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Following, not leading

01 September 2007

In the UK, there are two cremation forms – form B is completed by the “ordinary medical attendant”, form C by an independent doctor. On this occasion, Dr T completed form B, and Dr A, a specialist registrar in trauma and orthopaedic surgery, completed form C.

Form C includes a question that asks if you have seen and questioned the doctor who completed form B. At the time the doctors in this particular hospital did not worry too much about this question. It was common practice in the hospital to tick the box without having questioned, or even spoken to, the doctor who had completed form B.

Accordingly, Dr A, without speaking to Dr T, simply ticked the box, signed form C and collected the small payment that resulted.

However, the medical referee at the local crematorium, Dr D, refused to accept the cremation form at face value. He called Dr A to check that he had indeed spoken to Dr T, and Dr A said that he had. Still not convinced, Dr D phoned Dr T himself, who told him that he had not heard from Dr A.

Dr D referred the matter to the hospital’s medical director, Dr S, who called Dr A to a meeting. At the meeting, although initially insisting this was a one-off, Dr A admitted that, along with other doctors at the hospital, he had routinely signed form C without speaking to the doctor who had signed form B. The case was referred to the GMC.

Medical council decision

The GMC’s fitness to practise panel hearing took place three years later. At the hearing, Dr A admitted that on more than a dozen occasions he had not talked to the doctor who had signed form B. The panel must decide on a case based on the criminal standard. In other words, they must be convinced “beyond reasonable doubt” that the doctor is guilty. The panel decided that in this case, Dr A’s behaviour had been dishonest, misleading and unprofessional.

The panel accepted that, at the hospital, the system for countersigning cremation certificates was not operating correctly because there were not enough senior doctors who were willing to take on this responsibility. However, they decided that this was no excuse for Dr A to follow an incorrect practice and he should have known that it was wrong.

In particular the panel referred to the paragraph in the GMC’s Good Medical Practice on writing reports and signing documents: “You must be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents… you must do your best to make sure that any documents you write or sign are not false or misleading. This means that you must take reasonable steps to verify the information in the documents, and that you must not deliberately leave out relevant information.”

The GMC made a finding of professional misconduct, and suspended him from the medical register for three months. The panel also expressed concern that the Home Office advice to doctors on completing cremation forms, issued in 2004, was not in accordance with the statutory requirements of the Cremation Acts.

Further information

In the UK, the issue of completing cremation forms correctly was highlighted by the Shipman case and updated guidance was published shortly afterwards. For more on cremation forms, see Salmon R, Filling in Cremation Forms, UK Casebook15(1):9 (2007). The Department for Constitutional Affairs has published guidance on completing cremation forms, which can be found at: www.justice.gov.uk.

Learning points

  • MPS regularly helps doctors who have not completed paperwork correctly and have got into trouble as a result. Regulatory bodies everywhere take very seriously any dishonesty or attempt to mislead. The GMC’s guidance on dishonesty is that “dishonesty, even where it does not result in direct harm to patients… is particularly serious because it undermines the trust the public place in the profession”. It is also important to remember that omissions can be as serious as misleading information.
  • It is always tempting to take shortcuts and save time. Where a culture has developed within an organisation that supports an incorrect shortcut it can be very difficult to go against the grain. However, where the accepted practice is wrong, and you follow it, you may well be the one held accountable, not the culture or the organisation.
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