Danger Doctors - Beware!

The Sunday Telegraphs Health leads with the eyecatching, heart thumping headline of  '3 in 4 of Britains danger doctors are trained abroad'!

Now lets go a little more into their eyecatching, heart thumping headline and news.

They acquired the statistics using the freedom of information act so we can conclude that this juicy detail was actively sought to make a news article. Well that explains the catchy headline at least! 

The general tone of the article is obviously slanted toward   ‘overseas doctors are bad doctors compared to our native trained doctors’ though they cant hide the fact that 37% of those struck off or suspended are indeed native doctors, probably born and bred here, in addition to being wholly trained in Britain; doctors whose first language will be English and who know the nuances and cultural delicacies of the native population.

They also cannot hide the fact that in fact 17% of those struck off from among the Britsih trained doctors were referred by patients and only 11% in the same category for overseas doctors. Therefore it begs the question as to why more overseas doctors are being referred to the GMC by Hospital authorities, NHS trusts etc.

Another juicy subheading indicts Indian Doctors directly and fortunately comes with a table  so those who can read beneath the headline can get a better picture.

The subheading reads - Worst five countries by number! The figures beneath the headline tells us that doctors who have done their undergraduate training in India are in fact 25989 and thereby the largest group by a good measure than any of the other groups mentioned and therefore the number of doctors struck off or suspended from is far fewer in proportion to many other nations. 

There are indeed several issues with overseas doctors coming from a foreign land and culture to practice medicine here in the UK or for that matter anywhere else in the world.

The prevalent and persistent colonial culture of Britain does make these issues more pronounced to say the least.

These overseas doctors are indeed trained medically in systems akin to that of Britain. I for one was educated in India and most if not all our textbooks were written by British medics and scholars. From Cunningham for  Anatomy Dissection to Davidson’s for Medicine and everything in between. So its not the medicine that is at fault – but rather something larger and murkier than it all.

One cannot say that these overseas graduates are of poorer intelligence or social skills as well – for most if not all of them needs to master a foreign language in addition to their own mother tongue to even gain entry to sit the PLAB. The IELTS that tests for English language proficiency tests written, verbal, listening and reading skills and one is required to achieve at least a score of 7 in the academic module. This is followed by the PLAB theory and the PLAB practical OSCE’s. So after all these tests and rigours these overseas doctors begin their career in the UK under a vast and varied environment that has no standardised training pathways across schemes.

And again when they claim that 3 in 4 danger doctors are trained abroad they are referring to the 4 1/2 -5 1/2 years of undergraduate training. These doctors  have since then been entirely 'trained' in supposedly equal roles in the nations NHS for several years thereafter. Some of those referred have probably done double the amount of training in the UK as compared to their overseas training prior to being referred. 

So in actual fact the newspaper cannot be referring to their training background (as many would have trained for an equal length of time abroad and in the UK and most possibly longer within the UK than abroad). So then are they subtly alluding to their ethnic background?

That notwithstanding lets explore what it may be that fails these doctors and what is the real reason behind these referrals.  My surmise is that there are bad apples and poor apples as in any other given population and that these will account for some of the referrals. But then what about the rest? A few may fall out because even after all these testing  and years of training they fail to grasp regional colloquialism and conventions and fail to match up to patient expectations. There is also an amount of patient expectations differing when they see a foreign doctor as opposed when they see a doctor of their own kind –as in they may be able to give more leeway for failings from a doctor they like as opposed to a doctor they tolerate out of necessity.

The other more important factor is referrals from those in power and authority. The potential of potential whistle blowers being referred to the GMC for trumped up issues or for minor issues blown out of proportion should never be underestimated as there are plenty of anecdotal evidence to support this. This potential is more so if the doctor in question happens to be coloured. Outside of whistle blowing there are other referrals made without even a preliminary investigation or fact finding from the powers that be. I am a first hand witness to such a frivolous GMC referral where the deputy dean who referred  the trainee doctor didn't even bother to have a chat or elicit the facts about the issue from the trainee  before he referred him to the GMC. The first time the trainee doctor heard about it was after the referral. Had the deputy dean showed the common courtesy that he may have shown a local grad then such a frivolous complaint would not have been lodged.
But that is beside the point –these people give the GMC work to justify the fees they take from its members.

So to sum up –Overseas doctors in the UK beware – up your act if you are trailing, smarten up if you are smarting and jump the ship before they sink you if you have the wherewithal!

That the medical environment in the UK is becoming increasingly hostile to International Medical Graduates is no secret. The only question is how worse can it get?

ADaMMs - Awesome DAds Medical (Mango) Milkshake

Last night my dearest husband ventured into the kitchen. Each 'venture' is akin to a hair raising adventure for the rest of the family. OH loves to help - but when it comes to dishes I end up with less clean ones than the number of dirty ones that went into the sink --crick, clang, crash! One day it's a bowl, next day a glass may be and the day after a plate.
Luckily last night was Mango milkshake night so I was a little less apprehensive about the venture. But I quickly realised that not everyone shared my optimism as you can soon see.

I'm inviting a few guests over on News Day and have planned on giving them a nice cool welcoming drink. Since I'm the hostess I'll obviously be too busy with the 'really important' stuff you know! So my Dearest has been entrusted with the lofty job of creating an awesome mango milkshake to serve them.

Like everything in the medical world (OH was a surgeon before he changed his spots) preparation is paramount. OH decided that he would like to make a test batch of milkshake just to be sure that everything would be just right on the day. So after we put Lil DS to sleep OH declares to DD and DS1 -- " I'm off to the kitchen to make some Awesome Dads Mango Milkshake -- who would like to volunteer?"
"Sorry Daddy I don't want to 'vomiteer' "  quips  7 year old DS1 immediately, delivering an 'awesome' blow to Dads ego. Anyways he has us all in stitches laughing at his well timed play of words.

Long story short the kids didn't 'vomiteer' and Awesome Dad made his very own milkshake without any further mishap (or so I think as I didn't hear any of the usual sounds of clink, clank, clatter)!

Oh No! First post a scandal?

I dearly wish my first post didn't have to be bad news---but bad it is neehow!

Our beloved Royal College of General Practitioners (RCGP), the esteemed College  with the Royal Charter is now being accused of certain unsavoury goings on. Its all hush hush and behind closed doors at the college but the medical media is reeling under the onslaught of tales of woe and discrimination being rife within the RCGP.

Pulse, an esteemed GP online magazine in the UK has been reporting about potential bias in the Clinical Skills Assessment (CSA) conducted by the RCGP and which International Medical Graduates(IMGs) are failing left right and center  The first inkling that something was amiss started being reported in early November when Pulse said here that the RCGP could face legal action due to the huge differential in pass rates between local 'white' candidates and IMG's though both went through the same selection process and identical three year training rotations.
This article brought forth an unprecedented number of comments from local and IMG medical doctors alike. On its pages are a never before heard tale of woe and perceived discrimination of GP trainees who feel they are in a rut out of which an exit is impossible.

Over the past several months it had become blatantly obvious to any cursory observer that something was amiss - especially when doctors with excellent feedback from patients during their GP years and excellent scores at the Applied Knowledge test started failing the CSA in droves. This became excruciatingly painful when they were later booted out of their training schemes, thousands of pounds out of pocket and jobless. The only common factor in all these cases were that these candidates were IMG's and predominantly male.

Background investigation and hear say point to the fact that the bar for CSA was raised again in 2010. The candidate now had to pass in all 13 stations which were marked by a single examiner with no videoing or appeals process. The stations were simulated surgeries with professional actors role playing patients.

From the comments on Pulse it is obvious that some of the actors are far from fair in divulging information to the doctor and some examiners may fail terribly under closer scrutiny.

But the key reason for this mass failure seems to stem from the fact that the Clinical Skills Assessment is anything but. It has been designed to enable only high  end English communicators to pass the exam. And as such the trainers are woefully under equipped to help the failing trainee as this fact has probably not been divulged to them.

Recently the BAPIO (British Association of Physicians of Indian Origin) has decided to take up the issue on behalf of all the suffering IMG's irrespective of ethnic origin. We wish them all success in their pursuit for justice.


Good to read : theriskyshift.com - Black and Minority Ethnic Doctors within the British National Health Service: What can History tell us?


Add on:  It has just come to my notice that Pulse had apparently raised this issue here as early as in January 2011. And here we are one year later still reeling from its after effects.