GMC Conference workshop: Professionalism post Francis and Berwick
GMC Conference workshop: The role of complaints in professionalism
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Our first annual conference in Manchester brought together doctors, medical students and patient groups to consider and debate the challenges affecting medical professionalism in the 21st century. This workshop explored the type of complaints the GMC receives and the challenges we face in dealing with those.
Transcript of GMC Conference workshop: The role of complaints in professionalism
Objectives for this session
Your views on the type of complaints we
receive and the challenges we face in
dealing with those.
What we do
The GMC aims to:
Protect not punish
Maintain confidence in
doctors
Manage the mismatch
of expectation from
doctors and the public
How we do it
Advice to doctors – principles
not rules.
Take action where a doctors
standards are seriously below
– what behaviour will lead to
action?
‘Professionalism’ in practice.
Complaints to the GMC
We will be looking at:
Source of complaints
What issues are
increasing in volume?
Source of complaints
What issues are increasing in volume?
Clinical care – allegations about inadequate assessment,
inappropriate prescribing, failure to diagnose and suitable
action not being taken.
Health issues - allegations about affective disorders, alcohol
abuse and neurosis.
Communication with patients - a steep rise over the past
five years in allegations about rudeness, failure to understand
needs and failure to take account of patients’ views.
Probity – allegations of false / misleading reporting remains
the biggest concern. A rise in financial deception and a big
spike in indecent behaviour in 2012.
Seriousness
Not serious
Obvious we should not take action, eg: doctor hasn’t prescribed specific medication patient wanted or doctor has parked across neighbour’s driveway.
Some concerns
We need to investigate and action may depend on the context - could include warnings, undertakings, conditions, short suspension – we will discuss this further.
Very serious
Obvious we should make a robust response such as longer suspension or removal from register, eg: sexual assault of a patient, doctor defrauds a vulnerable patient out of his life savings.
Majority of cases
Most complaints fall between the extremes
people have different views
context is important
important to understand what people
expect/what is likely to undermine confidence
implications for ‘professionalism’ now and in the
future
Example – Dr X
Doctor X, a talented physician training in acute
medicine, attends a friend’s birthday at a local
night club. He has just passed his MRCP exam and
is celebrating.
At 2.00 am he plays a drinking game that results
in his drinking 4 pints very quickly over the course
of 20 minutes.
At 3.00 am he is offered a ‘joint’ which he smokes.
He is approached by a bouncer and evicted from
the club.
Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Example – Dr X continued
On his way to the station Dr X is approached by a
prostitute.
Although he has never done this before he agrees
to go with her.
As he follows her she pulls out a police badge and
books him for soliciting. He is cautioned and
allowed to go home.
Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Example – Dr X continued
He falls asleep on the train and his ticket is
checked by an inspector at the end of the line.
He is issued with an on the spot fine for travelling
without a valid ticket.
Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Example – Dr X continued
Dr X believed that he was on a late shift the
following day.
When he gets home at 6.00 am there is a
message on his phone from a colleague about
their 8.00 am shift.
He decides there is no point going to sleep so logs
onto Twitter and gets involved in a discussion
during which he posts a homophobic comment.
Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Example – Dr X continued
On his way to work he notices his breath smells of
alcohol and buys some mints.
His first patient is a girl that was at the party the
night before and who he was interested in but
became too drunk to approach.
Before she leaves he asks for her number.
Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Example – Dr X continued
On the ward he sets up an insulin infusion for a
diabetic patient. He feels nauseous so finishes
quickly and rushes to the bathroom.
An hour later the patient dies and it emerges Dr X
had set the insulin rate at 40 ml per hour instead
of 4ml.
Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Our role
Our role is to protect patients and maintain
confidence in profession
What does this mean?
Ensuring doctor is safe to treat patients in the
future
Not punishment or discipline for past concerns
But past conduct must not have fundamentally
undermined trust of the public
Scenario 1
Dr Blue is a young doctor who has recently registered with the
GMC.
He is part of a Facebook group for young doctors and in recent
months has become obsessed by a GP who is very active in
group discussions.
From a comment she made in a forum he thinks she might be
based in the catchment area for the hospital where he works.
The next day at work, when the medical records manager has
gone to the bathroom, he searches her name on the hospital
database, finds her details from previous treatment for an
injury, and makes a note of her phone number.
Scenario 1 - vote
How seriously do you think the GMC should
view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 1 – part 2
He makes an approach to her on Facebook.
When she doesn’t respond he sends her a text saying ‘Why
didn’t you answer my Facebook message? We have so much in
common. I would really like to get to know you better.’
She responds ‘where did you get my phone number?’ and when
he replies she complains to the GMC.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 2
Mrs Red has been diagnosed with cancer.
Her treating doctor, Doctor Green, tells her that he has developed
a ‘tonic’ that helps people in her situation and gives the patient a
bottle.
The tonic is made up of a combination of vitamin supplements.
Mrs Red takes the tonic and stops attending her chemotherapy
sessions.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 2 – part 2
You later learn that Doctor Green has charged Mrs Red £40 for
the bottle of tonic and that Doctor Green sells this through a
website on which she describes it as a cure for cancer.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 3
Doctor Brown is cautioned for possession of an ecstasy tablet
as a result of a search as he entered Glastonbury festival.
He has just completed medical school and has recently
registered with the GMC. He notifies the GMC of the caution.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 3 – part 2
Consider alternatively Mr Orange, a medical school graduate,
who applies for GMC registration and declares a caution he
received when he was seventeen for possession of an ecstasy
tablet in a night club?
VoteHow serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious
Scenario 4
Doctor Grey has witnessed a colleague issuing prescriptions for
controlled drugs on a number of occasions without seeing the
patient.
The colleague is an old friend, they started medical school
together. Doctor Grey mentions his concerns to his colleague
several times but the colleague laughs it off and tells him not to
be so uptight.
He is reluctant to get his friend into serious trouble so doesn’t
mention this to anybody.
Scenario 4 - vote
How seriously do you think the GMC should
view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 4 – part 2
One of the patients has a contraindication to one of the
prescribed drugs and suffers a serious reaction so Doctor Grey
mentions it to the Medical Director.
The Medical Director is busy with an annual review and takes
no action.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 5
Doctor Silver has recently arrived in the UK from overseas.
Where he comes from doctors are expected to speak to the
whole family about a patient’s care and do not need to obtain
patient consent to do so.
On his second day in his new job he speaks to a patient’s
daughter about the patient’s condition without getting her
consent to do so.
The patient complains.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 5 – part 2
What if he had been six months in the role when this happened?
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 6
Dr Gold, an orthopaedic surgeon carries out seriously deficient
hip replacements over several years.
20 patients have permanently lost mobility as a result of the
procedures.
In response to an investigation by the hospital that he works
for, Doctor Gold refuses to accept that there is any problem
with his performance.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 6 – part 2
The hospital raises their concerns with the GMC.
During the GMC investigation Dr Gold’s lawyers submit
evidence that the doctor has recently retrained in hip
replacements and has remediated any concerns.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 7
Mrs White attends her GP, Dr Black, with constipation.
Mrs White completed a questionnaire in the waiting room and
said she had blood in her stools.
She handed the questionnaire to Dr Black, but was
embarrassed to mention it again in the consultation.
Dr Black didn’t read the questionnaire and prescribed laxatives
without carrying out any further examination.
Scenario 7: vote
How seriously do you think the GMC should
view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 7 – part 2
Mrs White returns on two further occasions.
On the third occasion she refers to the questionnaire and the
bleeding.
At this point Dr Black sends her for tests and advanced bowel
cancer is diagnosed.
A GMC expert says that the cancer was aggressive and if tests
had been carried out earlier it wouldn’t have made any
difference to the outcome.
Scenario 7 – part 2: vote
How seriously do you think the GMC should
view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 8
An elderly patient is admitted to the ward with a fever, bad
cough, pain in left side of chest and leg pain.
Dr Stone sees the patient has a history of COPD (chest
problems) and orders an Xray which only shows changes
consistent with COPD but no other signs.
Doctor Stone treats the patient for a lower level respiratory
tract infection.
The family complains the doctor hasn’t considered all the
possible causes because of her age.
Scenario 8 - vote
How seriously do you think the GMC should
view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Scenario 8 – part 2
The symptoms don’t improve and 3 days after admission the
patient dies suddenly from a pulmonary embolism.
The autopsy also reveals deep vein thrombosis.
VoteHow seriously do you think the GMC should view any concerns?
1. Not serious
2. Some concerns
3. Very serious
Lunch and exhibitionUpper foyer and Exchange hall
