Revalidation - what is the problem and what are the possible solutions?

To the Editor: Kerry Breen has hit the nail squarely on the head.1

The Medical Board of Australia should heed Peter Ustinov's advice, “Don't just do something, stand there!”

And Oliver Cromwell's plea, “think it possible you may be mistaken”.

And mine: “Please think again!”

It is easier (more effective and cost-effective) to move the tail of the bell curve to the right than to shift the bulk of it to the right.

While every doctor's performance could possibly be improved, there is little point and dubious cost-effectiveness in improving doctors on the right of the bell curve from “good” or “very good” to “a little bit better”, when the point of the exercise is to improve the game of poor performers.

Alison Reid, former Medical Director of the New South Wales Medical Board, has suggested that the focus could readily be directed at doctors about whom there are a number of complaints, and at those in the groups known to be at risk: those with an impairment, the aged, and the professionally and geographically isolated.2

It is among these groups that the evidence shows that poor performance is most likely to be found. It would seem to me that assessment of doctors in these groups, in their practices, as is done by the Royal Australasian College of Physicians in its clinical audit program,3 would be more productive and cost-effective than wholesale assessment of all practising doctors.