Recertification that leaves you certifiable

I'm a GP (Toronto, class of '82) who's been practising family medicine with obstetrics, and now emergency, for the past 20 years. I also teach family practice residents (you'll understand the irony of this later) at our local hospital in Orangeville, ON.

I've always been very conscientious about CME. In 2002, I decided to obtain my CCFP, in order to broaden my future salaried job opportunities when the time comes to slow down. I was required to take an online course in evidence-based medicine, which cost me $900; the course was excellent and I passed. I then took the CCFP exams. I passed the written portion, but unfortunately I didn't pass the oral exams, which were made up solely of patient encounters � interviews but no physical examinations.

I was told that I didn't follow the precepts of "family centred patient care," and that I was "too directive" in my patient encounters. This came as a surprise since after 20 years in practice, with too many patients in my care, I consider myself an expert in determining what the patient needs from me (diagnosis, relief from symptoms, reassurance or a note for work) and providing it within a minimum time period.

A literature search on Medline for "family centred patient care" brought up six pages of nursing, social work, psychology, etc, journal references. As far as I can gather, it's a nursing philosophy adopted by the Ontario College of Family Physicians (and other colleges, I assume) and taught only to family practice residents. This is undoubtedly part of the College's efforts to identify family medicine as a specialized 'discipline.' Courses in family centred patient care for doctors aren't offered by the College, and the education director didn't know (or care) how I might obtain training in this 'discipline.'

I suspect the real reason they don't make a course in family centred patient care mandatory is that it would ruin their failure rate. I also suspect that the large majority of failures are confined to people who, like me, will still be able to practise medicine without their CCFP. In other words, I feel I was set up as a political scapegoat.

As a result, I no longer trust the College of Family Physicians to decide on my competence. I think it's time for a church-and-state style separation for recertifying bodies and colleges, with adherence to the following principles: 1) the authority responsible for the recertification must have no other function; 2) the authority must be independent from all other bodies of authority; 3) the body of knowledge required to recertify must be determined by the group being recertified; 4) that body of knowledge must be updated every year, on the basis of accepted practice and evidence-based medicine; 5) there must be no other use for the recertification.

� Dr Barbara Watts, Orangeville, ON

Note: A version of Dr Watts' statement was also sent to the Ontario College of Family Physicians and the College of Physicians and Surgeons of Ontario, Quality Assurance Committee.