Chainsaw attack? GMC scenario training will help…

Just in case you wondered what the GMC wasted all that subscription money on, take a look at this.

It is apparently the second episode in the exciting fictional life of Julia, a busy GP. In it, we are faced with a ‘dilemma’ and offered two possible solutions. Sally, a Down syndrome patient, and Dan, her carer, have turned up for a routine appointment. They have been kept waiting while Julia dealt with an emergency, and Sally is a little agitated as a result.

It transpires that an ophthalmology referral that should have been made by the hapless Dr Hicks (Julia’s predecessor) following her previous appointment does not seem to have been actioned. Sally and Dan know nothing about the intended referral. The dilemma, apparently, is whether Julia should tell Sally and her carer about this oversight, or ask her how her vision is now, refer if necessary, and discuss it with Dr Hicks later.

Now you may feel that this is an innovative way to reinforce the principles of good practice, utlising the power of the internet and reassuring the public that the GMC is committed to its educational role. On the other hand, you may think it is ill-conceived, mindless, patronising garbage, apparently written by someone who hasn’t experienced a real patient management dilemma for some considerable time, if ever.

Our mentors at the GMC don’t actually tell us what the right answer is, but under the heading ‘what we currently say’ they do offer a paragraph from their current guidance, which states: “If a patient under your care has suffered harm or distress, you must act immediately to put matters right, if that is possible. You should offer an apology and explain fully and promptly to the patient what has happened, and the likely short-term and long-term effects.”

This seems to imply that Julia should come clean, dump on the unfortunate Dr Hicks, and grovel for mercy. However, I suspect that you, like me, will have thought ‘so what?’, after reading that paragraph from Good Medical Practice. Sally has not ‘suffered harm or distress’ - she wasn’t even aware that she should have received an appointment - and it seems unlikely that there will have been any significant short or long-term effects from a delay of a couple of months in getting her eyes checked. And of course, Julia doesn’t actually know at this stage that the referral wasn’t made - it wouldn’t be the first time that someone failed to file a copy of a referral letter in the notes.

But perhaps I read too much into this - perhaps, despite the apparent implication of their choice of quotation from their own guidance, the GMC agree that the better of the two options offered would be to check Sally’s vision, tell her that she needs to see the optician or ophthalmologist if necessary, and check that Dr Hicks hadn’t already done so. I doubt it though. Dropping a colleague in the shit without checking that he has actually done anything wrong, or that anyone has suffered as a result, does feel like the GMC way.

But that’s all irrelevant. The fact is that banal, fabricated scenarios like this (not to mention role-playing - don’t get me started on role-playing) are already an unwelcome feature of too much of the non-clinical ‘training’ to which doctors are pointlessly subjected, and this one is a particularly facile and useless example of the genre.

I would like you - the GMC - to stop wasting my money in this way, and if you feel obliged to kill Julia off, I can let you have a script for the final episode involving a home visit to a farmer, an unfortunate misunderstanding over a rectal examination, and a chainsaw (thus highlighting the importance of chaperoning for intimate examinations).

Tags: GMC