One strike and you’re out – a medical student perspective of GMC erasure case.
Dear editor,
The high-profile case of the manslaughter charge brought to Dr Bawa-Garba has received significant attention from the medical community and wider public. The decision by the General Medical Council (GMC) to strike Dr Bawa-Garba off the medical register fails to address the systems failures associated with the case(1).
The GMC states that in addition to protecting patients, they also act to safeguard public confidence in doctors. This ruling seems to achieve neither objective. The Medical Practioners Tribunal Service (MPTS) concluded that Dr Bawa-Garba was not a continuing risk to patients and so removing her only furthers the ever-present staffing pressures. Retrospectively, the media coverage has not protected public confidence either. Perhaps the motive behind this ruling is to protect the reputation of the NHS, over the doctors that work for it. This might be fair considering that many see doctors as synonymous with the NHS, however it implies that as a profession we will be held legally responsible for what are ultimately institutional failings.
Exceptionally troubling is the news that Dr Bawa-Garba was prosecuted using her own reflections, as written reflections and feedback are deeply embedded in professional development. Some hospitals have already issued guidance to their juniors regarding this, but as students it is unclear as to the role and potential weight of reflections currently used in undergraduate assessment.
A previous letter addressed to Professor Stephenson to the GMC chair aptly summarises a core failing in this ruling which has significant impact on the overstretched workforce in the UK’s health system – doctors receiving blame for lack of training and supervision(2). From the perspective of two medical students who will shortly enter the National Health System (NHS) as foundation doctors, defensive medicine and ‘covering your own back’ are increasing and very real worries that the prospective doctor holds. The impact of the GMC’s ruling moves the focus on reasons for initiating treatment from purely patient needs to also the doctor’s needs, specifically to protect oneself legally.
This feeds into a culture of erring on the side of caution with potential for over treatment – unnecessary expenditure of limited resources, potential morbidity and in the case of sepsis, higher rates of antimicrobial resistance. Whilst in the case of Dr Bawa-Garba sepsis treatment should have been initiated in a timely fashion, it is clear that several factors contributed to the unfortunate death of Jack Adcock. Laying the blame on the shoulders of a single clinician lays a precedent for overaggressive treatment approaches from clinical staff. We are left confused as what to do in Dr-Bawa-Garba’s situation, from our perspective the alternative was to refuse the shift – how tenable is this in already pressurised healthcare system? Clinicians presently are expected to patch rota gaps, with an expectation of stepping into roles often outside of competency or personal capacity.
It seems an impossible situation – an organisation driving towards efficiency savings and ever-optimization of patient care, with a workforce who likely must second guess their clinical judgement to cover themselves. In a healthcare system that now more than ever needs to maintain its workforce quality and quantity, the implications that this ruling will have on practicing and prospective doctors daily practice and training is unclear. Should medical students, or indeed, medical schools, develop training in self-assessment of competency to ensure clinicians avoid accepting unsafe roles?
Rapid Response:
One strike and you’re out – a medical student perspective of GMC erasure case.
Dear editor,
The high-profile case of the manslaughter charge brought to Dr Bawa-Garba has received significant attention from the medical community and wider public. The decision by the General Medical Council (GMC) to strike Dr Bawa-Garba off the medical register fails to address the systems failures associated with the case(1).
The GMC states that in addition to protecting patients, they also act to safeguard public confidence in doctors. This ruling seems to achieve neither objective. The Medical Practioners Tribunal Service (MPTS) concluded that Dr Bawa-Garba was not a continuing risk to patients and so removing her only furthers the ever-present staffing pressures. Retrospectively, the media coverage has not protected public confidence either. Perhaps the motive behind this ruling is to protect the reputation of the NHS, over the doctors that work for it. This might be fair considering that many see doctors as synonymous with the NHS, however it implies that as a profession we will be held legally responsible for what are ultimately institutional failings.
Exceptionally troubling is the news that Dr Bawa-Garba was prosecuted using her own reflections, as written reflections and feedback are deeply embedded in professional development. Some hospitals have already issued guidance to their juniors regarding this, but as students it is unclear as to the role and potential weight of reflections currently used in undergraduate assessment.
A previous letter addressed to Professor Stephenson to the GMC chair aptly summarises a core failing in this ruling which has significant impact on the overstretched workforce in the UK’s health system – doctors receiving blame for lack of training and supervision(2). From the perspective of two medical students who will shortly enter the National Health System (NHS) as foundation doctors, defensive medicine and ‘covering your own back’ are increasing and very real worries that the prospective doctor holds. The impact of the GMC’s ruling moves the focus on reasons for initiating treatment from purely patient needs to also the doctor’s needs, specifically to protect oneself legally.
This feeds into a culture of erring on the side of caution with potential for over treatment – unnecessary expenditure of limited resources, potential morbidity and in the case of sepsis, higher rates of antimicrobial resistance. Whilst in the case of Dr Bawa-Garba sepsis treatment should have been initiated in a timely fashion, it is clear that several factors contributed to the unfortunate death of Jack Adcock. Laying the blame on the shoulders of a single clinician lays a precedent for overaggressive treatment approaches from clinical staff. We are left confused as what to do in Dr-Bawa-Garba’s situation, from our perspective the alternative was to refuse the shift – how tenable is this in already pressurised healthcare system? Clinicians presently are expected to patch rota gaps, with an expectation of stepping into roles often outside of competency or personal capacity.
It seems an impossible situation – an organisation driving towards efficiency savings and ever-optimization of patient care, with a workforce who likely must second guess their clinical judgement to cover themselves. In a healthcare system that now more than ever needs to maintain its workforce quality and quantity, the implications that this ruling will have on practicing and prospective doctors daily practice and training is unclear. Should medical students, or indeed, medical schools, develop training in self-assessment of competency to ensure clinicians avoid accepting unsafe roles?
1 Cohen D. Back to blame: the Bawa-Garba case and the patient safety agenda. BMJ 2017;359:j5534.http://www.ncbi.nlm.nih.gov/pubmed/29187347
2 Ross N. Letter to the GMC chair regarding Hadiza Bawa-Garba. BMJ 2018;360:k195.http://www.ncbi.nlm.nih.gov/pubmed/29348300
Competing interests: No competing interests