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The high anxiety of the GMC

Gareth Gillespie looks at the emotional and physical consequences of being investigated by the GMC, as revealed by two recent reports
01 May 2015

 
The pressures of practising in medicine today are well-known: rising patient expectations have, perhaps, been fed by an increasingly hostile media, a problem that has potentially led to a more litigious landscape at a time when dwindling NHS resources are already posing an obstacle to the safe delivery of healthcare. 

Against this background, an investigation by the doctor’s regulatory body imposes a further significant burden – which can sometimes have tragic consequences. When the GMC published its report into doctor suicides1 last December, it was shining a light on its own involvement in causing anxiety among doctors, revealing that 28 had taken – or were suspected of taking – their own lives while being investigated by the GMC between 2005 and 2013.

But if prevention is truly better than cure, this upsetting report has at least highlighted the magnitude of the issue – presenting an opportunity to tackle this problem at its source and prevent such levels of stress and depression in future. One recommendation from the GMC was to establish a national support service for affected doctors.

Deeper issues

  • To coincide with the GMC’s report, MPS conducted our own survey of 180 members to measure the impact of GMC investigations on their careers, health and wellbeing. The survey was aimed at members from both primary and secondary care who had been involved in a GMC investigation over the past five years. Some of the key findings are below. 
  • Top five areas impacted by GMC investigations:
    • stress/anxiety (93%)
    • personal life (76%)
    • health and wellbeing (74%)
    • confidence (69%)
    • professional reputation (52%).
  • Almost three quarters of respondents (72%) believed that experiencing a GMC investigation had a detrimental impact on their mental and/or physical health. 
  • Almost half of respondents (47%) did not believe they received enough support in looking after their health throughout the investigation.
  • 70% of respondents said that the GMC should offer more support to doctors facing an investigation.
  • More than a quarter of respondents (28%) considered leaving the profession as a result of their experience; 8% changed their roles and 2% left the profession. 
  • In terms of support, over a quarter of respondents (28%) called for clearer expectations from the GMC.
  • Media attention was experienced by 26 doctors as a result of the investigation.

Dr Pallavi Bradshaw, MPS medicolegal adviser, wrote in her opinion column in MPS’s New Doctor magazine: “While saddened by the findings of both reports, I was not entirely surprised. I see the negative impact GMC investigations have on doctors and, while most will be dismissed without further action, the damage of the process cannot be underestimated. 

“It is important that any doctor struggling to cope, whether under GMC investigation or not, should seek help and support as soon as possible from occupational health and/or their GP. MPS has a confidential counselling service for members with open cases and the BMA provides a counselling service to its members. The recommendation in the GMC report for a national support service is welcome, as is the need to treat a doctor as ‘innocent until proven guilty’ – surely a fundamental principle of our justice system.” 

Other factors

The GMC’s report also found that many of the doctors who committed suicide suffered from a recognised mental health disorder, or had problems with drug and alcohol addictions. Other factors that may have played a part in the suicides or attempted suicides included marriage breakdown, financial hardship and, in some cases, police involvement on top of the GMC investigation. 

Niall Dickson, chief executive of the GMC, said: “We know that some doctors who come into our procedures have very serious health concerns, including those who have had ideas of committing suicide. We know too that for any doctor, being investigated by the GMC is a stressful experience and very often follows other traumas in their lives. Our first duty must, of course, be to protect patients but we are determined to do everything we can to make sure we handle these cases as sensitively as possible, to ensure the doctors are being supported locally and to reduce the impact of our procedures.

“Although a referral to the GMC will always be a difficult and anxious time for the doctor involved, we want to handle complaints as effectively as possible and ensure our processes are as quick, simple and as low stress as we can make them. We have made some progress on this but we have more to do, and that includes securing legal reform. We will now review our current process for dealing with doctors with health problems and identify any further changes that may be needed.”

An opportunity for change

The unpredictable and sometimes drawn-out nature of GMC investigations can have a significant impact on the mental and physical health of doctors, and the GMC’s willingness to hold itself to account is most welcome. Improvements to existing processes will hopefully go some way to limiting the emotional impact of investigations, particularly as they are already likely to be one of the most stressful experiences a doctor will face. 

Dr Clare Gerada, medical director of the Practitioner Health Programme, said: “I welcome this long-awaited and important review. I applaud the GMC’s openness in putting in the public domain the issue of doctors’ suicides whilst under their process.

Going forward they need to continue to show their commitment to reducing the impact of fitness to practise investigations on vulnerable doctors whilst always maintaining patient safety – a substantial task.

“Doctors are sometimes patients too and supporting vulnerable doctors is a shared responsibility. It is important that in taking forward the recommendations in the review the GMC works in partnership with everyone who has an interest in this area, including the Practitioner Health Programme, the Royal College of Psychiatrists and the BMA.”

Prevention and cure

There are a number of other areas relating to the investigation process that MPS believes would help to reduce the stress for doctors involved. Dr Richard Stacey, senior medicolegal adviser at MPS, discusses the key points: 

Case conferences

Recently we assisted a member with a GMC investigation that took four months to be closed with no further action. After receiving an expert report that was supportive of the doctor’s care, we requested that the GMC promptly close the case. While we appreciate that GMC investigations sometimes have to move at a slow pace – and in many cases this is outside the GMC’s control – more can be done to reduce delays and allow doctors to be more actively involved in the investigation. 

The fourth recommendation in the GMC’s report is to introduce regular case conferences into the investigation process. This potentially allows doctors to co-navigate the investigation process with the GMC and reduce delays, and may also reduce unnecessary paperwork and give doctors more direct involvement. It may also go some way to resolving the problem, in our experience, of GMC investigators seldom giving explanations or updates for such delays. Such uncertainty only adds to doctors’ anxiety.

Case conferences would help all parties understand their roles, something that the MPS survey revealed to be a popular request – 28% of respondents called for the GMC to provide clearer expectations.

Review deadlines

Reasonable deadlines for doctors to respond to allegations is another way to reduce anxiety, with current timeframes of 28 days proving relatively short when considering the many other commitments of doctors.

References

  1. GMC, Doctors who commit suicide while under GMC fitness to practise investigation (December 2014)
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6 comments
  • By Paul Revell on 09 June 2015 07:42 What is worth remembering is that Doctor factors are much more likely to play a part in suicide (an absolute tragedy) and other psychiatric and physical fallout than the apparent magnitude of the case. Doctor factors of course include alcohol, drugs, past history etc but also how obsessional/conscientious/perfectionistic the Doctor is. Patients and other staff naturally admire these qualities and rather like them in a doctor but these individuals are more likely to take it hard and lose perspective (and loss of perspective allows suicide). Looking at procedures and support from the point of view of these types of doctors could well save some young lives and improve others (and their families …)
  • By Peter Evans on 05 June 2015 08:39

    Emotional support for doctors and by extension, their families, should be part of the process. It is not good enough to encourage the practitioner to provide his own support; the GMC should provide that support or make sure it is available now.

    Would it be acceptable for a surgeon to remove a patient's inflamed appendix whilst telling her/him to get their own support for diabetic care or any subsequent wound infection?

    This is 2015 and complaints are rising we are told. Look at what "No taxation without representation" did for the USA. Where might "No investigation without psychological support" eventually lead the GMC?

  • By David Swain on 04 June 2015 07:51

    A few years ago, I arrived home on a Friday evening to find a message on the answerphone from the GMC asking me to "contact them urgently". Attempts to contact them over the weekend were fruitless and I spent the weekend worrying about what might be about to happen. First thing on Monday morning, I spoke to some-one who said "Oh yes, we haven't received your subscription"!

    When I pointed out that it was the first time in over 25 years that my subscription was late; that such a call produced significant stress over a weekend and that a reminder letter might be a more appropriate way to deal with the situation, I was met with a deafening silence. I asked if the person had any concept of how such a call made an innocent doctor feel: again deafening silence.

    My heart goes out to anyone who faces a real investigation from a body so devoid of self-examination.

  • By Ameen Ameen on 04 June 2015 07:45 The GMC needs to be much more quicker in completing their investgations by  ? employing more experts to minimise the stress and the suffering caused by their investigations. The extra funding required could be obtained from increasing their annual retention fee or from the investigated candidates. 
  • By Paul Revell on 04 June 2015 06:43 Another thing that may need to be thought about is that the stress is in the process, not how likely it is that the case will be dismissed (and the dismissal letter may well be grudging rather than generous) or how trivial or unfair it appears to colleagues or the MPS. The more conscientious/obsessional/perfectionistic the doctor is at work, the more likely they are to take this kind of procedure hard and lose perspective. Loss of perspective is one of the things that allows suicide - which is clearly a disproportionate response to any accusation or indeed finding/sanction - but the brain can take humans down that path - to an absolute tragedy for the family; some of these will have young children.
  • By Christopher Price on 04 June 2015 03:21 This is all well and good but the culture of the GMC remains guilty until proven innocent. The GMC should read up on the Magna Carta for clarification on this. The GMC are also consulting on steps to ensure doctors apologise; this is precisely what they need to do to the families of doctors under investigation who have suffered illness or sadly taken their own lives.
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