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NOT CRICKET

By Blair Smith
Contact the author by e-mail at christopher.johnstone@ntlworld.com

Good Medical Practice is now the accepted standard by which we practise, and will be that alongside which we will be judged, come the big Revalidation. It describes moral and professional codes which have Hippocratic origins and which are now beyond the sphere of debate. However, it consists largely of generalities, and is inadequate for guiding many aspects of our daily practice. The GMC have therefore been seeking a more detailed list of criteria with which to regulate us. They were struggling to identify such a list until a member of the Council happened upon the very model required, during a visit to the hallowed cricketing corridors of Lords, where the MCC resides. Contrary to your probable interpretation, I refer on this occasion, not to Methlick Cricket Club (undefeated winners of Aberdeenshire 4th Grade, 2003, and inhabitants of Lairds1), but the Marylebone Cricket Club, which “owns” the Laws of cricket, and pronounces judgement on any matters arising from these.

The GMC has much to learn from the MCC. The Laws of Cricket are ancient, complex and comprehensive, have evolved over several centuries, and are steeped in the oaky, leathery and willowy traditions of British society such that their validity cannot be questioned. Much like the GMC. They (the Laws, not the GMC) cover forty-five pages and almost every conceivable eventuality, such as pigeons obstructing the ball (a no-ball) or a fielder’s detached helmet doing the same (five extra runs). This level of detail is attractive to the GMC, and can be transferred to medical practice. However, the rule for which cricket is most famous, is also one of the longest in the Laws – Law 42: being unfair. This embraces sixteen sub-headings and every member of the cricket team. The concept of official unfairness is an excellent one, to be upheld vigorously, and one with which we can all, from the age of three, sympathise. It is against the Laws, and therefore punishable, to be unfair. In medicine we all suffer from (and some of us indulge in) unfair practices, but in the face of these, must display stiff, cricketing upper lips, as the professional alternative to tantric rants in the waiting room. ("It's not fair!"). It is my fervent hope, therefore, that a similar unfairness regulation will be written into the new GMC Laws of Medical Practice, governing everyone from consultant to patient. Here is an extract from my submission.

The Laws of Medical Practice

Law 42. Unfair Practice

42.1 Patients.
It is unfair for a patient to present more than three complaints during a single consultation. Any patient doing so shall be dealt with sarcastically, and shall be told that each complaint is caused by “a virus”. It is unfair for a patient to exaggerate symptom severity in order to gain an emergency appointment or house-call. Any patient doing so shall be officially doubted on the occasion of his or her next symptom(s), and given a telephone diagnosis of “viral infection”. It is, however, fair for a patient to a doctor's knowledge into question with the production of a print-out from the worldwide web, so long as this (a) is no more than four pages long, (b) did not originate in the USA, and (c) does not include the words "complementary", "traditional" or "holistic".

42.2 General Practitioners
It is unfair to run surgeries more than twenty minutes late, other than through genuine medical emergency. GPs who deliberately delay beyond this time shall not expect normal biopsychosocial communication with ensuing patients. Furthermore Law 42.1(a) shall be invalid. It is unfair for GPs to exaggerate symptom severity, or to invent clinical signs in order to gain an emergency admission for a patient. Any SHO who suspects such conduct shall be entitled to write a sarcastic diagnosis on the subsequent discharge letter (eg "obviously gastroenteritis"), and the GP shall conduct future surgeries in a horsehair shirt. It is, however, fair for a GP to write to a consultant to request an earlier out-patient appointment than the one issued, provided that (a) the original appointment is no sooner than nine months hence, (b) the consultant is neither a dermatologist nor a neurologist, and (c) the patient is of social class II (lesser professionals) or higher.

42.3 Hospital Consultants It is unfair to tell patients to attend their GP for a discussion of any letter arising from a hospital visit within a period of less than six weeks after the visit. Any consultant thus underestimating this visit-to-letter interval shall be telephoned by the GP at any time of day and shall provide a full oral description of the potential letter's contents. It is unfair for a consultant to create the impression of being cleverer than GPs, for example by the wearing of bow-ties, the use of obscure TLAs (three-letter abbreviations) or the deliberate reading of textbooks. Any consultant found to be behaving in such a manner shall be liable for a round of claret at the next medical society dinner, or, failing this, shall be called upon to demonstrate his or her superior intellect by quoting Galen. It is, however, fair for a consultant to discharge patients from hospital when he or she feels they require no further in-patient treatment, provided that the patient has (a) awoken from anaesthetic, (b) an expected arrival home time of no later than 2300 next Friday, and (c) not died.

42.4 Practice Managers, Receptionists and Secretaries It is absolutely fair for any practice manager, receptionist or secretary to do, or say anything that he or she chooses. However, it is unfair of them to accuse a GP of being grumpy, particularly if they are, themselves, grumpy.
No rule 42.4(b)

Reference
1. Smith BH. Harbingers of summer. Hoolet 2003 37 13

Other hoolet online articles by Blair Smith can be found at:
hoolet edition 49 - Ethics and Repression in the Bloo Toon
hoolet edition 48 - May The Best Team Win
hoolet edition 47 - Hunting Pink Elephants
hoolet edition 46 - Predictive Texting
hoolet edition 45 - Role Models
hoolet edition 44 - Time To Go Killorglin'
hoolet edition 43 - Salt and Shake
hoolet edition 42 - Stepping up the Pace of Life
hoolet edition 41 - Smoking out the Irish Question
hoolet edition 40 - Not Cricket
hoolet edition 39 - Anniversaries and Predictions
hoolet edition 38 - Is There Life on Mars?
hoolet edition 36 - Onwards and Upwards
hoolet edition 35 - Goal of the Season‘s Greetings
hoolet edition 34 - Chickens and Eggs
hoolet edition 33 - On Shifting Goalposts
hoolet edition 32 - Period Zero
hoolet edition 30 - Annual Appraisal
hoolet edition 29 - Working Towards Scotland's Healthier Children For Us All 2020 and A Framework for Maternity Services in Scotland
hoolet edition 28 - In Memoriam Admiral Byng. A cautionary Tale