Actually, we don’t know what we don’t know

3 minute read

I'm curious and open-minded about PLAN, but I also have some questions, writes Dr Kerri Parnell


As a comment piece in the NEJM said last week, “in order to provide the best possible care for their patients, most physicians devote considerable effort to staying current on developments in their field”.

But while exciting, keeping up with new developments in medicine can be challenging, especially for generalists.

As well, the ground under our feet keeps shifting, as basic foundation knowledge evolves. With so much to stay abreast of, theoretically and procedurally, how do we, as individuals, know we’re succeeding?

This is no doubt the question on the lips of those tasked with ensuring GPs are practicing safely and providing high-quality care.

Without going too Donald Rumsfeld on you, the new RACGP PLAN self-reflection process seems simply about turning “unknown unknowns” into “known unknowns”, then “known knowns”. In theory, surely no one could argue this is not a good thing.

As it turns out, unfortunately, our ability to accurately self-assess is limited. One systematic review measured this by comparing physicians’ assessment of their own competence with observations by others. In around two-thirds of cases, there was little, no, or an inverse relationship between the physicians’ self-assessment and external assessment of their competence. Studies have found self-assessment poorest among doctors who were the least skilled, as well as those who were most confident.

For my part, I’m curious and open-minded about PLAN. Leaving aside member complaints about a lack of meaningful consultation, for me it’s hard to be too critical about something I haven’t even seen yet.

But I do have questions. How will success of the activity be measured? What does success look like? And how can we be sure there won’t be function creep over subsequent triennia? It wouldn’t be the first time a well-intentioned program ended up a decade later with GPs up to their necks in paperwork with an ever-increasing number of hurdles to jump.

In tricky negotiations, the wisdom is they’ll fail unless all parties can at least agree on a common goal. I think we have that here. GPs want to provide their patients with the best possible care, as does the RACGP.

But the ball is in its court, and top-down initiatives often fail. Whether PLAN is a success will depend primarily on flexibility on the part of the College, respect for and a willingness to listen to its members, plus transparency about measures of success.

Doggedness, alone, will not do.

Dr Kerri Parnell is the Editor-in-Chief of  The Medical Republic.

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