Some blunt dental views from Yorkshire
There have been many episodes I’m sure we all know about where a colleague has done something that has been their eventual professional downfall. Examples like the well publicised cases of Joyce Trail and Desmond D’Mello are a demonstration of how a professional has destroyed their own career and reputation through their actions, whether it be an illegal act, or a dangerous one.
But none is more worrying then the Case of Bawa-Garba. I am sure you are all aware of this, but if not, very briefly this involved a junior paediatrician being charged and found guilty of gross negligence manslaughter due to the tragic death of one of her patients whilst under her care. However, what is unusual about this sentence is that it was not only a very short one, but also suspended; something that very rarely happens in a case like this. As is then the usual route of action, the doctor was referred to the GMC for the associated disciplinary hearing that comes with a conviction. The tribunal found that her fitness to practice was impaired, but allowed her to stay on the register. However, the GMC appealed this decision, and she was subsequently struck off by the High Court last week. Interestingly, an interim orders committee of the GMC suspended the doctor initially, which was overturned on appeal by the high court who ruled that even a serious criminal charge did not always mean that suspension was necessary or appropriate to protect the public.
As someone with a conviction for manslaughter, then one could always argue that a professional actually should not be allowed to practice their art on the public again, but there is case law that supports the more subjective approach that was taken in this case initially. But this case (without going into even more detail) is as much, if not more, of an indictment of the systematic failings of leadership and organisation inherent in the environment Dr Bawa-Garba was working in. That the tribunal found no impairment was significant, as the doctor had engaged in insight, and had placed her reflections on the tragic event on her e-portfolio.
And that is the problem.
By honestly reflecting on the events and committing them to the permanent record of her E-Portfolio, this allowed the GMC to use this reflection against Dr Bawa-Garba, and subsequently was part of the case that was successful against her. In effect, by complying with the requirements of the GMC, she has committed professional suicide by recording her reflections as required. It is fine to record ones reflections to show insight, but to then have them used against you is surely unfair. You would have to trust the regulator implicitly when committing your reflections to a permanent record, and the actions taken by the GMC will have served to destroy any trust that our medical colleagues would have had in their regulator. Given that the GMC has always seemed to be to be a more considered and pragmatic regulator than the GDC of late, then once can only wonder just what manner of jeopardy we will have to place ourselves under as a result of this ruling.
In one fell swoop, the GMC have removed the chance for professionals to show they have learnt from their mistakes and develop in a no (or low) blame environment (as indeed occurs in the aviation industry) and installed a culture of fear that I think even the GDC at its worst a couple of years ago would have struggled to create so effectively. However, with the new GDC rules on CPD and reflective analysis requirements that we now have, is there anyone amongst you that thinks that the same couldn’t possibly happen to dentists? Once a regulator has set a precedent, it is likely that they will all act in the same manner.
I suspect the GMC realise there will be a problem with personal reflection now, and given the release of a blog by the GMC on this issue at the weekend, this might be seen to confirm it. The amount of internet noise coming from the medical profession over this matter is significantly higher than anything we have been able to generate, and as a result one must hope that there is a higher likelihood of something significant developing over the next few weeks and months as a result of this case, something which hopefully will roll down to the GDC as well. Even Jeremy Hunt has raised concerns about this case and its unintended consequences.
Once cannot forget the tragedy of the death of a child in the case, but there has to be consideration of the bigger picture of how a ruling such as this will now probably affect the analysis of mistakes in healthcare that are needed to protect the public. Furthermore, unless the use of reflective writing is somehow protected, the use against us of our own insightful learning could be our eventual downfall.