A higher standard

WHETHER we are on duty or making the most of our free time, doctors are expected to act in a professional way.

It is fair to say that we are never really off duty and the way we behave is held up to closer scrutiny than members of the general public. Indeed, failure to act in an appropriate way can have serious consequences for our careers.

Consider the following scenario:

It was not a serious incident really. We were celebrating passing the CSA and as it was a warm sunny night we had taken a few beers to the park. Unfortunately there was a rather unruly crowd nearby and some of us were caught up in the ensuing melee. The police came and I was charged with breach of the peace alongside some of my friends. Rather than go to court, and to avoid any hassle, I accepted a higher-tier fixed penalty notice and thought that would be the end of the matter. I was shocked to receive a letter from the General Medical Council stating that they had received information about me which may call my fitness to practise into question. It said they had reason to believe my conduct may have brought the profession into disrepute and my registration may therefore be at risk. My heart turned cold. I was at the start of my career – could it be over so soon?

A matter of trust

Some may wonder exactly why it should matter to the GMC if a doctor is given a fixed penalty notice at the higher tier. And why is it that doctors are subject to higher expectations of behaviour than the general population?

The GMC’s 2013 guidance Good Medical Practice goes some way to explaining this when it states: “You must make sure that your conduct justifies your patients’ trust in you and the public’s trust in the profession.”

The need for patient trust is quite straightforward. Doctors are allowed to access sensitive personal information, they perform intimate examinations and do at times hold the power of life and death in their hands.

With such privilege comes responsibility and the incumbent duty to be a good doctor. The GMC defines this as someone who makes “the care of their patients their first concern, they are competent, keep their knowledge and skills up to date …and act with integrity and within the law.”

In the above scenario the GP trainee has clearly fallen on the wrong side of the law and her behaviour could jeopardise the trust patients have in her as an individual. But equally importantly, and what many young doctors fail to understand, is that the actions of an individual may also serve to undermine the public’s trust in the medical profession as a whole.

The GMC as regulator has three main roles: to maintain the register; to protect patients; and to protect the reputation of the profession.

Professionalism in action

A 2005 report by the Royal College of Physicians, Doctors in Society: Medical Professionalism in a Changing World, defined medical professionalism as: “A set of values, behaviours, and relationships that underpins the trust the public has in doctors.”

As a doctor you are not just part of society you are a member of the profession of medicine. A doctor does not hang up her stethoscope at the end of a shift and go home a member of the general public. Whether at work or at home, on social media or at the gym, at the conference or at the pub, doctors at all times wear the mantle of the profession with all the duties and responsibilities that brings.

These professional duties are described in detail in Good Medical Practice which states clearly that: “Patients must be able to trust doctors with their lives and health. To justify that trust you must show respect for human life and make sure your practice meets the standards expected of you.” These standards are divided into four “domains”, covering: knowledge, skills and performance; safety and quality; communication, partnership and teamwork; and maintaining trust. It is this fourth domain that is most relevant here, with its three main points:

• Be honest and open and act with integrity

• Never discriminate unfairly against patients or colleagues

• Never abuse your patients’ trust in you or the public’s trust in the profession.

The guidance goes on to inform doctors that they are personally accountable for their professional practice and they must always be prepared to justify their decisions and actions. It adds: “To maintain your licence to practise, you must demonstrate, through the revalidation process, that you work in line with the principles and values set out in this guidance. Serious or persistent failure to follow this guidance will put your registration at risk.”

Reporting criminal matters

So what about our trainee with the letter from the GMC? The reason she is in trouble is not only for the offence she has admitted to committing but also because she has failed to inform the GMC of the charge as per the guidance in Good Medical Practice at paragraph 75 which says: “You must tell us without delay if anywhere in the world:

• You have accepted a caution from the police or been criticised by an official inquiry

• You have been charged with or found guilty of a criminal offence.”

The GMC’s supplementary guidance Reporting criminal and regulatory proceedings within and outside the UK provides further detailed information on what must be reported to the GMC. The trainees’ failure to inform the GMC at the time has resulted in an investigation into her probity. It is alleged that she acted dishonestly and tried to hide the matter from the regulator in addition to the investigation into her disorderly conduct. Fortunately the trainee contacted a medical adviser at MDDUS who was able to provide advice on how to respond to the GMC.

The GMC concluded the case by issuing her with a warning over her conduct which was to be published publicly on the regulator’s website for five years. It is likely that if she had reported the charge to the GMC at the time the case may have been resolved with a simple letter of advice.

If you are in any doubt as to whether you ought to report a matter to the GMC please do pick up the phone and either myself or one of my colleagues will be very happy to advise you.

Dr Susan Gibson-Smith is a medical adviser at MDDUS