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The thing I’ve learnt the most from my experience as a patient is that the world doesn’t actually “do” binaries.

My law training gave me training in being able to argue both sides of a case, and to present the case convincingly, so that I almost believed myself. A client pays a lawyer to win the case, and not to sit on the fence – or even worse, argue the opposite side.

As a doctor, I am taught to believe that people have diseases or not, and that each disease will have a relatively predictable outcome assuming that all the diseases act independently. As a doctor, I am not encouraged to think about what a condition makes a person feel like. I can think about it if I wish, but I don’t have to.

As for the difficulty with binaries, I am both a doctor and a patient. When the MPTS panel asked me in 2014 what I’d learnt the most from my time off the GMC Medical Register, on the assumption made by both me and the GMC perhaps that I would never be making a comeback, I replied, “I finally know it’s like to be a patient.”

Maybe it was the adrenaline talking. But I meant it.

I was a patient on the neurorehab ward in 2007 at the National Hospital for Neurology and Neurosurgery at Queen Square where indeed I’d been a junior SHO in 2002. I had just suffered a six week coma on the ITU of the Royal Free. My best friends were a young man who’d just got married but fallen down a pothole, meaning that his life had been totally changed by the fitting of a titanium plate as a skull. Another friend had been admitted as he had problems with his intermittent self catheterising at home, living with multiple sclerosis, and was now newly in a wheelchair.

People were describing to me conditions which I had read about in textbooks. But rather than hearing the history compressed in a short clerking, I got the full impact as an equal, as a fellow patient, but me with substantial problems of my very own.

When I later nearly went blind in the late 2017 due to a vitreal haemorrhage (but which was later then successfully operated on), I would listen to people who were blind on local radio describing what it was like to lose their disability living benefit. They like me felt as if they had nobody to turn to.

When I had been decisively erased from the GMC register in 2006, later to be restored in 2014, I spent a few weeks in rehab at various places around the country. I used to chat at length with various other people with histories of substance abuse. Some are now dead. They all had individual tragedies, but all had in common a long period of time when they thought they could tame the beast that is substance abuse.

I realised late on that there’s no magic bullet for substance misuse. And I can see how others are making the same mistakes as I did.

It’s taken me years to get to the stage of applying to return to medicine. In fact, nobody really knew at all that there is a scheme run here in London for doctors like me to return. It’s not as simple as finding a job off a website. It’s a scheme where you’re actually supported, given your health and wellbeing concerns, and where your training needs can be met.

The person doing the interview today on behalf of Health Education England admitted today I was starting from a much higher baseline than most people wanting to start medicine at my age. And, if it had not been for the arse-covering of my seniors, lack of support by colleagues, and my own illness over which I was powerless, I could have also done something too with my medical degree, my MRCP and my Ph.D. And I wouldn’t have become physically disabled either, maybe.

I think the concept and background of the ‘wounded healer‘ is interesting, and I’d like you to read some of the background from elsewhere. There are texts and subtexts, for example Jung and Picasso – but, like my own alcoholism, it’s not worth trying to make sense out of overintellectualisation.

But my tendency is to feel that my period of being very ill, with my life imploding, as an alcoholic who then became physically disabled, should ideally not go to waste, and I feel that looking after patients is now my genuine calling. I have to be careful though, as my own psychiatrist warned me against turning into one of those of people who likes to rewind the ending of his favourite movie, hoping the ending will be different one day. He coincidentally loves the idea of me joining the workforce – he’s one of those psychiatrists who believes that people with a history of mental illness have a lot to offer.

I have come to have a strong passion to want to help patients, which totally overrides the fear of the ‘hostile environment’ from my regulator who would take great delight in any future misfortune of mine. I am sure my comeback would not even deserve a smidgeon of embarrassment from the clinical consultants who failed to support my health years ago.

But I feel that as a ‘wounded healer’, the time is right. I am not doing this for the fame, title, or salary. Admittedly, I am doing this partly for my late father who died with the public shame of my downfall. I am doing this partly for my mum now.

I feel I have quite a lot to offer still, and I’m not finished yet.

 

@dr_shibley

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For a moment – guess who said this, and when?

“We will be studying the report carefully to identify learning points.  We are committed to taking any further action necessary in light of information revealed by this report.”

Do we need another report?

More lessons learned?

It seemed like – not that long ago – we were discussing Southern Health or Winterbourne?

This saying above was in fact reported to have been the responseof Charlie Massey, CEO of the General Medical Council (GMC), in response to the events at Gosport War Memorial Hospital.

Dr Jane Barton, meanwhile, the doctor at the centre of this, is reported to have said,

“Throughout my career I have tried to do my very best for all my patients and have had only their interests and wellbeing at heart.”

It is very hard for one  to know what Dr Jane Barton’s precise reasoning was behind the management of her patients, without reading the transcripts of her evidence in her GMC hearings. Media accounts and headlines can be misleading, and lend themselves to ‘trial by media’.

Dr Barton was found guilty of “multiple instances of serious professional misconduct” by the General Medical Council in 2010 but was not struck off and soon retired. But – likewise unfortunately – it is perhaps very hard to avoid one of the other problems in all: the concern that, if Dr Jane Barton had not been a Causasian graduate but been a BAME trainee, would she have been struck off? It has been recently announced that the General Medical Council (GMC) has today announced that Roger Kline and Dr Doyin Atewologun will lead a major project to better understand why some doctors are referred to the regulator for fitness to practise issues more than others. Although previous studies have apparently found that the GMC’s processes do not introduce disproportionality in investigations into doctors, research has not yet established deeper reasons behind why certain groups of doctors are referred to the GMC by their employers more often. We know from the fiascos of how various cases have been dealt with, such as Dr David Sellu’s where the GMC is reported to have wanted to proceed with fitness to practise proceedings after his conviction for gross negligence manslaughter was squashed,  that a review into “medical manslaughter” could not come a moment too soon.

Dr David Nicholl’s comment in the BMJ is truly chilling:

“The GMC’s own regulator, the Professional Standards Authority, has pointed out that the GMC did not have to appeal the MPTS (medical practitioners tribunal service) decision to suspend rather than strike off Bawa-Garba. This contrasts with the GMC’s failure to take action against convicted sex offenders. There is a higher rate of complaints about BME doctors to the GMC. My fear is that if the GMC lose the appeal court hearing, these aspects will be brushed aside, there will be a rush to blame, and a failure to properly investigate. Neither the Williams nor Marx reviews will fully address the wider issues of how gross negligence manslaughter is relevant to all healthcare professionals, not just doctors, for example, the nurse Isabel Amaro was given a suspended prison sentence following the death of Jack Adcock.”

Furthermore, there is, potentially and problematically, a fine line with an intent to kill a particular individual, the mens rea for murder in English law, and ‘symptom control’ as per palliative medicine. But, by keeping Dr Barton on the register, was the General Medical Council acting to maintain public confidence? Or, other hand, would a stronger sanction for Dr Jane Barton have had the inadvertent effect of criminalising palliative care? Contrast this with the case of Dr Bawa-Garba, who had had an unblemished career as a trainee. Dr Bawa-Garba was faced with a number of serious problems which could face any junior doctor: for example, there may be inadequate senior cover, or inadequate access to blood results. Here, in addition to the possible as yet unproven racist element, there are wider system factors.

If doctors cannot whistle blow or discuss errors, then there will definitely be a problem with public confidence.

Sir Robert Francis QC once remarked:

‘It’s not a system which is conducive to openness and learning and a blame-free culture. But we are not going to get away from prosecution and people being held to account until the public can be confident that proper processes are in place to address their grievances. Patients and their families need to properly involved in the process of looking at what happened after things go wrong.

Investigations need to be blame free and the outcome of all of this must not only be full disclosure of what happened, why it happened, a recognition by all professionals involved of what their part was and a commitment to take any remedial action. Only then can we get the trust the patients and public need to end the climate of fear.”

This means a holistic look at what is going on. For example, in a BAME junior doctor with a blatant alcohol misuse problem, the regulator could look at why that junior doctor’s consultants or the Trust did not actively deal with an alcohol problem when that junior doctor was seeing patients on the ward? Or if there was an incident what did the Trust’s clinical governance procedures do, if anything, at the time? If the answer to both questions is nothing, the GMC should look carefully at the morality of its case. There should be opportunity for a detailed ‘right to reply’ from accused doctors, especially when they have been ganged up on former bosses years after leaving their posts. I feel that a big step foreward would be to allow junior doctors or allied health professionals to whistleblow against their senior colleagues, if necessary, if they feel inadequately supported there is a clear threat to patient safety. We do know that, from the legal events and the response of institutions such as the BMA regarding Dr Chris Day, whose career was effectively prematurely destroyed, that institutions have felt uneasy about whistleblowing protection for junior doctors.

In summary, I feel that the GMC needs to be totally clear what its actual rôle in patient safety is, and, if it is not capable of promoting patient safety, I feel that parliament should take away its statutory power. All doctors, including Consultants, need training, and need to be able to learn from things which go wrong. Doctors are not above the law, and are commonly accused of shroud waving. But clearly there is a problem if patients are also dissatisfied with the actions of the medical regulator in the light of various cases, including Mid Staffs, Ian Paterson, Gosport War Memorial. Stunts, such as doctors being allowed to emigrate without sanction, or allowed to retire before being erased for serious misfeasance, have got to stop, and, again, Parliament may need to legislate.

As for the long term future of the GMC, I feel with the reform of the NHS and social care to be reported later this year, I leave this in the hands of parliament, such as the Health Select Committee. It could be argued that ‘there is nothing to see here’, but, if promoting patient safety does not include learning from mistakes, I strongly believe that the GMC should not survive. But I would be the first to be truly delighted if the GMC had the humility to learn from its serious mistakes.

Otherwise, as I myself have discovered, no-one or no entity is indispensable.

 

@dr_shibley

 

 

 

 

 

 

 

 

 

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