Wednesday, 10 December 2014

The Shape of Training - first do no harm Prof Reid?

I have been doing a fair bit of thinking about medical training reform in recent days, things appear to steaming ahead at full speed despite a rather large number of valid concerns that remain totally unaddressed by those pushing Shape through.  I stumbled upon an interview with HEE chief Wendy Reid and it is worth reading.

I think this brief interview succinctly demonstrates a number of crucial problems with those railroading through the review.  Firstly there is a lot of talk of doing good things:

“We’re really pushing forwards saying, ‘Here are explicit ways in which you can become this,’ and that’s where I think we will make a big difference.”

The meaning of such statements is debatable, it is actions that matter as cynics like myself have come to realise after years of seeing harmful reforms being packaged in a sheep's clothing.  Wendy Reid says we need major structural reform to meet the expectation of patients:

Reid says the structure of doctors’ training, which has remained the same for decades, needs to change to keep up with patients’ expectations. “We have doctors training in a system that is pretty much the same as it was in the 1980s when I trained”

This is a total straw man argument.  It is strange to say that our training system has not been changed since the 1980s, perhaps Wendy failed to notice the structural reform of MMC, I do not know.  Anyhow the argument that we need major structural change because we have not had it for a while is incoherent and sloppy.  In medicine 'first do no harm' is a fantastic motto by which to practice which serves one well in many different aspects of life.

As I have summarised in more detail here, the case for major structural reform has not been made by the review and no solid evidence is put forward to justify this needless change for the sake of change.   The reason for 'first do no harm' is that change is expensive, time consuming, disruptive and results in many unintended negative consequences.  The straw man has been exposed, so what are the real motives behind this major structural change Wendy?

Wendy Reid tries to answer "What is the future doctor going to be doing?".  I would suggest that if Shape is implemented then the future will see many quit medicine and emigrate to work in health care systems in which they can be trained to the level of a proper consultant.  Also how does dumbing down the consultant grade meet the expectation of patients?  Do patients want a lower quality service delivered by sub consultants?  Do they want a system of care delivery that traps a large cohort in the sub consultant grade and forces much top talent abroad and out of medicine?  These are the questions I would like Wendy Reid to answer.

1 comment:

Adlof Hilter said...

Ah! But what everyone has failed to spot is that this about producing CHEAP doctors. The government won't admit to the fact that good healthcare is expensive. SO if you can produce a sort of Middle-Grade consultant, you can pay him/her less, and justify it by saying, "Well they aren't REAL consultants like they were in the 1960s."