The tipping point: a question of conduct
The new edition of Good medical practice was published on 25 March 2013 and comes into effect on 22 April 2013. This page is part of the record of the review process.
In September's opinion piece, Miss Shree Datta, Specialist Registrar in Obstetrics & Gynaecology, Co Chair British Medical Association's Junior Doctors Committee, comments on the extent of a doctor's duties outside medicine.
The review of GMP offers an excellent opportunity to dissect and critically analyse the exact implications of some of the existing areas of guidance. One area which stands out in particular is the scope and extent of doctors' obligations outside medical practice. The current guidance suggests that GMC action is not limited to cases of illegality or where there is a link to the doctor's medical practice:
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.
This principle is used to justify action in GMC cases where doctors' actions are judged to have undermined public trust in the profession, but where the doctor's professional competence, skills or knowledge are generally not in question. In the past the GMC identified 'personal behaviour: conduct derogatory to the reputation of the medical profession' as one of the grounds for bringing disciplinary proceedings. The current formulation is intended to reflect the purpose of maintaining the reputation of the profession.
But what does this actually mean for the everyday junior doctor? As it currently stands, the guidance suggests that our personal actions and decisions could be questioned by the GMC. More disturbingly, this inclusion of conduct outside of working hours is a worrying concept for younger doctors who are experiencing their first taste of a medical career, amongst many other new responsibilities in life. The suggestion that our conduct must justify patients and the public's trust at all times may be an almost impossible task, blurring the boundaries between personal and professional conduct. It is not unusual for any employee to selectively present themselves at work, with their professional conduct differing from their personal beliefs and behaviours. There is little reassuring detail to distinguish between what is acceptable from what is deemed inappropriate - and whether all doctors will be investigated for the same offences.
The GMC says that patients - who may be vulnerable when they seek medical care - need to be able to trust doctors implicitly. Patients may let doctors into their homes, tell them very private or intimate details about their lives, or allow themselves to be examined, sedated or anaesthetised. Honestly and integrity is therefore fundamental to the success of the doctor/patient relationship. But are doctors really expected to be revered members of the community, given respect and deferred to as a matter of course? We are trained and expert in a profession, but this does not make us immune from making mistakes off duty. No more should be expected of us in our lives beyond medicine than of anyone else.
There must be scope for the perceived severity of the offence to be considered; criminal convictions and fraud are perhaps obvious examples of what is not acceptable. However, the implications of police cautions for minor conduct offences such as speeding are magnified by the current guidance and may encroach on our privacy. The impact of the guidance on social networking is also not clear cut; could a flippant comment on Facebook at 3am after a busy on-call be "vetted" by the GMC? The simple fact is that people make mistakes and it is unrealistic to expect doctors alone to remain flawless at all times in every aspect of life. Yet the current guidance suggests that that is what is expected of doctors and arguably does not ringfence our privacy or allow for our personal autonomy. Furthermore, my concern lies with the potential extrapolation of this guidance to students. What would be the future consequences for doctors who have, for example, in their undergraduate years furnished medical student bars with street signs, or collected a street cone as a souvenir of a social evening?
The risk is that young doctors may feel unable to enjoy their opportunities or express themselves naturally outside the working environment for fear of a private indiscretion being scrutinised by others, misinterpreted and reported to the GMC. Our responses, actions and decisions are partly influenced by external factors such as our working patterns and family illnesses, but there seems to be little allowance for such factors in the guidance. The evidence to suggest how much a doctor's behaviour outside the medical world reflects their competence as a clinician is not exact. The question therefore remains - what's the tipping point to refer doctors to the GMC, and will different groups of doctors be held to the same standard?
The GMC's review of GMP is certainly welcome and the implications of this key area of guidance should be reflected upon as a priority because the boundaries of what is expected of doctors, professionally and personally, must be clarified. Good Medical Practice needs to be concise and clear, and take into account both professional and public views of the conduct and behaviour that should be expected of doctors. Although well-intended, the underlying consequences of the current guidance may well influence the type of doctors we nurture in the UK for many generations to come.
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