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

[Granny Midges]

Originally Posted by ipsiLoquitor

BEan of Jelly:

In real life you would at first reject me, then get curious and eventually find me extraordinarily helpful and insightful.

There is some evidence you're missing though. You're not distinguishing between different sources of evidence. Yes, posters have been largely scornful, rejecting and unable/unwilling to see any value in my points. However, posters are a small part of the total viewers and these in turn are probably a smaller part of the e-mails which are circulating about this thread. So don't be surprised if you look around when leaving the room to see a silent audience of 'listeners'.

Also, I am sure you know this, how many times in the history of medicine and medical practice have people been rejected on similar grounds ?

I was incredibly fortunate in that I was brought up to believe in judging people by the quality of what they say, to see the possible value in it etc. I was not brought up to value the popularity of a vested interest group.

You sound really hard done by. What is it that you want ? I have read some of your recent posts,they have a sinister tone to them. 'Vested interest' ? Now what would that be ? Give you a clue...it's got something to do with med school and getting in.
This is not about being popular. Are you surprised that people are not going to sit quiet when you use gross generalisations in your posts ? Most of which have a very condescending and arrogant tone to them. Indeed I cannot make sense of some of them. You are an intriguing person...but all for the wrong reasons.

[ipsiLoquitor]

Originally Posted by Granny Midges

You sound really hard done by. What is it that you want ? I have read some of your recent posts,they have a sinister tone to them. 'Vested interest' ? Now what would that be ? Give you a clue...it's got something to do with med school and getting in.
This is not about being popular. Are you surprised that people are not going to sit quiet when you use gross generalisations in your posts ? Most of which have a very condescending and arrogant tone to them. Indeed I cannot make sense of some of them. You are an intriguing person...but all for the wrong reasons.

Actually, I have not been at all hard done by. Not sure where you got that from. The most recent public use of the term 'vested interest' was by Tony Blair before trying to reform the health service. He felt hard done by saying he had 'scars on his back'.

Can you give me a specific example of a generalisation which is condescending and arrogant which you don't understand ?

The last bit sounds like a line from X-Factor !

Trust me, I am ahead of the game on this one. Join in with thinking critically and constructively about the admissions process ... if my arguments seem week to you, give me an example of a strong argument for change...do better than me ? ...

[ipsiLoquitor]

Originally Posted by ipsiLoquitor

Actually, I have not been at all hard done by. Not sure where you got that from. The most recent public use of the term 'vested interest' was by Tony Blair before trying to reform the health service. He felt hard done by saying he had 'scars on his back'.

Can you give me a specific example of a generalisation which is condescending and arrogant which you don't understand ?

The last bit sounds like a line from X-Factor !

Trust me, I am ahead of the game on this one. Join in with thinking critically and constructively about the admissions process ... if my arguments seem week to you, give me an example of a strong argument for change...do better than me ? ...

Granny:

Just noticed I didn't answer your Q about what I want. I ahve a detailed agenda but a summary would be :

"An admissions process that is fully up to date with current psychological/psychodynamic research and practice, that is open to scrutiny without resorting to legal means, that matches interview panelist's objective skills with public criterion which they are supposed to be measuring..''

Here, on this site, I just want to stimulate some thought about the correlation between entry process and fatal error.

I don't expect agreement, but think that of all the posters/viewers/e-mail recipients, one or two may just hit on something.

[Doc Skin]

How do we even know the paediatrician in this case studied medicine in the UK? She was born in Saudi, maybe she trained over there, therefore it would say nothing about our admissions process. Maybe more should be done to implement continuous assessment of doctors to ensure they have the skills to continue to practice. Isn't this something that is already in the process of being enforced, yearly assessments?

[giella]

Fair comment. Do you think this will have any impact on the OP, who is clearly a malevolent imbecile?

[ipsiLoquitor]

There is more than one admissions process, of course. My belief is that regardless or country of training, admissions processes should involve psychological/psychodynamic evaluation. Continuous assessment tends to cover skill/competence based evaluation in the 'medical' sense where as what I am proposing is competence in the personality/psychological sense. As someone who worked with a 'genius' Saudi consultant the issue is unlikely to be the quality of medical training in Saudi - but, of course, it is unlikely that she would have been given psychological/psychodynamic evaluation if this is the case. My belief is that people working with children should have a minimum of an hourly psychodynamic assessment every three months. If there had been nothing wrong with Baby P, this doctor would have gone unnoticed and might even be winning an award for something. No 'near miss' would be reported and she herself would have had her 'prejudice' (that her judgements were correct) reinforced. The yearly assessments do very little to challenge doctors assessments of themselves and indeed tend to cover so many issues that it is highly unlikely that an ordinary assessment would pick up a psychodynamic/psychological problem.

[ipsiLoquitor]

Originally Posted by giella

Fair comment. Do you think this will have any impact on the OP, who is clearly a malevolent imbecile?

Giella:

I noticed when I was helping someone with a university entrance exam (GMAT) and 'malevolent' was one of the '600 new words' words that it means having or exerting a malignant influence.

To describe me like this is an extraordinary cognition/perception.

Do you fear psychological/psychodynamic evaluation ? Is there something in my posts which you fear so much as to insult ? Do you doubt your own intelligence/motives? Thrall me with your acumen.

[Doc Skin]

But how would a psychological/psychodynamic evaluation detect that this doctor was going to make a mistake? This kind of test may detect a sinister character like Shipman, especially if the test was done frequently and his crimes were triggered throughout his career. But the paediatrician made a terrible mistake, she did not intentionally harm Baby P, so nothing in her personality would show any cause for concern.

[ipsiLoquitor]

How it would detect the likelihood would depend on the methodology chosen and the proximity of the assessment to the state that caused the problem. To give a couple of examples, models using ego-state contamination would be able to detect the kind of cloudy thinking that might temporarily have someone making decisions more like a child than a well paid professional. There are lots of methodologies and it is likely that the psychodynamic tools would act as an additional 'preventer' as well as detector. There is and has historically been quite a lot of 'insanity' in the health service (in relation to junior doctors' hours for example). For this reason and others it is very unusual indeed for doctors to feel comfortable about having their own mental states checked out - some of the defensiveness involved is justifiable in terms of the uses to which info might be put. However, it is not the poposition that all doctors have this 'MOT' but that those entering as students, as overseas doctors travelling abroad or working with vulnerable children. It would probably surprise some posters to know that this is already happening under different labels/guises in other areas of child protection and mental health. Thanks for the constructive input.

[Granny Midges]

Originally Posted by ipsiLoquitor

There is more than one admissions process, of course. My belief is that regardless or country of training, admissions processes should involve psychological/psychodynamic evaluation. Continuous assessment tends to cover skill/competence based evaluation in the 'medical' sense where as what I am proposing is competence in the personality/psychological sense. As someone who worked with a 'genius' Saudi consultant the issue is unlikely to be the quality of medical training in Saudi - but, of course, it is unlikely that she would have been given psychological/psychodynamic evaluation if this is the case. My belief is that people working with children should have a minimum of an hourly psychodynamic assessment every three months. If there had been nothing wrong with Baby P, this doctor would have gone unnoticed and might even be winning an award for something. No 'near miss' would be reported and she herself would have had her 'prejudice' (that her judgements were correct) reinforced. The yearly assessments do very little to challenge doctors assessments of themselves and indeed tend to cover so many issues that it is highly unlikely that an ordinary assessment would pick up a psychodynamic/psychological problem.

You are trying to solve a problem with the wrong solution. The way I see it is that mistakes will always happen, some go unnoticed,some hit the headlines. The GMC discourages doctors working in isolation..so what I would like to know is that there must have been other doctors who reviewed the case of baby P or were following him up and must have suspected the poor child had been abused and why alarm bells didn't ring for them ? Surely there must be a system in place where cases are reviewed by different doctors in the same case ? If a particular doctor missed something it could be picked up by another ?
Ipsi it is farcical to think that by carrying out psychological testing you are going to weed out 'underperforming' doctors. There are a huge number of reasons why mistakes happen, and it is not necessary because the doctor is 'bad'. This whole discussion leads me to believe that you are not a practicing clinician because if you were you would realise how non-sensical your suggestion is. The admissions process that you are suggesting is not going to solve the problem of doctors making mistakes. There needs to be safety nets in the form of regular review of cases by different doctors, I think this is already in practice. Also doctors are encouraged to speak up if they see problems such as underperformance in a colleague as to not to do so could be seen as negligence.