Doctors, like everyone else, can make mistakes. I sometimes wonder what the general public thinks about this – what sort of investigations they think doctors should get, and what punishments would be appropriate. But should the process ever be so awful that the doctor being investigated commits suicide before the conclusion is reached?
The latest headline in the medical press is “The family of a doctor who took his own life while under investigation by the General Medical Council (GMC) has applied to appeal at the Supreme Court.”.1 The GMC is the body which deals with regulation of doctors’ behaviour, and it takes its duties very seriously; – its primary role must always be to protect the public.
In this case the GMC wrote to the doctor (a consultant anaesthetist) saying that it was investigating him following an allegation of sexual assault on a teenage girl while she was sedated. He denied the accusation and a police investigation dropped the case because of a lack of evidence. However the GMC continued to investigate, and the doctor took his own life shortly after. Now the question in court is over whether the regulator has a duty of care towards doctors it is investigating, and is being backed by the British Medical Association (BMA), (the Doctors trade union). Last month the Court of Appeal ruled that the General Medical Council does NOT have a duty of care when it is investigating. It is this ruling the family of the consultant anaesthetist is seeking permission to appeal, and it would mean that the law would have to be changed by the Government.
So should the GMC have a duty of care to those it is investigating?
Suicides and depression are very common in doctors under investigation. In one report there were 114 doctors that had died during 2005 and 2013 inclusive, and had an open and disclosed GMC case at the time of death. 2. The powers of the GMC to strike someone from the register mean that it has total power over the doctor’s livelihood, and the public shaming is huge. If the doctor was in fact guilty, and felt that suicide was the only way out, yes that might be very difficult to prevent. But suicide is extremely complex, and many other things may have have been going on which caused the doctor to despair, and prompt care and treatment could have prevented the suicide. The doctor could have been entirely innocent of the crime. Doctors go into medicine knowing that their conduct has to conform to the standards set by the GMC and certainly my generation were petrified by it. It often seemed to us to be interested more in its own standing than actually keeping up standards. In those days even an extra-marital affair could be punished severely, although fortunately times have changed.
When I was in General Practice, I was involved in the local system of investigating GP’s where a complaint was made by a patient. These complaints were only looked into if it was about the competence of the doctor and whether mistakes had been made. I worked as an unpaid advisor for the hearings, and had considerable experience of how they worked. I found that most patients who made a complaint about how they had been treated by the doctor or the surgery, were mainly concerned about making sure the error was noted and steps taken to prevent such a thing happening again, and most hearings were considered helpful by both doctor and patient. I did see several examples of patients just trying to get back at the doctor for supposed failings which did not stand up to scrutiny. And also there were times when lay members of the committee (who were in the majority) seemed me to really “have it in” for the doctors. But mostly it worked very well mistakes were acknowledged and sanctions imposed as necessary. This system was abolished in the nineties as it was thought that such complaints at a local level should really be resolved informally by the practice itself. Some rather litigious minded patients were very upset at the time, but the new system soon bedded in and patients were mostly satisfied. If not, the complaint could have been sent to the GMC. My feeling is that patients are much more concerned with whether a doctor was good at their job and could save their lives than the doctor’s sexual practices, say, if unrelated to the medical case. They wanted to know – Should the doctor have done better? Or were the circumstances of the case such that the doctor was doing as best they could under the circumstances? We doctors thought that this also should be true for the GMC.
There was a famous case 3,4, in 2018 where a young resident doctor, just back from maternity leave, failed to recognise that a young boy had sepsis, and not gastroenteritis as she thought. She nevertheless did all the right tests, but there was a glitch in the IT systems resulted in the crucial results being delayed; there was no backing from senior doctors, and there was a mix up on the ward when the patient was moved. The patient died. The resident doctor and two nurses were charged with gross negligence manslaughter in December 2014; . One of the nurses was convicted and later struck off. The doctor received a 2-year suspended prison sentence and the GMC then removed her from the Medical Registrar, which would end her career.
Ordinary doctors were appalled. It was clear that the unit was grossly understaffed, she had only just returned after pregnancy leave, and the senior doctors were not available immediately. It was made worse the by the fact that another organization – the Medical Practitioners Tribunal Service (MPTS) rejected the removal from the register, accepting her plea that the unit was under severe pressure and she had failed to receive senior support. Erasure was disproportionate, the MTPS said in June 2017, But the GMC removed her anyway. So there was a big campaign involving the BMA, and a lot of money was raised towards her legal fees, In 2018 the Court of Appeal ruled that she should be reinstated to the medical register, and later the Government passed a law saying that GMC should have its right to appeal fitness-to-practise decisions removed. They said there was “fundamental loss of confidence in the GMC”. It called on the GMC to make fundamental reforms to end what her supporters had called “a toxic culture of fear and individual blame in the health service” in place of the need “to learn from events and prevent future harm”. Subsequently the doctor passed all certifications and became a consultant paediatrician. She has had an unblemished career since.
As a result of cases like this, right now there is great interest in the profession as to whether the GMC really should have no “duty of care” to those it is investigating.
While I was practising I never had any dealing with the GMC, for which I was truly thankful, as some of my colleagues did. But on one occasion long after I had retired, I wrote a private prescription for myself, which they said was against the rules. The pharmacist I took the prescription to decided it was suspect (he did not recognise my signature) so phoned the GMC. They decided to open an enquiry. The prescription was for a week’s supply of amoxycillin for a recurrent infection, which cost about £7.00. The enquiry took 6 months at enormous expense ( two meetings and a legal opinion) and it found no case to answer, as a consultant had authorised the prescription to be written when the problem recurred. They did indeed tell me each time they wrote that they did appreciate that I might feel under stress because of this, as presumable they did to every doctor who took his own life. But it was couched in very dispassionate language, and did not offer any meaningful support, so no one would be likely to take them up on their offer. For me, as a retired doctor, there was no stress, only annoyance that such a tiny possible misdemeanour was investigated with the full force of its investigational powers.
So it is a valid question whether the GMC should have a duty of care to doctors, when the stakes for them are so high. Suicide is complex, and there may have been many other factors affected the doctor as well as the court case. Some young doctors may be insecure, in debt, young, and frightened. But the process is long drawn out, intrusive, and, as stated above, can completely destroy careers. There is a counter argument that the punishment of doctors should be sufficient to make sure that such an event would not happen again, and if some doctors were distressed enough to take their own life, so be it. Most doctors, and I hope, non-doctors, would not agree with that.
Nowadays doctors are advised (by other doctors) to remove themselves from the GMC list immediately they retire, as the GMC is so keen to take cases through their processes. I don’t suppose we will ever reach a situation when doctors never commit suicide when threatened with investigation, but I would like to think that that the GMC can be made truly accountable by having a legal duty of care to the doctors they are regulating.
References.
2. https://committees.parliament.uk/writtenevidence/56677/html
Elen Samuel, doctor and writer 