Doctors Should Have Annual Check-Ups Too!

Modern medicine is at crisis point.

The public have lost faith in the medical profession. The number of complaints patients make about doctors is soaring. Doctors are desperately searching for ways to regain the trust and status they have lost.

I have little doubt that one of the main causes of the distrust is the fact that a growing number of patients are now aware that the medical profession is too closely allied to the drugs industry - and doctors are often too ready to prescribe new, powerful and potentially dangerous drugs.

This problem is exacerbated by the fact that a majority of doctors stop learning the minute they qualify.

The average doctor in practice gets most of his information from drug companies and spends just a few hours a year at postgraduate courses.

We need to make changes. And we need to make changes fast.

Doctors should be examined annually to make sure that they keep up-to-date.

Airline pilots have to undergo regular examinations and so should doctors.

How many people would be happy to fly in Concorde with a pilot who was trained in a Tiger Moth - and had never had a course to update his knowledge?

The analogy is an accurate one.

Thousands of today's doctors were trained and qualified long before most of the available modern drugs were put on the market. They neither know about nor understand the drugs they prescribe. It is this lack of independent knowledge which so often explains bizarre prescribing practices. There are an estimated 30,000 drugs available in the world. It is impossible for the average doctor to have a working knowledge of more than around 50 of those. Doctors who prescribe brand new drugs without studying the contraindications, possible side effects and interactions are putting their patients at risk.

We don't allow old cars onto the roads unless they pass an annual test. Similarly, we should not allow old doctors to carry on prescribing without keeping up-to-date. Physicians whose knowledge has passed its sell-by date should be forcibly retired. And surgeons should not be allowed into the operating theatre unless they have shown that they have made some effort to keep up-to-date.

Doctors have a tremendous position of power and can probably do more harm than any other group of individuals in the community. But once a man or woman receives a degree certificate he or she is given a licence for life.

For all our sakes that must stop.

The bad doctors would object vehemently, of course, to any suggestion that doctors should be given an annual certificate of competence before being allowed to remain in practice.

But I believe that good doctors would welcome annual `knowledge checks' for doctors.

In addition to introducing annual tests for doctors the authorities should make an effort to encourage doctors to think more about the patient's point of view.

All doctors should be taught to ask themselves a series of very basic questions.

* Is this investigation worth doing?

(Thousands of unnecessary investigations are performed every week by doctors acting out of habit. As a result enormous numbers of patients are damaged or harmed quite unnecessarily. And the cost to the nation is vast).

* How will what I find, influence the way I treat my patient?

(There is no point at all in doing a test unless the result of the test is going directly to influence the treatment).

* Is the possible advantage to this patient of this treatment worth the associated risk?

(One in six patients in hospital are there because they have been injured by a doctor. When a patient is injured by a treatment that may have saved his life then the risk is worth taking. But when a patient is injured by an unnecessary treatment the risk is not acceptable. Doctors must be taught about the risks associated with modern forms of treatment.)

* Should I interfere or do nothing?

(Doing nothing is sometimes the bravest option of all. It takes a good doctor to have faith in the body's own healing powers. Many doctors like to interfere so that they can take the credit when the patient gets better.)

* What are the main priorities and main risks here?

(Sorting out priorities is vital. Relieving pain is sometimes forgotten by doctors - though to patients relieving pain is often a number one priority.)

* What would I do (or what would I want done) if the patient was someone I loved? How would I like to be treated?

These are key questions all doctors should ask themselves every time they see a patient. Sadly, they are, I suspect, questions which are often forgotten.

Copyright Vernon Coleman 2003