RCPath talk tough

I have obviously happened on this issue rather late, but I noticed this document on the RCPath website the other day. It’s a response to another document I hadn’t heard of before, a discussion paper called ‘The future of the medical workforce’, published by NHS Employers.

I read the RCPath’s response first and it’s quite a strong-worded response considering pathologists often hedge their bets with phrases like ‘suspicious but not diagnostic of’ in histology reports. I wondered what had provoked this and read the offending document. This is a piece of writing supposedly about the recent ‘reconfigurations’ in the NHS, the European working time directive (EWTD) etc and the effects these things have had, and will have, on how doctors work, how they are trained and how many are needed. To me it looks like a load of vague waffle written by somebody who uses the buzzwords but doesn’t really understand the issues. It talks about ‘mergers and closures of some smaller units’, the reduced training time for doctors due to MMC and EWTD without any hint that the authors have considered the effect of these things on patients and doctors and whether these are a good thing or not. The document is full of ‘key questions’ and I’m glad to see the RCPath have answered many of these in their response. Here are a couple of examples:

‘Is there a need for a new specialist grade below consultant?’ ask NHS Employers.
RCPath response: ‘No’

‘What will the doctor of the future look like?’
RCPath response: ‘Here is a likely distinction between expectation and reality. The doctor of the future should be fully competent in the clinical management of patients through a deep understanding of the scientific and pathological basis of disease. The reality is that he/she will be a politically-correct apparatchik who responds to clinical situations in a protocol-driven and codified manner. If such an event occurs, it will be highly detrimental for the medical profession and patients alike as well as being severely damaging for society as a whole.’

The RCPath’s conclusion says: ‘Overall, this is a naive document that exposes many errors and misconceptions currently held by employers and managers within the NHS. There continues an inherent advocacy of a ‘top-down’ directive approach without an acceptance that medically trained doctors are probably best suited to develop the environment necessary for good clinical care within society. Obvious lack of appreciation of fundamental constraints such as time and money do not engender confidence in the proposed discussion or consultation process as advocated at the beginning of this document.’

Neither of these documents is very long and they make interesting reading, particularly if you’re careful to read between the lines. I think the RCPath is pretty spot on in the majority of what is said, I just wish they’d shout about it more.