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Dr Rosin's secretary, Eve, has come into his consulting room with his post.

(The story so far...)

Dr Rosin is consultant in a busy obstetrics and gynaecology unit. Six months ago, he took action in relation to the poor attitude and behaviour of Dr May, a junior doctor in a training post. After remedial training in team working and communication skills, Dr May decided to take up a post in a non-clinical speciality where he would not be directly responsible for patient care.



I think that's about it for today...oh, Dr May's sent you a CV with a request for a reference.

Dr Rosin

Dr Rosin

Oh really? Well, let's see what he's been up to since he left us...



...under a dark cloud as I recall...

Dr Rosin

Dr Rosin

I don't believe this! He's applying for a place on a general practice training scheme! With his communication skills?! Last I heard he'd switched to non-clinical medicine. I hardly think that someone who brings patients to tears is going to...oh but this is ridiculous! He says on his CV that while in the Obs & Gynae post he "enjoyed a good rapport with colleagues of all professions and grades"!



Ha! I reckon some of the nurses might have something to say about that! Why don't you just refuse to write the reference. If you can't say anything nice, don't say anything at all, I always say.

What should the doctor do...? (Select A,B or C)


Write a full and frank account of Dr May's performance in the Obstetrics & Gynaecology post, including his problems communicating with patients and staff?


Refuse to write the reference about Dr May because he feels he could not honestly give a positive one, and is concerned that writing a truthful reference could be defamatory?


Write the reference, leaving out any specific information about Dr May's attitude and communication problems, instead stating purely factual statistical information about his performance while he was on the rotation?

Dr Rosin

See what the doctor did

Dr Rosin wrote a reference for Dr May, being careful to ensure that what he wrote was factual and not based on his personal views, or those of his other team members. In commenting on Dr May's suitability for the general practice training scheme, Dr Rosin included information about a complaint made by a patient about Dr May, which he judged to be relevant.


You must be honest and objective when writing references, an when appraising or assessing the performance of colleagues, including locums and students. References must include all information relevant to your colleagues' competence, performance and conduct.
(Good medical practice, paragraph 41)

4. Prospective employers use references to gather information about a candidate's qualifications and employment history and to help them assess their suitability for the post in question.1 They also give both employers and candidates an opportunity to verify the information supplied in an application. So you should write references in a way that is fair to both the candidate2 and the prospective employer.

5. Employers need to be confident that they can rely on the information in references, particularly when they are employing healthcare professionals. Candidates also need to be confident that references written about them are accurate and reliable. A reference that presents an inaccurate picture of a prospective employee could lead either to an unsuitable candidate being appointed or the most suitable person not being appointed. In some cases this will put patients at risk of serious harm and it may undermine trust in the profession.

6. You must be honest and fair when providing references. You should usually provide a reference if you are the person best placed to do so. When providing a reference, you should state the basis upon which you are making your assessment of the candidate, such as how long you have known them and in what capacity.

7. When assessing whether information is relevant, you should consider whether including it (or leaving it out) could mislead an employer3 about either a specific issue or the overall suitability of a candidate. If you agree to provide a reference, you must do the following.
Only provide comments that you can substantiate.
Provide comments that are objective, fair and unambiguous.
Do not base comments on your personal views about a candidate that have no bearing on the candidate's suitability

8. You should include all information you are aware of that is relevant to a candidate's professional competence and be prepared to provide evidence to support this, where appropriate.

9. You should provide information about a candidate's conduct, including matters that might affect a patient's trust in the individual candidate or the public's trust in the profession as a whole.

10. You should draw attention to any other issues that could put patients at risk. This may include information relating to unresolved, outstanding or past complaints about the candidate's competence, performance or conduct, if you judge that this is relevant to the candidate's suitability. You should take reasonable steps to check the information you provide. If this is not practical, or the information is incomplete, you should make this clear.

11. You should not usually include personal information about a candidate, for example in relation to their health, in a reference. However, a situation may arise where you are aware of confidential information about a candidate that has a direct bearing on their suitability for the particular post in question. In these circumstances, you should get consent to disclose the information. If this is not practical, or consent is withheld, you should consider whether the benefits (to individual patients or the public) of disclosing the information would outweigh the possible harm to the individual candidate. For example, including health information may be justified if it is necessary to protect patients from risk of serious harm.5 You can find more guidance on releasing information in the public interest in paragraphs 36-56 of Confidentiality.6

13. If you are not sure about whether to include information in a reference, you should consider getting advice from your medical defence body or a professional association such as the British Medical Association.
(Writing References, paragraphs 4 - 13)