GMC Consultation – Good Medical Practice 2012

This weekend I did my good turn for humanity by responding to the General Medical Council Consultation on Good Medical Practice. This draft guidance encourages debate about what good medical practice should look like in the future. This post isn’t likely to be of interest to many of you, but if you are interested (and can make your way through the appalling formatting – apologies) then please feel free to see my responses that I submitted – and better still discuss/debate/disagree with me – I do love a good online debate! Thanks.

Section 1: Continuity of Care

Q: How important is continuity of care? (Options: Very — quite — fairly — slightly — not)

A: The single most influencing factor in my experience of the NHS has been continuity of care – I reference this as influencing because it has had significant positive and negative impact. When continuity of care is well established, professionals talk to (and respect) each other, work well in collaboration and are able to easily pass information between those involved with providing care – this makes for a top notch customer/patient experience.

When continuity of care is not well established, when computer systems don’t ‘speak to each other’ and different professionals provide you with conflicting messages, when professionals don’t treat each other with respect, when local and professional politics are played out in front of patients, it can add further stress at an already stressful time.

Q: Do you agree that doctors should take action whenever they see poor care?

A: I think all staff, and patients, should take responsibility for taking action when they notice poor care.

Section 2: advising patients on their lifestyle

Q: Do you agree doctors should give patients advice about their lifestyle choices?

A: If we expect doctors to treat patients holistically, and if as a patient I complain when a doctor does not consider me as an individual, then I’d fully expect a doctor to advise me on my lifestyle choices.

Q: Would you be happy for your doctor to advise you in this way?

A: Yes

Section 3: Supporting and encouraging research

Q: Should doctors encourage patients to take part in a research study that is relevant to their condition?

A: I think doctors should provide information, inform patients of the benefits or risks of taking part, and support patients to make their own decision.

Section 4: Doctors’ personal beliefs

Q: Doctors must tell patients of their right to see another doctor if they object to providing treatment themselves. Do you think that’s fair?

A: Yes

Section 5: Openness

Q: Doctors must be open and honest with patients if things go wrong. Doctors have a duty to: 1) put things right if they can 2) offer an apology and 3) explain what has happened and its effects on the patient’s health. We say doctors must do this when patients have suffered harm or distress. Should doctors always follow this guidance when something goes wrong?

A: Doctors invariably know more than their patients, they usually hold the power (and responsibility) in the doctor-patient relationship and therefore it would seem essential that they follow this guidance. I would also expect that patients would follow it to and would be comfortable with a doctor-patient agreement that both signed up to.

Section 6: Doctors treating themselves and those close to them

Q: Do you agree that doctors should, wherever possible, avoid treating themselves?

A: Yes

Q: Do you agree that doctors should, wherever possible, avoid treating their close family members or others close to them?

A: Yes

Q: Do you agree that doctors should be registered with a GP who is not a member of their family?

A: Yes

Section 7: Vulnerable Adults

Q: Do you think that doctors should tell the police or social services, even if the patient doesn’t want them to?

A: Yes. I think *everyone* has a duty to protect and speak up for vulnerable adults or adults at risk. Doctors are in a position where there concerns are likely to be taken more seriously than some other members of society and therefore I’d like to see all doctors taking a more active role in the protection of this group.

Section 8: Maintaining trust

Q: Patients must be able to trust their doctors. So we think that doctors should not do things that could undermine a patient’s trust in them as a doctor, or society’s trust in the medical profession, even in their lives outside their medical practice.

A: I completely agree, however I think this is quite a value laden judgement. I suspect I have a very different view to my parents, for example, about what would undermine my trust, and about what I consider to be professionalism.

If this criterion is important then I think it needs to be made explicitly clear what these standards are considered to be – as a patient I do not wish for the professionals treating me to treat me with disrespect or abuse the trust I place in them. That said, I also think that the GMC, and the public, need to be realistic about what can be expected of doctors – they are after all only human, and need to be treated as such, with real lives in which they may make mistakes.

Section 9: General

Q: Anything else you want to say….

A:  I’m sure that it would be considered implicit in the other sections but as a patient, not a professional, I’d like to see something explicit about communication and an acknowledgement of the patient’s role within the doctor-patient relationship.

In my experience when doctors have treated patients as equals, when they genuinely listened to and responded to what the patient shared, it has led to better clinical, professional and personal outcomes for all. I’m not inferring that the patient always knows best, in fact I don’t believe they do. However, I do believe that much of health is linked to a patients experience of the health service/doctor – not just to their medical treatment, and therefore I’d like to see something that explicitly references communication between professionals and patients, and acknowledges the power balance between them.

So what do you think?

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3 thoughts on “GMC Consultation – Good Medical Practice 2012

  1. Hi George,
    I like what you have written but have a different view on several counts.Section 5: I dont believe doctors always know more than the patients. Although the patient may not know the medical term for something or the cure, invariably they have a felt sense that something isnt right. The doctor brings the skills and techniques but the patient knows themself better than anyone. This creates a more equal dynamic for this relationship that I personally prefer.
    In the past doctors have been given all the power especially if we look at our parents generation, they always trusted doctors. Doctors are not infallible and an authoritarian position can at best be unhlepful and at worst lead to abuse of that power.

    Section 7: Tell the police what? That they are vulnerable? Some police divisions have vulnerable persons unit these days so possibly. Depends on what that means if you disclose that. What will they do with thisn information.Of course its different if there is possible harm to self or others, in which case they should be encouraged to speak for themselves, if not and you have serious concerns letting relevant people know would be a good idea so that the vulnerable person can get the support they need.

    Hope this makes sense I wrote it early when just waking up!

    Regards
    Laura

    1. Thanks very much to everybody for your interest. We’d urge anyone reading this to have your say – it needn’t take long. We’ve got different questionnaires to suit doctors and patients, as well as a longer questionnaire for those who have the time.

      See how to participate at http://www.gmc-uk.org/guidance/10780.asp – we’d love to hear from you.

    2. Hi Laura

      Thanks for the reply – as ever, really appreciate the discussion. I’m inclined to agree with you on Section 5 (and am now slightly concerned I was too moderate in my submission), I guess I was responding to the GMC and probably therefore being quite compliant 😉 I agree with what you say, and would prefer genuine partnership, I guess I do think there is a power imbalance and I’m not sure patients always know themselves best. Not sure, think its a great discussion.

      Section 7 – I think it is *everyone’s* responsibility to advocate for those less able than themselves – certainly when there is suspicion of abuse. This is my lazy copy and pasting to be honest – the consultation document is much clearer on this point, I’ve just not done it justice.

      Thanks for the thoughts, hope you get to submit to GMC too. Cheers, George

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