Doctors complain that the General Medical Council (GMC) does little but strike their colleagues off the medical register. Members of the general public believe that the GMC is too lenient on doctors. These apparently incompatible views are both correct. When a complaint is made against a doctor the main consideration of the GMC is whether the complaint raises issues about conduct or performance that call into question the doctor's right to practise. The GMC lacks powers to consider misconduct or poor performance by a doctor unless it is sufficiently serious to be called “serious professional misconduct” or “seriously deficient performance.” Therefore the only cases considered by the GMC are ones where there is a strong possibility that the doctor will be removed from the medical register if charges are proved. As a result many allegations about doctors that the public considers serious are dismissed by the GMC at the screening stage. I believe that there is inappropriate rejection of serious allegations by lenient screeners.
There is inappropriate rejection of serious allegations
I complained to the GMC about a professor of cardiology who had lied over many years about his qualifications when applying for posts as a senior registrar, honorary consultant, and senior lecturer. He had put a qualification that he had not been awarded after his name on his letters and in medical directories. Although this had been brought to the attention of his academic institution when he was a senior lecturer, his university promoted him to a professorship. The GMC was able to confirm the facts and the professor admitted them. How dishonest can one be before we say this is incompatible with being a doctor? Can we trust the integrity of the research published by this doctor? Should he have an important position in training and examining students and junior doctors? The GMC decided that this misconduct was not even serious enough to take to the preliminary proceedings committee, let alone to the professional conduct committee. I believe that the GMC made a serious error.
One might believe that failure to adhere to the standards in the GMC's guidance Good Medical Practice would be enough for the GMC to consider disciplinary proceedings. I asked the GMC to investigate cases in which eminent doctors mentioned during radio and television programmes the treatment that they had given to patients whom they named. In one case two high profile professors openly discussed the treatment for alcohol abuse one had given to a named celebrity. I asked the GMC to check if the doctors had approval to breach confidentiality. An officer of the GMC wrote back within 10 days saying, “Although we provide guidance to doctors about what constitutes good medical practice, not all alleged breaches of that guidance will warrant formal action by the GMC. We have powers to take action against a doctor only when his or her behaviour justifies restricting or removing his or her registration . . . The incidents which you describe do not appear to raise an issue of serious professional misconduct or seriously deficient performance. Therefore we cannot take this matter further.” I do not understand how a doctor can breach the GMC's Good Medical Practice and face no sanctions for doing so. I believe that many members of the public would share my lack of understanding.
In another case, investigation by the GMC confirmed that a group of doctors did not obtain ethics approval for their research in which they injected patients who had a neurological disease with a radioactive isotope. Screeners for the GMC have been trying to decide for months whether this is serious enough to warrant taking the case to the preliminary proceedings committee. A similar case has previously been thrown out because failure to obtain informed consent from patients participating in research was considered too insignificant to warrant referral for disciplinary proceedings. This is despite the fact that one patient died during the experiment. The complainant has asked the local police to investigate. The police take a more serious view, believing that the patients who were experimented on without consent were assaulted. I intend to ask the police to investigate other cases that the GMC has said were insufficiently serious to warrant disciplinary proceedings.
The public trusts doctors. Most members of the profession merit that trust. It is also right that the public and profession understand that doctors are fallible. We all need to learn from, correct, and forgive genuine errors. This is distinct from dishonesty and misconduct, which should not be tolerated. If the profession wishes to regulate itself we need to ensure that we take appropriate measures to deal with misconduct. Not all breaches of rules such as those in Good Medical Practice will require erasure from the medical register, but they should require a sanction if charges are proved. The GMC must be given powers and funding to consider complaints that do not merit erasure from the medical register, but do require a lesser sanction.