Pearls and pitfalls

Some words to the wise on risk and responsibility from Dr Jim Rodger, chief medico-legal adviser at MDDUS

YOU’VE arrived. You’ve passed your MB ChB and can now change the designation on your cheque book and look for all the benefits that flow from being Dr rather than Ms or Mr. Deservedly so, because you’ve worked hard and passed a rigorous assessment process to be allowed to graduate. You will be looking forward to an exciting and slightly scary world of medicine or surgery and being able at last to do ‘things’. With this new phase in your life comes a list of added responsibilities which you may not have thought of or even be aware of. I don’t want to dampen the enthusiasm for your new job but simply introduce a measure of realism and a warning about pitfalls that may lurk ahead.

Professional and personal conduct

The General Medical Council (GMC) is the body that records your various states of registration. Once you have provisionally registered you must accept that you are a medical practitioner 365 days a year, 24 hours a day. The reach of the GMC to regulate the conduct and behaviour of doctors is not confined to working hours or solely to when practising medicine. Your behaviour and conduct outside work may have serious consequences for your registration and your ability to work as a doctor.

Any criminal conviction affecting a medical practitioner is automatically notified to the GMC. Examples include drink driving, dangerous driving, assault, fraud and notably in recent years possession of or supplying drugs. These can be drugs of recreation, as well as the abuse of prescription drugs. Doctors charged with any criminal offence should seek appropriate advice from MDDUS before they take any action. Legal representation will not normally be available to doctors in matters not relating to the practice of medicine but MDDUS will give advice on the implications of admitting to or defending any such charges.

The GMC also looks very carefully at and punishes, if proved, allegations of dishonesty or a lack of probity. These might include exaggerating qualifications, inventing qualifications, not divulging details of failures or lack of progress in training. Be careful with the preparation of CVs. FYI and FY2 trainees have also been reported to the GMC in cases of significant underperformance but this is generally viewed as the responsibility of educational supervisors.

Another major concern of the GMC is the health of doctors, particularly when it affects performance and may put patients or other colleagues at risk. Similarly, the GMC seeks to protect doctors from ‘themselves’; doctors must recognise when they are unwell and avoid the temptation to self-medicate. Any doctor has a responsibility to ensure they keep in good health and if unable, to seek help and guidance from MDDUS and even the GMC itself.

Many of these issues are covered in the GMC’s core guidance document, Good Medical Practice. Ensure you read it before you start your job.

Disciplinary matters

Possibly the next best thing after graduation and starting work is your first pay cheque. You may even want to double-check that all your sessions have been properly paid as set out in your NHS employment contract. But have you looked at the rest of this contract?

It contains numerous rules and regulations governing your daily work, relationships with colleagues and general behaviour. The employing body has an expectation that you will turn up for work when required, complete your allotted hours, remain attentive to your work, keep proper notes and be organised in your routines. If not, they can take action against you.

If a doctor persists in personal conduct that is judged by the Trust or Board to be serious or detrimental to the efficient discharge of a doctor’s duty, they may make that doctor subject of a disciplinary process that can result in dismissal from a post. Some leeway is obviously given to young doctors early in their training, but perhaps not much. You must be clear on your responsibility to the organisation that is paying for your services.

Patient complaints

The last thing you ever think about when you start to work in medicine is that someone, patient or relative, is going to complain about you or your actions. Everyone who takes up medicine as a career is aware that it involves a high degree of altruism and commitment. To have this questioned by anyone is a blow to one’s ego and sense of professionalism.

Do not be under any illusions – we no longer operate in a paternalistic environment where medical care and its application lie solely in the hands of the profession. This is a consumer-based society and medical care is regarded as no different in some ways from other service industries. Patients have expectations of the service and how it is delivered.

Therefore, it is inevitable that some patients, carers and relatives will complain. The NHS is not perfect and without significant investment cannot render a fully comprehensive service of healthcare. Thus patients’ expectations, unrealistic or not, will not always be matched. Those on the ‘shop floor’ must bear the brunt of these failed expectations. This is simply now part of the ‘job’ and truly professional doctors must accept that and learn to live with it. Complaints are normally of great value to an individual or an organisation in order to learn from mistakes and determine why such failings occur and how they can be prevented in future.

You will face complaints from early on in your career. You must always seek advice about how to respond to complaints, particularly in these early years. You must never rush into responding, either in an overly apologetic or angrily dismissive manner. Responses to complaints must be measured and informative.

The most common complaints that all sections of the health service receive are those about the attitude of doctors, nurses and other staff. There are many and good reasons (tiredness, overwork, stress etc) why people may be rude, short or dismissive as perceived by patients. However, it is a professional responsibility to remember that patients, carers and relatives are in very unusual and vulnerable states when their or their relative’s health or life is at risk. Always remember that your attitude may be more important to a patient than your competence, but try to avoid being a ‘charming quack’.

The future

Few doctors are dismissed or struck off during foundation training. This two-year period is meant to be educational as well as service-related. It should be the ‘foundation’ of your medical career and – considering a possible 40-year stint – is relatively short. Friendships formed in your early years often last a long time. It may sound like a bunch of old buffers talking – but many doctors look back on their training as the best years of their career.

Make the most of them!

Dr Jim Rodger is a medico-legal adviser and Head of Professional Services at MDDUS