GMC Conference workshop: The role of complaints in professionalism
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GMC Conference workshop: The role of complaints in professionalism

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Our first annual conference in Manchester brought together doctors, medical students and patient groups to consider and debate the challenges affecting medical professionalism in the 21st century. ...

Our first annual conference in Manchester brought together doctors, medical students and patient groups to consider and debate the challenges affecting medical professionalism in the 21st century.

This workshop explored the type of complaints the GMC receives and the challenges we face in dealing with those.

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    GMC Conference workshop: The role of complaints in professionalism GMC Conference workshop: The role of complaints in professionalism Presentation Transcript

    • Objectives for this session Your views on the type of complaints we receive and the challenges we face in dealing with those.
    • What we do The GMC aims to:  Protect not punish  Maintain confidence in doctors  Manage the mismatch of expectation from doctors and the public
    • How we do it  Advice to doctors – principles not rules.  Take action where a doctors standards are seriously below – what behaviour will lead to action?  ‘Professionalism’ in practice.
    • Complaints to the GMC We will be looking at:  Source of complaints  What issues are increasing in volume?
    • Source of complaints
    • What issues are increasing in volume?  Clinical care – allegations about inadequate assessment, inappropriate prescribing, failure to diagnose and suitable action not being taken.  Health issues - allegations about affective disorders, alcohol abuse and neurosis.  Communication with patients - a steep rise over the past five years in allegations about rudeness, failure to understand needs and failure to take account of patients’ views.  Probity – allegations of false / misleading reporting remains the biggest concern. A rise in financial deception and a big spike in indecent behaviour in 2012.
    • Seriousness  Not serious Obvious we should not take action, eg: doctor hasn’t prescribed specific medication patient wanted or doctor has parked across neighbour’s driveway.  Some concerns We need to investigate and action may depend on the context - could include warnings, undertakings, conditions, short suspension – we will discuss this further.  Very serious Obvious we should make a robust response such as longer suspension or removal from register, eg: sexual assault of a patient, doctor defrauds a vulnerable patient out of his life savings.
    • Majority of cases Most complaints fall between the extremes  people have different views  context is important  important to understand what people expect/what is likely to undermine confidence  implications for ‘professionalism’ now and in the future
    • Example – Dr X  Doctor X, a talented physician training in acute medicine, attends a friend’s birthday at a local night club. He has just passed his MRCP exam and is celebrating.  At 2.00 am he plays a drinking game that results in his drinking 4 pints very quickly over the course of 20 minutes.  At 3.00 am he is offered a ‘joint’ which he smokes. He is approached by a bouncer and evicted from the club.
    • Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Example – Dr X continued  On his way to the station Dr X is approached by a prostitute.  Although he has never done this before he agrees to go with her.  As he follows her she pulls out a police badge and books him for soliciting. He is cautioned and allowed to go home.
    • Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Example – Dr X continued  He falls asleep on the train and his ticket is checked by an inspector at the end of the line.  He is issued with an on the spot fine for travelling without a valid ticket.
    • Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Example – Dr X continued  Dr X believed that he was on a late shift the following day.  When he gets home at 6.00 am there is a message on his phone from a colleague about their 8.00 am shift.  He decides there is no point going to sleep so logs onto Twitter and gets involved in a discussion during which he posts a homophobic comment.
    • Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Example – Dr X continued  On his way to work he notices his breath smells of alcohol and buys some mints.  His first patient is a girl that was at the party the night before and who he was interested in but became too drunk to approach.  Before she leaves he asks for her number.
    • Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Example – Dr X continued  On the ward he sets up an insulin infusion for a diabetic patient. He feels nauseous so finishes quickly and rushes to the bathroom.  An hour later the patient dies and it emerges Dr X had set the insulin rate at 40 ml per hour instead of 4ml.
    • Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Our role  Our role is to protect patients and maintain confidence in profession  What does this mean?  Ensuring doctor is safe to treat patients in the future  Not punishment or discipline for past concerns  But past conduct must not have fundamentally undermined trust of the public
    • Scenario 1  Dr Blue is a young doctor who has recently registered with the GMC.  He is part of a Facebook group for young doctors and in recent months has become obsessed by a GP who is very active in group discussions.  From a comment she made in a forum he thinks she might be based in the catchment area for the hospital where he works.  The next day at work, when the medical records manager has gone to the bathroom, he searches her name on the hospital database, finds her details from previous treatment for an injury, and makes a note of her phone number.
    • Scenario 1 - vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 1 – part 2  He makes an approach to her on Facebook.  When she doesn’t respond he sends her a text saying ‘Why didn’t you answer my Facebook message? We have so much in common. I would really like to get to know you better.’  She responds ‘where did you get my phone number?’ and when he replies she complains to the GMC. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 2  Mrs Red has been diagnosed with cancer.  Her treating doctor, Doctor Green, tells her that he has developed a ‘tonic’ that helps people in her situation and gives the patient a bottle.  The tonic is made up of a combination of vitamin supplements. Mrs Red takes the tonic and stops attending her chemotherapy sessions. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 2 – part 2  You later learn that Doctor Green has charged Mrs Red £40 for the bottle of tonic and that Doctor Green sells this through a website on which she describes it as a cure for cancer. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 3  Doctor Brown is cautioned for possession of an ecstasy tablet as a result of a search as he entered Glastonbury festival.  He has just completed medical school and has recently registered with the GMC. He notifies the GMC of the caution. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 3 – part 2  Consider alternatively Mr Orange, a medical school graduate, who applies for GMC registration and declares a caution he received when he was seventeen for possession of an ecstasy tablet in a night club? Vote How serious do you think this is for the GMC? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 4  Doctor Grey has witnessed a colleague issuing prescriptions for controlled drugs on a number of occasions without seeing the patient.  The colleague is an old friend, they started medical school together. Doctor Grey mentions his concerns to his colleague several times but the colleague laughs it off and tells him not to be so uptight.  He is reluctant to get his friend into serious trouble so doesn’t mention this to anybody.
    • Scenario 4 - vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 4 – part 2  One of the patients has a contraindication to one of the prescribed drugs and suffers a serious reaction so Doctor Grey mentions it to the Medical Director.  The Medical Director is busy with an annual review and takes no action. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 5  Doctor Silver has recently arrived in the UK from overseas. Where he comes from doctors are expected to speak to the whole family about a patient’s care and do not need to obtain patient consent to do so.  On his second day in his new job he speaks to a patient’s daughter about the patient’s condition without getting her consent to do so.  The patient complains. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 5 – part 2  What if he had been six months in the role when this happened? Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 6  Dr Gold, an orthopaedic surgeon carries out seriously deficient hip replacements over several years.  20 patients have permanently lost mobility as a result of the procedures.  In response to an investigation by the hospital that he works for, Doctor Gold refuses to accept that there is any problem with his performance. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 6 – part 2  The hospital raises their concerns with the GMC.  During the GMC investigation Dr Gold’s lawyers submit evidence that the doctor has recently retrained in hip replacements and has remediated any concerns. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 7  Mrs White attends her GP, Dr Black, with constipation.  Mrs White completed a questionnaire in the waiting room and said she had blood in her stools.  She handed the questionnaire to Dr Black, but was embarrassed to mention it again in the consultation.  Dr Black didn’t read the questionnaire and prescribed laxatives without carrying out any further examination.
    • Scenario 7: vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 7 – part 2  Mrs White returns on two further occasions.  On the third occasion she refers to the questionnaire and the bleeding.  At this point Dr Black sends her for tests and advanced bowel cancer is diagnosed.  A GMC expert says that the cancer was aggressive and if tests had been carried out earlier it wouldn’t have made any difference to the outcome.
    • Scenario 7 – part 2: vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 8  An elderly patient is admitted to the ward with a fever, bad cough, pain in left side of chest and leg pain.  Dr Stone sees the patient has a history of COPD (chest problems) and orders an Xray which only shows changes consistent with COPD but no other signs.  Doctor Stone treats the patient for a lower level respiratory tract infection.  The family complains the doctor hasn’t considered all the possible causes because of her age.
    • Scenario 8 - vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Scenario 8 – part 2  The symptoms don’t improve and 3 days after admission the patient dies suddenly from a pulmonary embolism.  The autopsy also reveals deep vein thrombosis. Vote How seriously do you think the GMC should view any concerns? 1. Not serious 2. Some concerns 3. Very serious
    • Lunch and exhibition Upper foyer and Exchange hall