A nervous disposition
Between 2005 and 2013, 28 doctors undergoing fitness to practise investigations died of confirmed or suspected suicide. Last month the General Medical Council (GMC) published a report commissioned into whether its fitness to practise procedures are adequately managing cases of vulnerable doctors who are under investigation.
Of the 28 doctors, 20 of them were being investigated for health concerns. Of these 20 doctors, 9 also had conduct concerns, 6 were subject to police or fraud investigation, and 2 had other performance concerns. The remaining 8 doctors appeared to have no pre-existing health concerns.
54% of these doctors were referred to the GMC by an employer with 14% being referred by police, and in 7% of cases a direct complaint was made to the GMC. In only 11% of cases had self-referrals been made which may be demonstrative of an unwillingness to involve the GMC, a lack of insight, embarrassment, or fear of the process.
Multiple jeopardy, when a doctor is involved in a number of investigation processes at once, has been identified as being a particular risk to the mental health of fitness to practise subjects. The report found that the nature of numerous investigations including employer disciplinary proceedings, police investigations and coroner’s inquests means investigations can take many years, intimidate and undermine doctors, and contribute to mental health problems and suicide.
Underestimating the effects of investigation?
Research from New Zealand in 2004, considered in the report, showed that in the short term, 73% of doctors who received patient complaints expressed anger, 65% felt depressed, 38% had reduced enjoyment of practise and 36% felt shamed. Whilst this may be the case, the GMC research shows that half of the suicides occurred at the collection of evidence stage of the investigation, whilst 43% occurred when the investigation was at case review stage, thus identifying two key areas which appear to place particular strain on these doctors.
The GMC of course recognises that there are doctors who are vulnerable by virtue of their health concerns which have brought them into the fitness to practise process, however the question is whether the nature and wider implications of a fitness to practise investigation themselves render a doctor vulnerable.
Symptom not cause
The research has found a tendency of the GMC to concentrate solely on impairment itself rather than the contributory factors preceding a referral, which at times fail to be taken into account. These may include marital breakdown, financial hardship, legal issues, or bereavement. The report also makes clear that the GMC referral itself is a major stress factor which then adds to the burden placed on the doctor.
In spite of this, the report does not discuss these stress factors being a potential result of the fitness to practise investigation, nor appear to appreciate that health is not a stagnant picture, and so whilst a doctor may not be under investigation for health concerns, this does not eliminate the presence of or susceptibility to mental health problems whilst under investigation for other matters.
The report found that in the majority of suicides, the doctor had received IOP or FTP conditions or suspension or undertakings. This coupled with the statistics on referrals show that restrictions on practise and resulting financial or emotional hardship, as well as multiple investigations, all are indicators which may lead to a heightened risk of suicide.
What can be done?
Sarndrah Horsfall who authored the report made nine recommendations which include bolstering the message of ‘innocent until proven guilty’, increasing awareness of GMC employees to mental health issues, making emotional resilience training an integral part of the medical curriculum and changing the processes for assessments and support in health cases. Notably, it was recommended that a National Support Service be established for doctors to build on existing services and support available.
Doctors facing fitness to practise allegations may not fully appreciate the impact that the process may have on their mental health. As part of our approach to GMC litigation, we encourage doctors to talk to us about how they are feeling and about what support they think they might need; together, the legal profession and the GMC, ought to be able to reduce the number of doctors for whom the whole process is just too much to bear.
For more information on GMC fitness to practise proceedings or to discuss the advice that Kingsley Napley can provide then please contact Julie Norris in the Regulatory and Professional Discipline department.
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