New Doctor Editor-in-Chief and Medicolegal Adviser Dr James Thorpe demonstrates why probity is paramount to the role of a foundation doctor.
The word ‘probity’ is derived from the Latin for good, honest and upright. The GMC expects a doctor to be all of those things, as well as fair, law-abiding and of general good character. Probity is central to the public trust placed in the medical profession and junior doctors should, through their actions, uphold this reputation. Here at Medical Protection, we frequently see cases arising from allegations calling a doctor’s probity into question. Although many of these result from clinical incidents, junior doctors are sometimes surprised by the interest that the GMC takes in their private lives. The following cases are fictional but based on real events. They demonstrate a number of areas where it is important to ensure that you are completely open and honest. As we will see, failure to do so can potentially have a significant impact on your career.
Case 1 - Cautions and convictions
Dr A was working in her FY2 year and was late for a night shift. Whilst driving to work, she was caught by a mobile police safety camera driving at 82mph in a 50mph zone. The police notified her that, due to the severity of the offence, they intended to prosecute rather than offer a fixed penalty notice. She attended court and was given six penalty points and a 30 day driving ban.
Dr A was unaware of the GMC’s requirement that all doctors must self-refer in the event of a criminal conviction. When she applied for her GP training scheme, she was notified that her enhanced disclosure check had flagged her conviction for speeding. Dr A was referred to the GMC.
Dr A was a Medical Protection member and contacted our medicolegal advice line. With our assistance, Dr A submitted a statement detailing the circumstances of the conviction. Her case was closed with a letter of advice from the GMC.
The GMC make clear in Good Medical Practice (2013) that doctors are expected to inform them if, anywhere in the world, they are charged with, convicted or accept a caution for a criminal offence. This usually does not include fixed penalty notices for speeding but does include driving offences which result in a court appearance. Any doctor who finds themselves in a position where they are concerned that they should self-refer should seek advice from Medical Protection.
Case 2 - Note keeping
Dr B was a FY2 doctor in a major teaching hospital. He was asked to review a post-operative patient on the surgical ward during a busy night shift. He reviewed and examined the patient but was called to see another sick patient and made only a brief entry in the patient’s case notes.
The patient deteriorated suddenly the following day and died. The FY2 doctor was approached to contribute to the Trust Serious Untoward Incident (SUI) Investigation. On reviewing the notes, he realised that they did not accurately reflect his assessment of the patient and he amended his entry in the records. He did not make it clear that these additional notes were written in retrospect. After being confronted by his consultant, he was reported to his educational supervisor and after an investigation, Dr B was referred to the GMC.
Dr B contacted Medical Protection and was assisted during the GMC investigation. The case was concluded with a warning.
The GMC will investigate any allegations relating to alleged dishonesty in your clinical work. Any retrospective entry made in a patient’s case notes should be clearly marked as such and the date and time when the entry was made clearly stated. Cases where notes have been changed have even resulted in doctors facing criminal charges for perverting the course of justice.
Case 3 - Student assessments
Dr C was working as a FY1 doctor in general medicine in a district general hospital. There were a number of final year medical students attached to the ward, many of whom he knew socially from his time at medical school. One student had been ill during their medical attachment and on the final day before rotating to surgery, approached Dr C and asked him to complete a number of compulsory assessments.
The other ward FY1 doctor was off sick and Dr C was extremely busy; despite not directly observing the student performing a respiratory or cardiovascular system examination, he completed and signed the assessments to say that the student’s clinical skills were appropriate.
The student and Dr C were reported to the medical school by a fellow FY1 doctor. After an investigation, Dr C was reported to his educational supervisor and subsequently to the GMC. Dr C contacted Medical Protection and was supported through the GMC investigation and Fitness to Practice (FTP) hearing. The sanction imposed by the FTP panel was a short period of suspension from the medical register.
It is important to remember that probity extends to the assessments you must complete during your training and to any assessments you complete for others. You must also be completely honest in any CV or job application that you submit.
Case 4 - Maintaining professional boundaries
Dr D was working in A&E as a FY2. He reviewed a 19-year-old female patient who had broken her ankle whilst playing sport. She was discharged but then contacted Dr D via Facebook having noted his name from his identity badge. She invited Dr D out for a drink which he accepted. Thereafter, they had a short sexual relationship. Dr D then ended the relationship and the patient complained to the GMC that Dr D had abused his position as a doctor.
Dr D initially denied having a sexual relationship with the patient and denied any wrongdoing in several investigatory meetings. During the subsequent GMC investigation, text and social media messages were recovered which demonstrated that Dr D had lied during the initial stages of the investigation. This was considered an exacerbating factor and Dr D was suspended from the medical register for one year.
The GMC make it clear in Good Medical Practice (2013) that you must not use your professional position to pursue a sexual or improper emotional relationship with a patient or someone close to them. Further guidance on this issue is available through the GMC supplementary guidance Maintaining a professional boundary between you and your patient. In this case, the outcome for Dr D’s lack of probity was considered a significant exacerbating factor by the GMC.