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Indicative of Tendencies Dangerous

Posted by Dr No on 16 November 2013

dangerous_tendencies.jpgPloughing through General Turkey Council Fitness to Practice data with a tractor ever more bogged down in numerical mud, Dr No got distracted by another question: what do ‘erased’ – the chilling term used by the GTC in place of the plebeian ‘struck off’, chilling because where the plebeian leaves a name albeit with a line through it, erasure effects obliteration, total obliteration, for not even a name remains – doctors get erased for? In the past, one was encouraged to suppose it was the three As, alcohol, advertising and adultery, a supposition borne out by the General Medical Council’s, as it was then, 1965 ‘Blue Book’ guidance, which does indeed list the three As (alcohol comes under splendidly archaic ‘Offences Indicative of Tendencies Dangerous to Patients’ heading), along with other examples of ‘infamous conduct’ likely to bring a doctor to the Council’s attention. But over time, as two of the capital As have become, so to speak, of lower case severity, we might suppose that ‘gross neglect in diagnosis or treatment’, the 1965 heading for clinical failings, might have risen in prominence, such that today most doctors are struck off for substandard treatment. But what are the facts?

Curiously, because we might expect Stilton keen to highlight the character of those misdemeanours most likely to end in erasure, the GMC is somewhat coy about allegation numbers. The Council does publish regular annual FTP statistics, and routinely provides reports on individual hearings, but in only three recent years (2009, 2010 and 2011) has it released allegation statistics detailing, inter alia, the commoner allegations faced by doctors whose final outcome is erasure. Sure enough, substandard treatment makes the top five allegations leading to erasure in each of the three years, and there we might leave it, an unremarkable finding, were it not that underneath that unremarkable finding lie two remarkable, even startling, observations.

En passant, Dr No should perhaps note that there may be a small element of fiction in the factsheets: figures are not always carried across accurately from year to year, and at least two ‘top five’ tables have, rather bafflingly, eight rows, but it remains the only detailed data we have, despite a real turkey of an opening disclaimer: ‘any outcome attributed to an allegation may actually be a result of other allegations’…but then again, we are where we are.

The first observation is that while substandard treatment is one of the commonest allegations leading to erasure, it is not, of itself, a common cause, a reflection of the fact that none of the causes are, of themselves, particularly common. Taking the three years together, substandard treatment is the primary allegation in less than one in five of all erasures, such that over eighty percent of all erasures result from allegations that either have little or nothing to do with direct harm to patients – financial deception, fraud, 'failing to cooperate' with the authorities – or at best are only potentially, and often remotely at that, related to patient harm – poor record keeping, inappropriate (usually self or familial) prescribing. The GMC will no doubt argue that these allegations indicate ‘tendencies dangerous to patients’, and no doubt in some cases they do, but the starling fact is most – over eighty percent – of erasures do not come about because of primary allegations of direct patient harm. Indeed, the commonest allegation placing a doctor before an FTP hearing (an earlier step in the chain) in 2011 was not clinical care (30% of doctors), but probity (44% of doctors).

The second observation is that the numbers of erasures for substandard treatment are small: 9 (2009), 15 (2010) and 13 (2011). These figures can be played many ways, be it from showing the GTC is roasting the wrong birds through to a claim that they show the vast majority of doctors are generally competent. But what makes these small numbers, or rather their comparison, startling, at least to this observer, is when they are placed alongside the number of deaths among doctors subject to ‘an FTP matter’ over the same three years. Compared to 37 erased for clinical failings, we now know, from data released here, that at least – Dr No suspects the data may not be complete - 30 doctors died under investigation over the same period. In broad terms, almost as many – possibly more, if there is significant under-reporting - doctors are erased by death as are erased by an FTP panel for substandard treatment. Surely the time has come to concern ourselves not just with medical tendencies dangerous to patients, but equally with GMC tendencies dangerous to doctors.

1 comment:

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