Honesty and integrity are central to probity and define how any professional person should act: being upstanding and law-abiding, and respectful of the trust placed in you by others. This is vital in healthcare as trust is the fulcrum on which the doctor–patient relationship is balanced. Patients confide in you a great deal of personal and private information, exposing a degree of intimate information usually only reserved for those close to them, such as family. A good consultation is an open one and this requires a patient’s complete and justified faith in your professionalism.
Your duty to be honest and open covers all aspects of your professional practice. This includes:
- Writing your CV
- Preparing medical reports
- Record-keeping – medical records should be contemporaneous and not retrospectively altered in the event of a complaint or claim
- Any other documents or forms you are asked to sign or complete – they must be comprehensive and include all relevant information
- Giving evidence or acting as a witness – as well as being truthful when giving a spoken or written statement, you must be honest about the limitations of your knowledge and competence
- Co-operating fully with any complaint or investigation related to your treatment of patients, including disclosing any relevant information with appropriate consent
- Assisting the coroner or procurator fiscal with inquests or inquiries into a patient’s death.
"Honesty and integrity are central to probity and define how any professional person should act"
Research is another area of clinical work that you may become involved in. It is essential in improving the standard of healthcare and for exploring new possibilities, ensuring clinical care continues to develop now and in the future. In recognition of its importance, the GMC has produced supplementary guidance on the good practice principles of working in research: Good practice in research and Consent to research (2010).
Avoiding conflicts of interests is another important aspect of probity and can be complex, and even innocently committed. Any financial interests or commitments you may have in a healthcare, pharmaceutical or biomedical organisation must play no part in the treatment decisions you make for your patients. If it is in the patient’s best interests that their treatment utilise the services of such an organisation, then you must disclose this to the patient. This is particularly pertinent in the new arena of clinical commissioning groups – and the GMC has produced specific explanatory guidance on this topic – Financial and commerical arrangements and conflicts of interest (2013).
Overall it is the patient’s best interests that are the deciding factor in any decision made about their treatment, and this must not be affected by any inducements offered to you or by you. The Bribery Act, introduced in 2010, carries severe punishments of up to ten years in jail for anyone who improperly carries out a “function or activity” for financial or other advantage.
Case Study: Fight night
The GMC is not just interested in how doctors practise in a clinical setting. The GMC is interested in any aspect of the conduct of a doctor, which could raise a question about their fitness to practise, and undermine the public’s trust in the medical profession. What many students and junior doctors fail to grasp is that a serious mistake in your personal life could harm your prospects before you’ve even qualified.
Dr Hassan was out celebrating the completion of her F1 year, and her impending full registration with the GMC, when she got embroiled in a fight in the city centre. During the fight the police arrived and arrested all those who appeared to be involved. After this, Dr Hassan subsequently accepted a caution for assault.
When she came to apply for full registration with the GMC, Dr Hassan completed the declaration on fitness to practise. She didn’t think that the caution was relevant, since it did not arise from her professional conduct, and was embarrassed, so filled in the forms without disclosing the caution.
A few months into Dr Hassan’s first job as an F2, a CRB check highlighted the issue. Dr Hassan’s trust referred the matter to the GMC. The GMC soon instigated fitness to practise proceedings on the basis of dishonest failure to disclose, which led to her being dismissed from her post.
The GMC takes dishonest and inappropriate behaviour very seriously. Probity in the eyes of the GMC means being honest, trustworthy and acting with integrity, which is at the heart of medical professionalism.
The GMC requires full and prompt disclosure of cautions and convictions. If you do find yourself in difficulty, take advice from your MDO, trainer or deanery – don’t be tempted to cover it up; if such attempts are discovered, it can do serious harm to your medical career. Hospital trusts will generally take a hard line on dishonest applications, and can treat it as gross misconduct, leading to immediate dismissal.
Examples of other things that may concern the GMC include: alcohol misuse affecting clinical work, misuse of drugs (even if there are no legal proceedings), drunk driving, bullying and physical violence.
Be aware that your behaviour outside the clinical environment, including in your personal life, may have an impact on your fitness to practise.