The document discusses various scenarios involving complaints to the GMC against doctors. It examines different levels of seriousness for concerns - not serious, some concerns, and very serious. Several hypothetical scenarios are presented involving doctors' conduct, with votes on the seriousness of any concerns. Issues discussed include clinical errors, unprofessional behavior, inappropriate prescribing, failure to obtain consent, and probity concerns. The majority of cases fall between the extremes, and context is important to understand expectations and maintain confidence in the medical profession.

2. Objectives for this session
Your views on the type of complaints we
receive and the challenges we face in dealing
with those.

3. What we do
The GMC aims to:
 Protect not punish
 Maintain confidence in
doctors
 Manage the mismatch of
expectation from doctors
and the public

4. 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.

5. Complaints to the GMC
We will be looking at:
 Source of complaints
 What issues are increasing in
volume?

6. Source of complaints

7. 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.

8. 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.

9. 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

10. 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.

11. Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious

12. 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.

13. Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious

14. 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.

15. Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious

16. 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.

17. Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious

18. 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.

19. Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious

20. 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.

21. Vote
How serious do you think this is for the GMC?
1. Not serious
2. Some concerns
3. Very serious

22. 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

23. 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.

24. Scenario 1 - vote
How seriously do you think the GMC should view
any concerns?
1. Not serious
2. Some concerns
3. Very serious

25. 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

26. 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

27. 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

28. 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

29. 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

30. 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.

31. Scenario 4 - vote
How seriously do you think the GMC should view
any concerns?
1. Not serious
2. Some concerns
3. Very serious

32. 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

33. 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

34. 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

35. 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

36. 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

37. 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.

38. Scenario 7: vote
How seriously do you think the GMC should view
any concerns?
1. Not serious
2. Some concerns
3. Very serious

39. 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.

40. 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

41. 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.

42. Scenario 8 - vote
How seriously do you think the GMC should view
any concerns?
1. Not serious
2. Some concerns
3. Very serious

43. 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

44. Lunch and exhibition
Upper foyer and Exchange hall