Reducing stress for doctors undergoing an investigation

At the end of 2015, Professor Louis Appleby was appointed by the GMC as an independent expert to help identify what changes could be made to improve GMC investigation procedures to help reduce the stress and impact they can have on doctors – particularly those with health concerns.

When the GMC asked me to examine its fitness to practise procedures following a report into suicides by doctors under investigation [PDF], it was the return of an issue that has been with me throughout my career.

When I was a junior doctor, someone who graduated with me from medical school took his own life after a fatal medical error. As a new consultant in psychiatry, based in a university, I found distressed doctors being referred to me because they did not want to be seen in the NHS, out of shame and fear for their careers.

Doctors are high-achieving and perfectionist. We work in a culture where it is hard to admit failure or ask for help.

During my time as national director for mental health a young psychiatrist killed herself and her baby. The inquiry report [PDF] highlighted gaps in the community care she received, not despite the fact she was a doctor but because she was a doctor. I met her husband – he started the meeting by placing a photo of his wife and child on the table beside us, an unforgettable statement about lives needlessly lost.

Future fitness to practise, not punishment for the past

Not one of the country’s 150,000 doctors came into medicine with the aim of harming patients, abusing colleagues or damaging public confidence in the profession. So when it happens, something has changed and any investigation should look for what has gone wrong and how it could be put right. At the heart of the GMC’s role is fitness to practise in the future, not punishment for past mistakes.

GMC's fitness to practise process map for health concerns, December 2014

The GMC’s fitness to practise process for dealing with health concerns (Doctors who commit suicide while under GMC fitness to practise investigation, December 2014, page 27)

Doctors are high-achieving and perfectionist. We work in a culture where it is hard to admit failure or ask for help. We work long hours, lose our work-life balance and cope with stress through anger or alcohol. Recently, hardly a week passes without reports of doctors feeling the pressure or planning to retire or emigrate.

Any investigation should look for what has gone wrong and how it could be put right.

It is into this stressful cocktail that the GMC steps – 2,750 investigations were launched in 2014. In the last few weeks doctors have written to me about the distress an investigation can cause – the tone of correspondence, the delays, the sense of being guilty until proven innocent. For some it may be the last straw: 28 doctors with an open GMC case died by suicide in 2005-13 [PDF].

Graph shows complaints received and investigations by the GMC during 2010-14

Complaints received and investigations by the GMC during 2010-14 (The state of medical education and practice in the UK 2015, chapter 2, page 59)

Doing more to support doctors

The GMC has recognised the problem and is committed to doing more to support doctors who may be vulnerable or at risk, to make the process more compassionate – though its over-riding remit remains the protection of patients. I will look at how mental ill-health is identified, how decisions are made, how letters are worded, how ‘difficult’ behaviour is interpreted. I will explore whether the system could be more consensual and whether all those investigations are needed: only 18% end with a warning or sanction.

Graph shows outcomes of investigated cases closed during 2010-14

Outcomes of investigated cases closed during 2010-14 (The state of medical education and practice in the UK 2015, chapter 2, page 63)

It is not only those with explicit mental illness who are at risk: a common feature of suicide is that risk has gone unrecognised. Suicide can occur when problems both in and outside the workplace mount up or when a person feels trapped, humiliated or angry over unjust treatment. Suicide is rarely caused by one thing but when a GMC investigation plays a part, it is a high price to pay for public accountability.

Over the coming months I will oversee a GMC review to revise its way of working and proposals will be put forward in April to make these needless tragedies less likely.

If you’d like to contact Professor Appleby about this review, please write to him at louis.appleby@manchester.ac.uk

Headshot of Professor Louis Appleby

Louis Appleby is Professor of Psychiatry at the University of Manchester where he leads a group of more than 30 researchers at the Centre for Mental Health and Safety.

 

Related posts

Anthony Omo, the GMC’s Director of Fitness to Practise and General Counsel, writes about our work to improve investigations for doctors and patients

Anna Rowland, Assistant Director of Fitness to Practise Policy at the GMC, outlines changes to the way we communicate to better support doctors during FTP processes

Anthony Omo talks about our response to the Hooper Review and the support available for whistleblowers

9 responses to “Reducing stress for doctors undergoing an investigation

  1. I am glad GMC is doing this work . I went through an extremely stressful time when a patient complained against me.Unfotunately the expert examiner for some reason wrote a very unfair and in fact ” cruel” report against me and the case went to the case examiners but fortunately they were sensible and the case was dropped without any warning/ further action. I later came to know from the MDU solicitor that this particular GP who gave the expert opinion in my case was ” sacked” by GMC as they realised his reports on doctors were not fair . I have felt very angry at GMC for choosing such experts who can be unfair and unreasonable and play with doctors’ life and career. I feel GMC is very supportive of patients but not of it’s own doctors!

  2. I am not sure of where this would lead too however i hope it may lead to some positive results for doctors. I am a doctor trained in psychiatry currently the GMC have set certain limitations on my registration due to certain situations which is disabling me to return to work even though i want to retrain a rectify my mistake nobody is employing me as they find that they are not able to support me. i am at a loss of what to do.
    i feel that the GMC is not hearing about my difficulty in seeking employment and return to work

  3. I am so pleased to see Prof Louis Appleby has been appointed to this important work by the GMC. I can not imagine anyone better than him to do this job. NHS is a great Institution and each year 360 million patients are seen by 1.3 Million staff. Most patients get the best care. However sad reality is that each year 20,000 patients die and 55,,000 patients suffer moderate to sever harm due to medical errors and nearly 85% of them are preventable.

    Each year nearly 12,000 doctors are referred to GMC and each year GMC investigates nearly 2000 good doctors, sometimes it takes more than a year only to say ‘there is no case to answer’. Many of these doctors are scared, frightened, stressed and they and their families suffer.

    Doctors are simply human beings and will make mistakes. Important is to have robust systems and processes to prevent harm to patients. Most doctors need help, support and guidance and not naming, blaming, shaming or discipline and humiliation.

    Sadly GMC is only the tip of iceberg and most suffering of doctors take place at local Trust and CCG level where there is a culture of naming, shaming and blaming or ignoring problems for a long time. NHS tolerates poor behaviour and poor care for too long. If only NHS has a system of dealing with doctors at early stages many tragedies for patients and for doctors can be prevented.

    Hope we create a culture of caring, kindness and compassion but also courage to make sure patients are protected and doctors are supported. So that many of these human tragedies are prevented

  4. The investigation have to be comprehensive. As the individual doctors are being dragged by mighty GMC into a quagmire, it is the resposibility of the GMC to conclude investigations in timely manner.

    It beggars belief that the doctors have to endure eighteen months of investigation, during which they have to attend upto six Interim panels.

    The IOPs can decide on the doctor on the basis of flimsiest concerns. For instance they do not need to uphold ANY wrongdoing on the part of the doctor accused. They simply need to read all the correspondence received and decide to sanction the doctor including suspending the doctor.

    Of course the doctors are traumatised.

    At the end of eighteen months, the GMC offers ‘Undertakings’.
    The defence organisations, GMC make offer which cannot be refused by the doctor. The doctor will be ‘coerced’ into signing their career death warrant.

    Of course doctors are vulnerable.

    The doctors with health problems face insurmountable obstacles in this process.

    They are being asked to attend GMC appointed Psychiatrists, called as Medical examiners. These Psychiatrists are trained by the GMC.
    Using Psychiatry to medicalise and then traumatise and stigmatise the members of the profession is open to enquiry, I guess.

    The same examiners also act as medical supervisors for the ‘mentally ill doctors’. What do they do in the process of supervision is of variable quality. For this work, they are paid handsomely by the GMC.

    And the process of ‘Undertakings’ and ‘Conditions’ by the GMC IOP, FTP, Undertakings, etc destroy the livelihood of the doctors .

    This leads to financial ruin, loss of morale, loss of relationships, both social and family.

    During this half decade of intense scrutiny, if any one is not mad to start with, they will be by the end.

    Thanks for the review.

    Hope you will address atleast one problems. As there are too many to handle at the moment in the current system of functioning.

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