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Learning Objectives:-
- The role, responsibilities and requirements of the GMC in whistleblowing
- The importance of trust, integrity, honesty and good communication in all professional relationships
- The need to know how and where to seek appropriate help
Students should be able to:
- Respond appropriately clinical errors
- Follow procedures for reporting adverse incidents
- Adhere to legal and ethical responsibilities that protect patients
Legal Aspects of the case
Is Dr A legally protected if she makes a complaint?
The Public Interest Disclosure Act 1998 (PIDA), states that "The disclosure must relate to raising genuine concerns about risks to patients, financial malpractice, or other wrongdoing from the following categories:
- a criminal offence;
- breach of any legal obligation
- miscarriage of justice
- danger (or potential danger) to the health and safety of an individual
- damage (or potential damage) to the environment; and
- the deliberate concealing of information about any of the above."
PIDA gives right not only to full time staff but also to locums, students and contractors. This was designed to protect employees by protecting anybody who informed the authorities from being victimised or dismissed. Therefore, in this case, the doctor is legally protected as her registrar may be endangering his patients.
What action can the GMC take?
The GMC has a set out a list of what they can and they can't take action against. They can take and have taken action against:
- Misconduct
- E.g. misuse of alcohol/drugs, sexual advances, treating without consent
- Deficient performance
- E.g. not examining properly, serious/repeated mistakes
- A criminal conviction
- Physical or mental illness
- A decision by a regulatory board in the British Isles or overseas
When fitness to practice is found to be impaired, the possibilities include suspension, removal/imposing conditions of a doctors registration. A warning can also be issued if it is not believed that fitness to practice is not impaired but there has been a significant departure from the principles set out in the GMCs Guidance for Doctors: Good Medical Practice.
In this case, the Registrar, is guilty of misconduct with alcohol. Further investigation to elucidate if this was a onetime occurrence, or a recurring problem is necessary. His/her performance should be evaluated, to ensure patient care has not been compromised.
What is the correct reporting procedure to follow?
The first port of call in this situation is the consultant. After this, the PCT should be informed.
Ideally the following information should be provided in writing, so that an investigation can begin:
- The doctor's full name, or surname, initials and reference number
- The doctor's address, or the address of the hospital/practice where they work
- A full account of the events or incidents that concern you, with dates, if possible
- Copies of any relevant papers and/or any other evidence you have
- Details of any action you have taken already - for example, if you have spoken to the doctor, or made a complaint to the doctor's employer
- Details of anyone else who will support your complaint.
If a doctor is concerned that by providing information they will be breaching patient confidentiality they may wish to take advice from the GMC or their defence organisation.
Ethical Issues Raised
Is the Registrar putting his patient's interests first?
In this case, the Registrar would not be able to make his patient his first concern since alcohol will impair his decision making. The GMC Guidance also states that 57 "
You must make sure that your conduct at all times justifies your patients' trust in you and the public's trust in the profession." Obviously, practising medicine whilst under the influence of alcohol does not promote public trust in the profession.
As the Consultant is not there, is the Registrar leading the team appropriately?
GMC Guidance: Management for Doctors sets out what is expected of a Doctor in a position of leadership, which in this case in the absence of the Consultant is the Registrar. In particular the following are relevant to this case: 20. "Whether you have a management role or not, your primary duty is to your patients. Their care and safety must be your first concern." And 21. "Management involves making judgements about competing demands on available resources." In this case, by drinking the Registrar is impairing his ability to do either of the above.
Is a Doctor responsible for a colleague's performance?
GMC Guidance: Good Medical Practice 43. states that "If you have concerns that a colleague may not be fit to practice, you must take appropriate steps without delay, so that the concerns are investigated and patients protected where necessary. This means you must give an honest explanation of your concerns to an appropriate person from your employing or contracting body, and follow their procedures". In this case, if the reporting doctor ignores this incident, she is neglecting her duty and would be in breach of the Good Medical Practice Guidelines.
Is the health of the Registrar affecting his ability?
GMC Guidance: Good Medical Practice 79. "...if your judgement or performance could be affected by a condition or its treatment, you must consult a suitably qualified colleague. You must ask for and follow their advice about investigations, treatment and changes to your practice that they consider necessary. You must not rely on your own assessment of the risk you pose to patients." Also relevant here is GMC Guidance, Management for Doctors, 58. "Doctors should also protect those they manage from risks arising from a colleagues health and respond constructively to signs that colleagues have health problems, in particular mental health problems, depression and alcohol and drug dependence."
In Clinical Practice
Ever since the Bristol Heart Case, where a number of operations were performed on children with sub-optimal results. Legislation has been put in place so that poor clinical practise can be reported without repercussion. Currently it is thought that there are various inequalities in how whistleblowers are treated in the NHS, as well as a lack of adequate protection.
Andrew Lansley (Health Secretary of the UK) realised that the NHS Constitution should more accurately reflect whistleblowing culture to counteract the culture of silence and fear within the working environment. He has established a NHS Constitution consultation paper.
The paper states that dismissal of a whistleblower would be considered unfair if they are dismissed for making a protected disclosure as defined by PIDA 1998.
At the time of writing this, the paper is still undergoing review.
References
- GMC Guidance: Good Medical Practice
- NHS Department of Health: The NHS Constitution and Whistleblowing (A paper for consultation)
- Antecedents and Outcomes of Retaliation Against Whistleblowers: Gender Differences and Power Relationships by Michael T Regh, Marcia P. Miceli, Janet P. Near, James R. Van Scotter in Organization Science Vol.19, No. 2, March-April 2008, pp. 221-240
- The key to effective whistleblowing is interprofessional collaboration. BMJ 2009;339:b3055