An investigation by the GMC is a stressful experience and it can be a protracted process. Tammy Lovell reports on an initiative to help doctors cope by providing emotional support.
On the brink of losing his career and livelihood as a result of a GMC investigation, a GP found himself sinking into anxiety and overwhelmed with feelings of shame.
The overseas-qualified doctor, who we will call Dr Handen, says: ‘I didn’t know what would happen next. I wasn’t sure about anything. I was at the point of losing my job and my licence and everything I could survive from.
‘I wouldn’t be able to get any job other than [as a] doctor. It would mean someone would cut my feet off and leave me alone to walk.’
Dr Handen faced an investigation after concerns were raised about his clinical skills and ability to speak English during a 360-degree appraisal.
Following a clinical governance audit, it was suggested that his primary care trust place him in a training practice so that he could become more familiar with UK practices. However, after nine months they had still failed to find him a suitable post.
Instead, he underwent six weeks of remediation in place, being observed by a trainer at this practice.
After it was felt he had not made satisfactory progress, he was referred to the GMC for investigation and suspended from the medical performers list.
In the meantime, he took annual leave and was supporting his family on his basic pay. This was for a 20-hour week, whereas he previously worked extra hours.
Dr Handen says: ‘I was extremely anxious and we were short of money. Each day we were thinking about what we were going to eat.
‘We would go to the nearest shop in the evening, just before they closed, and buy the cheapest bread on reduction.
‘We went to Tesco and checked everything on sale. My wife and I would only drink water.’
Stigma and shame
During this time, his sense of stigma and shame was so acute he felt unable to speak to anyone or confide in friends or family back home about the troubles he faced.
He explains: ‘I stopped phoning any of my friends because I didn’t know what to tell them.
‘We used to attend church and I was a member of the parish council but we stopped attending because we didn’t have money for petrol and I felt extremely ashamed - too ashamed to tell anyone what had happened to me
‘I couldn’t speak to my father and mother because they weren’t healthy and it could kill them. I had nobody to talk to.’
Dr Handen said he felt people would expect his children to be well off because they had a parent who was a doctor, but in fact he could not afford anything but the basics for them.
Risk to mental health
These feelings of depression and anxiety are not uncommon in doctors facing complaints or investigations, according to a survey responded to by 8,000 BMA members.
Research by Bourne et al published in BMJ Open in January found:
- Doctors who had been subject to investigation within the past six months were twice as likely to harbour thoughts of self-harm or suicide than those who either had not experienced a complaint or had had a complaint longer ago
- Doctors who had been referred to the GMC were most at risk of mental ill health, with 26 per cent suffering depression, 22 per cent suffering anxiety and 15 per cent having thoughts of self-harm
- Defensive practice was common, with 79 per cent of those who had experienced a complaint saying they had changed their clinical practice as a result. They used tactics such as avoiding difficult tasks, ordering too many investigations and, in some cases, acting against their professional judgment
- One in five of those who had been subject to a complaint felt victimised for having raised concerns about poor clinical or managerial practice, and almost four out of 10 (38 per cent) said they felt bullied during the investigation.
The research follows a GMC report published last year that found 28 doctors committed suicide while under investigation over their fitness to practise between 2005 and 2013.
In response to the Bourne et al research, GMC chief executive Niall Dickson said: ‘Unsurprisingly, the study found that, among the 374 doctors who responded to the survey who had been referred to the GMC, levels of stress were higher - a referral to the national regulator is often more serious and, of course, carries with it the additional (albeit extremely small) risk that their livelihood could be taken away.
‘Some distress is therefore inevitable, but the onus is on us to do whatever we can to reduce the fear and upset doctors experience, without in any way compromising our duty to investigate thoroughly in order to protect patient safety.’
A listening ear
Since 2012 the GMC has funded the BMA Doctor Support Service to offer confidential emotional support from fellow doctors to those under investigation.
Telephone support is available throughout the process from the time a complaint is received by the GMC. Supporters can offer a listening ear and help find strategies to cope with the stress of the proceedings.
They can also accompany the doctor to a GMC hearing to provide emotional support, although they are unable to provide medico-legal advice.
Mr Dickson said: ‘The response to the service has been overwhelmingly positive and an independent evaluation, which we will be publishing soon, found that the service delivered real benefits to the doctors who used it.’
Dr Handen contacted the BMA Doctor Support Service after reading about it in BMA News.
He found having another doctor to talk to helped to ease his feelings of isolation and shame.
He says: ‘The BMA Doctor Support Service put me in touch with a doctor who helped me with advice and support.
‘Every time I found something unclear I spoke to him. He was always there for me when I had a specific question to ask and I knew there was someone who could help me.
‘He was one of the important supports I had. I wasn’t in touch with any other medical staff.
‘He made me understand how the system worked. I needed a translator of applicable English culture in my life.
‘He was very patient and I realise that sometimes I spoke to diminish my anxiety. He was a good listener. I couldn’t speak to anyone else. I was so ashamed.’
BMA Doctors for Doctors unit head Mike Peters says: ‘The research highlights the stress of going through a complaints procedure and, importantly, how this may have an effect on a doctor’s practice with possible subsequent patient safety implications.
‘The BMA Doctors for Doctors unit has been commissioned by the GMC to provide the Doctor Support Service, which offers confidential emotional support to doctors going through fitness to practise procedures.’
Eventually Dr Handen found a training post and returned to his previous practice with undertakings on his registration.
After a performance assessment the undertakings were removed and Dr Handen has returned to work full time in a walk-in centre.
However, the stressful investigation process took more than three years. He still maintains contact with his doctor supporter for ongoing emotional support.
Speaking about the BMA Doctor Support Service he says: ‘It reduced my anxiety and helped me feel much less isolated. I was in contact with the world.
‘It was an open door. I don’t feel I could have got through these three years without that support.’
Contact the Doctor Support Service
Read the Bourne et al research paper