Tuesday, July 27, 2021
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Some very peculiar practices

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HAVING had recent cause to examine the General Medical Council’s (GMC) Fitness to Practise Register – it is a public document – I thought I would share some of its contents.   

The GMC keeps a register of those legally authorised to practise medicine in the UK, currently 338,327.

The GMC ‘fitness to practise’ statement states: ‘To practise safely, doctors must be competent in what they do. They must establish and maintain effective relationships with patients, respect patients’ autonomy and act responsibly . . . But these attributes, while essential, are not enough. Doctors have a respected position in society and their work gives them privileged access to patients, some of whom may be very vulnerable. A doctor whose conduct has shown that they cannot justify the trust placed in them should not continue in . . . practice while that remains the case.’

Doctors who do not meet ‘professional or behavioural standards,’ or who are the subject of ‘serious’ patient complaints, can be investigated by the GMC. If found deficient, they can be disciplined, up to and including being struck off the register.

At the end of May, the register held details of 73 doctors who were formally disciplined in the previous 12 months – clearly a tiny proportion, but worth examining. Eight doctors committed to Undertakings – an agreement requiring them to comply with additional restrictions on their practice or to undertake specific retraining. Sixty-five were given Warnings, a much more serious measure, ‘intended to maintain professional values and prevent a repeat of the behaviour’.

Some of the doctors disciplined appear to be fairly newly qualified, but others were mature practitioners, consultants, and even some ‘specialist trainers’.

Fifty-three men were disciplined and 20 women. Forty-one (more than 56 per cent) of doctors disciplined received their primary medical qualification overseas.

Twenty-five doctors were guilty of driving while over the legal alcohol limit, several of them women. One was caught drinking on duty and another was ‘high’ during a shift. Seven were charged with unlawful possession of cocaine or cannabis.

One ‘drove a motor vehicle when the proportion of cannabis in his blood exceeded the specified limit’, while another repeatedly stole drugs from his ‘place of employment’. 

One individual was on their fourth ‘Undertaking’ to improve their practice and appears to have been on a ‘performance recovery plan’ for the past few years. Two more undertook to ‘improve their English,’ acknowledging that they did not have the ‘necessary knowledge of English for practising in the UK,’ which they had been doing for some years.

Twelve doctors had been found guilty of criminal offences, including theft, fraud, assault, stalking, ‘taking, and circulating unauthorised images of a naked and unconscious patient [by] uploading the photographs to their Facebook and Instagram account’. Two had carried out ‘unlawful’ surgical procedures.

A handful had breached ‘prescribing protocols’, one having prescribed a ‘meditation chant’ for an ill patient and another had given out scripts for nine courses of hydroxychloroquine while failing to ‘discuss the indication for the medication and any potential side effects’ or whether the recipients understood the risks involved in taking hydroxychloroquine in an ‘off-licence manner’.

The worst offenders were disciplined over failures in their clinical care, ‘poor relationships with patients and colleagues,’ and lapses in practice. One was described as causing ‘unnecessary pain and injury,’ and another was implicated in a child’s death. None of the 73 doctors was struck off.    

Oddly, the GMC register has little to say about the prevalence of ‘more minor,’ but no less invidious behaviours that patients experience in their interactions with doctors. Patients are subject to rudeness, condescension, indifference, sexism, poor communication, shoddy administration, and a lack of respect or empathy: behaviours that are not only unprofessional, but also cruel, given the unequal balance of power between patient and doctor.

Researchers have suggested that few people ever complain about these behaviours or defects in their medical treatment for fear of reprisal or simply because they think it unlikely to make any difference.

The GMC is also silent on the ethical breaches that have occurred during Covid-19. It is blind to doctors withdrawing diagnoses and treatments from thousands during the ‘pandemic’. Nor does it speak to doctors’ culpability in promoting and facilitating patient involvement in experimental medicines without their full consent and knowledge of the risks of harm, and without disclosing that they have a pecuniary interest in delivering jabs.  

A long time ago, in a pre-Covid world, Dame Clare Gerada, then Director of the NHS Practitioner Health Programme, warned that the wellbeing and mental health of physicians in the UK was deteriorating. She believed this was because they were having to survive in a ‘a sick system’

In the British Medical Journal, she wrote, ‘I believe that something is profoundly wrong with the NHS. The health service’s prevailing culture is fear, even though its staff are meant to espouse kindness and compassion. [It] is a place where staff feel attacked, unloved, and abandoned by their political and managerial leaders.’

You might consider that we are grown over-reliant on medical professionals and that our expectations of them are unrealistic. Doctors in Distress, a charity set up by Gerada to offer non-judgemental support to doctors, reports that even before Covid, they were between three and five times more likely to take their own lives than other people.

Perhaps the GMC disciplinary register shows little more than a few bad apples, or maybe it reveals symptoms of a much deeper malaise.

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Kate Dunlop
Kate Dunlop is a mediator.

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