useless. Piles and piles of yellowing paper sit gathering dust in remote filing cabinets never to see the light of day. So, when I am about to retire I intend to write under "results of procedures" survival 0%, mortality 100% and under "relations with patients" I shall put "regularly , if young, female and attractive". Lets see if anyone notices!

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Doug Grave

Dr Grave has spent two decades as a consultant cardiologist and lectures both in the UK and abroad. He has more than 100 scientific articles to his name and has published widely in peer-reviewed journals. He has written two educational books for patients and plans to publish a third book describing the life of an oppressed NHS consultant, a subject on which he is something of an expert.
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