Given Baby P/Shipman whats more important, evidence based medicine or admission ?

**ipsiLoquitor** · 17-11-2008, 01:39 AM

My 'naive' position is supported by rather a lot of experience. You will find that discovering one in a million/rare diseases is one of the jobs of Consultants. I recall one consultant finding Chuvash Polycythemia in an East London hospital. Also, I din't say 'simple' personality profile, I didn't even say that the current protocols are sufficient. I suspect that there are some yet to be published protocols that could do a better job than those currently used. The point is that the interview process, if applied to the application of medicine generally, would result in the practice of medicine which was not evidence based but subjective. I recall that before women had the vote, before various diseases were discovered and 'cures' found there was often a refrain of 'there is no other way'. Sometimes the decision to change came first and at others the change was the instigator of altered views. You are of course correct that it would be a rather simple matter to discover the problems with the paediatrician if the reports are correct whereas shipman is in some ways different. What joins the two cases together, of course, is the lack of attention paid to the recruitment and selection process. My own experience of these things is that there are far more questions left unanswered than answered in medical school interviews - and in one case I am aware of 'gossip' from the shop floor appeared to play a role - just women chatting amongst themselves - but that was highly probable, since the most likely entrant to med school is a female, below thirty who hasn't worked in the NHS. I guess any change that is to come will probably be the result of yet further totally preventable trajedies. The area of initial selection is rarely investigated (academically or by the police) although some medical schools have tried to address the issues it is widely accepted outside 'the system' that they have failed.

**Hughman** · 17-11-2008, 01:48 AM

Airtones, don't get involved, this guy is just trolling. *awaits the raging*

**AimsRJ** · 17-11-2008, 01:53 AM

Originally Posted by ipsiLoquitor

since the most likely entrant to med school is a female, below thirty who hasn't worked in the NHS.

you seem to have an issue with this. you dont think it might be to do with the fact that the most likely APPLICANT is female, under 30 who hasnt worked in the NHS? or indeed that there is still a huge range of entrant backgrounds that this covers?

(apologies Hughman for encouraging the trolling!)

**ipsiLoquitor** · 17-11-2008, 01:53 AM

May I quote you, Houghman ?

**Hughman** · 17-11-2008, 01:59 AM

It's a free country ipsiLoquitor.

**ipsiLoquitor** · 17-11-2008, 02:00 AM

Yes, from the patient's perspective there are a number of issues here. First of all, if you take any social situation framed by a governmental body or quasi-governmental body the people applying for money/med school etc are a sign and symptom of health or disease like anywhere else. To say that because a university has a matching profile of applications to successful applications is just cognitively a mistake. It focusses on the 'downstream' information and is like looking at the last two reactions in a cascade. There are many reasons why particular groups of the population apply for medicine - this much has already been recognised and some schools have begun working on it - and some of them are to do with indirect discrimination before the application process itself. This has now been recognised and changes are currently being 'white papered' in some places and initial implementation has started in others. If I sell my Ferraris fairly amongst all those approaching me with he £100k to do so I suspect I may miss out on one or two groups ? Financial discrimination is just one form and its reaction path lies wel l upstream of the admissions process and student loans.

**BeanOfJelly** · 17-11-2008, 02:07 AM

What realistic assessment process do you actually want to be instigated instead of what we already have?
IQ tests? Personality tests? (laughs to self) Psychologist's review for every candidate?
I can understand that it would be a better world if we could reliably test for bad future doctors, but we can't. Do you honestly believe that the doctor who missed the signs on that baby could have been objectively tested for at the application stage?

(Ps: there are more female under thirties who haven't previously worked for the NHS because:
a) more of them apply
b) women, on average do better in education (no offence guys, but its true)
Do you want schools to discriminate against them so that more doctors will be older men, just to even things out?

**xXx H xXx** · 17-11-2008, 02:24 AM

soooo...ummmm what is your point ipsiliquid???
ur missing one major factor here. ur saying that the medical interviewers that interviewed shipman missed his 'serial killer' trait. wat makes u conclude that he waz crazy 4m the beginning, his mind became instable at a later stage than when he waz an 17/18 year old being interviewed. him being personality profiled back then wouldnt have made a difference.
as for the baby p case, she made one stupid mistake of not seeing to the child as he was cranky bears no realistic relation to the her entry route to medicine, how do you know it wasnt a sparking admissions test that won her a place at medical school.
the fact that u hav no EVIDENCE of welll anything relating these cases into the admissions process certainly classifies ur judgement as 'naive'
u say ur not discounting others opinions but ur tone of language states otherwise. also the occasional snidey/bitchy remarks mind u.

**NorthernLight** · 17-11-2008, 02:31 AM

I feel bound to agree with the view that the only naivety being shown on this thread is from the OP who feels there is some kind of link between two high profile cases, one of which we know only what has appeared in newspaper reports. The link appears to be - a doctor was involved in both cases, and that doctor should have been spotted at interview as inadequate in some way.
You're a verbose troll, but a troll nonetheless. If you have a serious point to make, go ahead and make it.

**ipsiLoquitor** · 17-11-2008, 02:37 AM

Originally Posted by BeanOfJelly

What realistic assessment process do you actually want to be instigated instead of what we already have?
IQ tests? Personality tests? (laughs to self) Psychologist's review for every candidate?
I can understand that it would be a better world if we could reliably test for bad future doctors, but we can't. Do you honestly believe that the doctor who missed the signs on that baby could have been objectively tested for at the application stage?

(Ps: there are more female under thirties who haven't previously worked for the NHS because:
a) more of them apply
b) women, on average do better in education (no offence guys, but its true)
Do you want schools to discriminate against them so that more doctors will be older men, just to even things out?

The point is that the problem of errors is more widespread than Baby P and Shipman. Yes, some tools are available to prevent poor practice and to improve practice. Although they may seem expensive, they are actually cost-effective taking long run costs into account. I don't know anything about the doctor in Baby P's case except what I have read, but, in principle, yes I think it could have been detected at application stage. If I were able to wager a long-term bet I would be willing to put money on people I have met causing similar problems - the technique involved in detecting this already being used in industry. The idea that things universally can't be detected at application stage is obviously nonsensical although I'd be the first to agree that some behaviours will be 'triggered' at a later date. The reasons why this hasn't been done before are at least half political and half to do with an institutional 'we know better' attitude amongst doctors themselves who are often resistant to change even when it is proposed by an 'expert' in the field.
Yes, much more can be done at entry stage and I suspect that over the next 5-10 years this will become more and more obvious. It is the 'elephant in the room'. In the meantime, more weight given to the already administered quasi-IQ tests, profiling and individual psychological and psychodynamic review ? Yes, absolutely.

As far as the other point is concerned, not just older men but older women and people who have atypical applications. The point about medicine, when practised well, is that a superb doctor will pick out the important point amongst all the data e.g. the presence of a particular marker and give it sufficient weight. It is the inability to weigh a minor but highly significant aspect of a candidate's application where the systemic approach fails. The current process is simply a clumsy tool/set of tools. This requires much more sophistication than is currently present. I think that if you look at the previous posts the 'upstream/downstream' point has already covered the cognitive fallacy that you repeat. The profile of successful candidates from applying candidates misses out the pre-application filtering stage completely. I don't care if 100% of the successful applicants are women under 30 if they are the best for the role. I think that bastion of male power Dr Carol Black actually agrees with me on this point - although I am not sure whether that will inflame you or weaken my case ! It might help if the universities established 'core' requirements such as Chemistry etc but then allowed discretionary points which could be applied for.

My point isn't anti women but pro patient, pro older women (and men) and pro diversity.