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Dropping Like Flies


Posted by Dr No on 23 August 2013

flies.jpgThe Inquisition known for the time being as the General Medical Council is under fire. Its fitness to practice procedures, which for doctors caught on the sharp end of one of Stilton’s prongs feel much like being popped into a beaker of dilute sulphuric acid with a rack of Bunsen burners arrayed underneath, have come under scrutiny because of an apparently high mortality attached to being left to simmer in warm sulphuric acid. Figures available online suggest that there were at least 92 deaths between 2004 and 2012 in doctors under investigation. The denominator – which Dr No suggests should be the number of GMC cases referred to panel investigations – stands somewhere in the region of 2300 (see footnote), giving an approximate average annual mortality rate of 4%. Working age (25-64) mortality in the same period was around 200 per 100,000, or 0.2%. Something is clearly going on. If we apply some crude ‘observed over expected’ numerology to these figures, we get a (very) crude mortality ratio, on the normal 100 base, of around 2000: that is, where we would expect 100 deaths, we find 2000.

This figure is crude – that is, not adjusted for age or sex or any other factor of known or possible relevance - occupation springs to mind, as health care professionals are known to be prone to suicide. Nor does it tell us about confounding or chicken and egg causality - maybe the doctor was under FTP investigation because of irregularities caused by a life threatening, perhaps mental, illness. But, even with due allowance for those lack of refinements, the figure is eye-wateringly large. Something is clearly going on. Doctors under FTP investigation really do appear to drop like flies.

Yet the extraordinary thing is that we know next to nothing about these deaths. The GMC does record deaths in doctors undergoing FTP investigation, but until recently this has been largely as an ‘administrative event’ that triggers closing of the file. No doubt the Lord-of-the-Flies elements in society will claim good riddance – them quacks must have been bad’uns, otherwise they would never have got caught up in Stilton’s machinery. But that is itself an extraordinarily harsh judgement. No doubt some of the doctors will turn out to be bad’uns, but there will also be the innocent who – had they survived – would have been cleared, and those suffering from mental illness which, while it may even have contributed to their death as to their falling foul of the GMC, is hardly cause to turn a blind eye to their fate. Indeed, some have gone so far as to say deaths while under FTP investigation should be ‘never events’ for all health care workers, a laudable aspiration (Dr No is not being tongue in cheek), but one which perhaps should be tempered with an acceptance that some natural and causally unrelated deaths are inevitable.

What is needed is an in-depth enquiry – the proper terminology is a confidential enquiry, which has wide ranging powers to investigate – into these deaths. Dr No is not normally one to support causes or urge action – he sees his role more as commentator, with readers free to draw their own conclusions, and act as they see fit – but on this matter of 2000 deaths where 100 are expected, he is going to make an exception and suggest readers may wish to review and consider signing this e-petition, which calls for just such an enquiry.

Footnote: The GMC’s own annual figures for 2005 to 2011 are available here, here and here. Averaging those annual figures and multiplying by eight (to cover the eight years 2004-2012) gives an estimated 2337 cases referred to FTP investigation over that period.

61 comments:

Thank you, Dr No.

We need to know what happened to those doctors as much as possible and in public interest.

There may be individual factors to do with doctors only or mixture of social/political circumstances that were so detrimental one could not wait to close their files.

It is not normal that suicide rate for men has been three to four times higher than in women in UK for decades. In other countries it is not like that. Government has already decided to deal with these discrepancies but we do not have information as to what happens in doctors.

For example, humiliation has detrimental effect on mental and physical health and can lead to death.

I have had a brush with injustice so know of the emotions involved in such situations - damage they do, destroy they may.

Petition signed.

Anna, thank you so much. Please, be so kind to send the link to at least twenty people in your contact list and please, ask them to do the same. Five cycles of friendship like that and we are done. We need 100,000 signatures to secure a debate in Parliament.

http://epetitions.direct.gov.uk/petitions/54034

Not terribly many have signed it so far. I don't suppose for one moment the BMA would give it any publicity?

Anon on 25-8-2013 @ 11:17

I agree. It appears that people sign and then not forward it on to their contacts. Some doctors say they are afraid to sign in case they are monitored.
BMA could give it publicity as you say. They certainly, have the resources. I wrote on doc2doc forum about the petition but their editor is asking for me to write a paper on it.
Facts are shocking.
You may wish to write to BMA or comment on doc2doc or other fora

Anon on 25-8-2013 @ 11:17

I agree. However, our petition is rated as "trending" and appears in the top two pages on the website. A petitions' trending is based on the numbers signed in the last hour. When a momentum gathers it can all happen very quickly.

We got to get the message out that people not just sign it but forward to their contacts, all of them, in batches so anti-spam program does not catch them

Forgive me but I am on your e-mail list because I am terribly afraid of a doctor who practices and resides in the UK. I never came forward with my story due to fear for my personal safety. He is a brilliantly manipulative and powerful man. Thank God I live in the United States, far away from him. My experience was never about his ability to practice; it was about his disturbingly dangerous and sadistic personal behavior. I am not paranoid; I am a realist who sees the tragedy of injustice at many levels of this story. I wish you well.

Afraid To Sign, yes, there re frightening people around. I met more than one manipulative doctor and once they are part of the establishment it is difficult to dislodge them. Our petition is very important because it will uncover much wrongdoing and it has to be confidential (to protect patient identity) and independent enquiry - not done by medical profession. You are free to forward petition to your contacts in UK and if you did sign your signature does not show to others.

Thank you for starting this important petition and for making us aware of these shocking figures that represent untold emotional torture. Why did I feel afraid when I signed it - what does that say about our medical culture? If so many suicides only from GMC investigations I wonder how many through all the other types of investigation. Also other health professionals, students. And what of those who survive...

It is indeed telling of our times and professional culture that many of us (Dr No included) feel a twinge or more of apprehension on putting our names to the petition. But, Dr No likes to think, the risks are minimal. All we are saying the that there appears to be a very high excess mortality and we think that should be properly looked in to by way of a confidential enquiry. We also know that senior members of the profession are equally (and publicly) concerned: Dr Rajan Madhok (BAPIO) has raised the matter in both the BMJ and HSJ, and Dr Clare Gerada (RCGP Chair) is on record suggesting that death while under FTP investigation should be a 'never event', so to that extent we are in good company.

Quite agree that it's not just doctors - other health care workers/students are likely to be affected. And while death is extreme, it is also likely to be just the tip of an iceberg of great stress and terrible suffering, all awash in a Stygian pit of blown careers and busted souls.

Lastly, it's Helen Bright who deserves the praise for establishing the petition - all Dr No did was write a post about it!

Thank you Helen for creating the petition - is there a website explaining it? I'm being told by some that the figures seem too incredible to be true (I've seen them myself in your FOI request).

I feel perturbed that our own GMC subscriptions are funding these deaths... Does anyone else get that feeling? We subscribe just the same as we do for College fees, BMA and MDU - all go out by direct debit, all send a journal. It feels as if I'm a 'member' .. yet unlike the other organisations the GMC is compulsory (a separate issue of course whether or not we should personally fund the GMC).

I agree

The number of deaths does seem very high, even incredible, were it not for the fact the source of the data is the GMC itself. In effect, the GMC has a register of all doctors subject to FTP investigation, and each individual case 'file' has to be 'closed' by some event, one of which is the death of the doctor. So, in general terms, the 'case-finding' is likely to be somewhat better than, for example, trying to pick up the deaths through some remote monitoring service or survey technique (think cancer registries vs scanning death certificates).

Secondly, there is the Medical Register itself, which one imagines Stilton is under a duty to keep as up to date as possible, which amongst other things will mean removing ('erasing' in GMC-speak) doctors who have died, that is to say the GMC needs to know when a doctor has died, so it can keep the Medical Register up to date.

So, in general terms, 'case-finding' should be reliable, so far as it goes. A few 'cases' may fall through the cracks, but most will be identified. However, incredible as it may seem on a figure that is already incredible, the number is likely to be an under-estimate of all FTP related deaths. If you look at the GMC's response to the FOI request, the identified 92 death are doctors 'erased...as deceased' who 'at the time of their erasure, had an open fitness to practise case concerning them'. So the number explicitly excludes any deaths occurring after any FTP proceedings had been concluded. It is not beyond imagination that further perhaps FTP related deaths occur after case closure. Perhaps we should apply ye olde 'year and a day' rule, and ask how many doctors were 'erased as deceased' not only with open FTP cases, but within a year and a day of the closure of their case.

The more I think about it, the more I appreciate that these are reliable figures. This is nothing like trawling through patient notes or carrying out a clinical audit.

I agree that number of deaths within a year (and a day?) should be asked for. Also I don't know if there are other types of GMC investigation.

Even that word 'erasure' is terrifying isn't it? It has connotations of a person's identity being ironed out and not just their registration.

Hands up then who would like to make the FOI request... Perhaps Dr Gerada or Dr Madhok?

Doctors who are erased are pushed onto the margins of society. They find as time goes by that their civil rights in society are non existent. No one listens to them, they are shut out from justice in other ways and become permanently traumatised. The GMC is a corrupt and venal organisation that any self respecting country would have closed down by now. The GMC greatly enjoys torturing those whom it has in its sights. Look inside it as I have. It is beneath contempt, dangerous and life threatening to some. It should be closed down.

is there a Facebook link that can be shared to advertise this petition more widely?

is there a Facebook link that can be shared to advertise this petition more widely?

Here is the link to the new page just made this morning:
https://www.facebook.com/pages/Doctors4Justice/567247416655900?fref=ts

Please, use it and it will develop

I agree that doctors (and nurses) are being forgotten about in the rush to demonstrate complete openness in investigation of medical performance.
The pusruit of someone to blame along with the confrontational nature of public and GMC enquiries leaves doctors hanging out to dry. As if the job wasn't streesful enough without the threat of such interrogatiojn and investigation.

The concept of the GMC as an organisation fills me with wonder! I am all for an organisation that looks after the patients well being and polices doctors behaviour and practice. But the GMC is simply an exercise in making money. The organisation is vindictive and inept! Too many innocents get prosecuted too justify the organisations existence and too few corrupt inept doctors are penalised because they are usually manipulative and know how to work the system. Furthermore why do I have to pay for the existence of this organisation which persecutes me! It makes no sense. The solution is simple. All doctors must unite and refuse to pay the extortionate fees that are raised year after year!

Editor's Note: comment edited to remove potential copyright infringement (linked post had been cut and pasted verbatim)

Interesting blog here: Monday 13 May 2013: Occupational hazard-links between professions and suicide risk have changed over time. Suggests 'traditional' high suicide risk professions including doctors have lowered their risk in recent decades. If the high death rate amongst FTP doctors is partly due to higher suicide risk then that suggests the contrast is even more stark...

Perhaps the overall suicide risk is lower due to the higher proportion of women in the profession? The risk for men could be the same (or higher).

I've searched but the petition isn't being mentioned in the press (1,073 signatures). Came across more GMC horror stories in another petition (has no date and looks as if signing is public). Click on 'view signatures' to read the comments.

http://www.petitiononline.com/phipps/petition.html

That enquiry is not only crucial to doctors wellbeing, it is also important to shed light what led to the referral to GMC.

http://www.pulsetoday.co.uk/your-practice/practice-topics/regulation/gmc...

Still needs a Confidential Enquiry, as per Helen Bright's petition - that now has its first plug in the press on Pulse.

Thank you Dr No.
May I suggest you ask 'survivors' of this barbaric process!
It's not just the GMC.
It's the opprobrium, the lack of support from employers and colleagues, downright abuse, the public nature of the investigation, the 'balance of probabilities', the (fear of) loss of a career.....
I'm only surprised it's not more!

Dr Know does no directly of a number of individuals who have been detained at Stilton's Pleasure, and has also received private communications from others who have been through the same crushing mill. What is striking, at least to Dr No, is the similarity of the accounts: the bullying bruising habits of Stilton's goons, the double jeopardy nature of 'the (GMC appointed) psychiatrist will see you now' sub-routine, and the sadistic ways of the GMC lawyers. The whole process appears to have everything in common with medieval witch-hunting, and nothing to do with considered and proportionate modern approaches to professional regulation.

Those who have read Dr No's other posts will know that broadly summarised his views are that external regulation is an industry doomed to failure. Stilton's racks will get ever longer, and his vats of hot oil ever hotter, but still the big ones will get away, while an ever increasing number rank and file will get hung drawn and quartered to no possible benefit to anyone, let alone the poor doctor whose personal and professional entrails get splattered.

What we need now, Dr No suggests, is a dossier of despair in which doctors who have been through Stilton's dark and satanic mills give accounts of their experiences. Informally this is already happening, but the accounts are diffused and the cumulative impact of their collation lost. Dr Bright, a veteran of those dark and satanic mills herself, might be prepared to host such a dossier on doctors4justice.net: all that would be needed is a post as a 'collection header', with personal accounts added as comments. There would need to be some attention to detail, including but not limited to inhibiting multiple postings of the same account, and attention to concerns (both ways) about anonymity. But it should by no means be beyond the wit of man or woman to achieve it, and with its achievement we would have a hard-hitting dossier of human despair that might, just might, cause a press largely indifferent to a statistic of 92 to perk up at the harrowing and all too human cost of a modern-day variant of witch-hunting.

Excellent idea - a compilation of experiences is needed. It would be a harrowing read no doubt :(

One day someone will make a voice recording in the public interest... public interest is of course an excuse they enjoy hiding behind so they might appreciate the tables being turned on them!

Meanwhile the petition has 1284 signatures: http://epetitions.direct.gov.uk/petitions/54034 with about 6 weeks to go.

I am a Medicolegal Champion for doc2doc. Having read Dr Nos' views and subsequent comments it seems clear to me that this issue should be raised on doc2doc(possibly it already has been but I can't access the search facility due to a technical problem and I don't immediately recall). How reliable is the collated data? Have you received any response whatsoever from the GMC in relation to the figures? I will raise this on doc2doc, but will look into it a little more closely first. If anyone can assist me with information please email me at: kirked@justice.com

EK 08/10/13

Hi EK, great that you're interested. Doc2doc as in BMA? Helen posted there and was editorially quashed before she could take a breath. This made me wonder. A search of BMA + GMC reveals they are mates. Great as I pay both - maybe a discount is in order? Please do try again as it is so difficult for this issue to be aired and it is effectively invisible. Seriously, there would be more signatures on the petition if we had gone out with clipboards.

Re the information, the links in Dr No's explanation on here will lead you to the FOI request and the expected mortality rate. The numbers are stark: this is not hypothesis but actual deaths. The gmc has now announced its own internal inquiry thanks to Helen's petition yet it had already gone into partnership with the BMA for counselling services...

These statistics relating to deaths of doctors under investigation by GMC are truly alarming.

The Association of Surgeons of GB and Ireland (ASGBI)has long held the view that the GMC is, with regards to it's disciplinary function, inadequate and unfair .

See ASGBI newsletter, no 27, Sept 2009 for comment about the GMC based upon an article entitled "Is the GMC fit for purpose"

(Go to ASGBI website, select publications and scroll down until Sept 09 issue reached, or contact ASGBI direct and they will supply a reprint)

My experiences of Medical Misfortune mirror many. A close friend, a kind sensitive doctor (I am not!) killed themselves after a minor much locally publicised complaint..”Why?” ..One wonders?
Many Doctors under duress are "brittle" in Schopenhauerian terms and break too easily.

Another I knew, took a fatal overdose just a week after a patient said in a crowded and witnessed waiting room..

“Call yourself a doctor
You are bloody useless”

Obviously the final straw and quite trivial really. So why do they do it?

… Perhaps from isolation from years of study, perhaps just the way Medicine is structured. The Legal Profession and Politicians seem far more able to cope with duress or misfortune, I have my own theory on “Why?” and it is not derogatory to these two noble Professions at all.

My Medicine noir fact and fiction blogs may be of interest to some. Although my target audience is not the Medical Profession.

Dr No was somewhat irked last weekend to discover that a favourite remark of his - better an approximate answer to the right question than an exact answer to the wrong question, which he coined in the 1990s while under the stewardship of that stickler for precision, Professor Walter Holland - had in fact already been long attributed, incorrectly as it turns out, to the well known numerologist John Maynard Keynes (the true origin is thought to be 'It is better to be vaguely right than exactly wrong', coined in 1898 by an entertaining cove rejoicing under the name Carveth Read).

These musings arise because Dr No has received a well meant (and well received) critique that the data and calculations used in the original post were verging on the sloppy, and so offered an Achilles heel to those who would poo-poo the very high excess mortality among doctors subject to FTP investigation. Dr No used the figures he did (from poverty.org.uk) because they are both ONS based and readily available, unlike ONS data itself, the discovery of which tends to be a project of Byzantine perplexity. Dr No took the view that the poverty.org.uk figures were 'good enough', and provided, as they did, an approximate answer to the right question, rather than an exact answer to the wrong question.

Nonetheless, a day or so after posting, Dr No did, for the sake of robustness, extract original ONS data and re-run the calculations, and was satisfied the original post figures were indeed good enough, and so did not merit a re-write, something which in general terms Dr No tends to frown upon: once posted, a post stands. That said, for those who do want to verify the original figures and calculations, here they are (from the ground up, for those not familiar with the methodology):

Mortality ratios (including of course Sir Jar's infamous Hospital Standardised Mortality Ratios) are ratios between the observed number of deaths and the expected number of deaths (O/E), conventionally multiplied by 100, such that a mortality ratio of 100 means the observed number of deaths match the expected number. A ratio greater than 100 means more deaths than expected, a ratio less than 100 means less deaths than expected, 'all other things being equal'.

To calculate a mortality ratio, then, one needs the observed number of deaths, and a way of estimating the expected number. Since all manner of things can influence mortality, a further sophistication is to standardise the ratio. Conventionally this is done at the very least for age, age being one of the biggest determinants of mortality (hence age standardised mortality ratios) and often for other factors - say co-morbidity - that undoubtedly have an influence on mortality. In short order things can get rather complicated, and the calculations subject to vagaries in the underlying data (one of the flaws in Sir Jar's HSMRs), and furthermore the estimation of confidence intervals (and so interpretation) is prone to a certain elasticity of method.

None of this need bother us here, for the simple reason that we do not know the age distribution (or anything much else, for that matter) of the 92 doctors who died while under FTP investigation. We can however surmise that they are all very likely to be of working age, and thus we might use working age mortality rates to estimate the number of expected deaths. Dr No fully appreciates (and indeed pointed out in the original post) that this is a very crude calculation, but...better an approximate answer to the right question...

ONS do make available, if that is not to strain the word available too far, summary tables in Excel format of death registrations: the 2012 tables for England and Wales are here. Table 1 of the spreadsheet gives mortality rates (per 1000 population) by age band for 2002, 2011 and 2012. Taking working age to mean 25-64, mortality rates range from 0.3/1000 for women aged 25-29, to 12.7/1000 for men aged 60-64. Increasing age (and being male) is indeed bad for your health.

If we assume (we need to do a fair bit of assuming, so let's make it upfront) that the age/sex distribution of working doctors is similar enough to that in the general working age population, then in principle we can estimate the expected number of deaths among doctors, assuming they have the same mortality rates as do the general working age population.

The ONS figures are in fact more fine-grained than we need - it breaks down mortality into five year bands, whereas we want overall mortality for 25-64 year olds. If we assume (not a completely unreasonable assumption - see here) that the numbers in each five year age/sex band are broadly similar, then a simple unweighted average of the mortality rates (there are other methods, but let's keep things simple) will give us an approximation of the overall mortality rate for 25-64 year olds. If you have downloaded the ONS Excel spreadsheet, you can do the calculation yourself: enter "=average(B18:G26)" in an unused cell and you will get the average overall mortality - 2.9/1000 - for 25-64 year olds, based on the years 2002, 2011 and 2012.

We can estimate (from GMC figures linked to in the original post footnote) that around 290 doctors a year (actual figures: 2005:310; 2006:335; 2007:196; 2008:359; 2009:319 2010:314; 2011:212; average:292) are referred to FTP panels. Applying our average general working age population mortality rate of 2.9/1000 means we would expect around 0.8 (yes, Dr No doesn't know what 0.8 of a death looks like either) deaths per year. In fact, we observed 92 deaths over an eight year period, when we would expect 6 deaths (0.8 x 8 years, and dropping those pesky fractional deaths), giving us an observed/expected figure of 92/6 = 15, or a crude mortality ratio of 1500 when multiplied, as is usual, by 100. Where we would expect to find one death, we find 15.

This figure is indeed smaller that that given in the original post (20 deaths where we would expect one) but Dr No took the cavalier view that 20 was 'near enough' 15 not to merit a re-write of the original post; and the number, whether 15 or 20 where we would expect one, is so 'gross' as to make its own point. Furthermore, the number is almost certainly an underestimate. The GMC may not be aware of all relevant deaths, and its figure excludes deaths occurring after FTP investigation - the so-called year and a day deaths - in which the FTP investigation played a part. We have also done a fair amount of assuming - for example, that the age/sex distribution of doctors matches that of the general working age population (Dr No suspects active doctors are weighted towards younger ages, meaning less expected deaths; similarly, being members of the more affluent classes suggests less expected deaths, with both factors tending to increase the ratio - 'E' is smaller so 'O/E' becomes larger, even if some other factors - more males? - may tend to lower the ratio) but the number, be it 15 or 20 or more, or indeed less, remains an approximate answer to the right question, not a precise answer to the wrong question. Dr No rests his case, and so the case for signing the petition:

http://epetitions.direct.gov.uk/petitions/54034

I agree

"Injustice anywhere is a threat to justice everywhere." (Martin Luther King)
To be frank the more I hear concerning the hospital work place, of nepotism, sexism, of bullying (passive-aggressive and overtly aggressive behaviour, leading to emotional and yes, in some instances even physical abuse), of poor quality staffing, reduced/inadequate staffing, of poor supply of the better costlier drugs, of a negative attitude toward staff needing support due to illness or loss, the poorer, the more appalling, inadequate and archaic the system seems. It seems like it is overseen by some sort of 'exclusive' hierarchy, that knows these doctors, these individuals will not challenge, will not buck the system. Why? Because for some it is not just a job, more a calling, for others, they have invested so much of their years, so much of their youth, their social life and family life, their health, their money, their belief in, their concern, to do this job to the best of their ability, they cannot back out. And is not this what we want, dedicated individuals, highly skilled, caring individuals? Why then is there no one, no group looking over the needs of, looking out for improvements for these doctors, that they may continue their good work for everyone who goes to them in need, while at the same time knowing that their best interests are also being looked after?
There is an atmosphere of fear. This fear is well founded and has halted whistle blowing on incompetence, and even the most awful behaviour of staff toward other staff. It is, in this day and age a sign of lack, lack of wisdom and insight, lack of community, lack of care, lack of concern about looking after those most needed to fulfil the requirements made by so many on so few, and lack of money.
Ah money...the root of ALL evil so the saying goes. How can you run a social service as a business? And if you do, why are those who work and pay into it, indeed who work for that service and pay into it, so undermined, unvalued and unsupported? Is it then that there is not enough money going into the coffers to service demand, or is this a 'business' trying to offer a service to the world that is not paying into it for the work being done on its behalf? Or is there enough funds but they are just being managed poorly? Or is it run like some secret society, where only a few are really 'in the know' and use their power unjustly? There is an answer, but is anyone asking the right questions of the people who can and should be making the necessary decisions.
Believe me when I say, if you knew of the demands and treatment of these doctors you would be shocked, and you too would be frightened. So please sign and forward this petition. Their voices need to to be heard, should be heard, and change must be made.

It is shocking to know the figures of so many doctors commiting suicide while fitness to practice proceedings by the GMC. I agree to support this petition so that doctors and other health professionals who are subject to such proceedings can be given enough support to cope with the stress. At the end of the day even doctors are also humans who have emotions and can break down at some point.

The investigations most of the time is started on corruptly, by people./colleagues. There is lot underlying. Jealousy? lot of torture. Peolple turn their faces away./ Friends, so called shy away.
Team work is done against doctors who are going through this.
They are literally crying for support.
They are tormented in the system.
I am not suprised that they undergo divorce/seperation during this period. I agree that this sort of torture should be stopped, before more lives are lost.

I agree, that injustice should be stopped. That is the torture. People are reported to the GMC, MOST OF THE times by their colleagues. People in junior positions are deskilled. They cannot open their mouths. They have no say. They local investigation which is carried out against them, is full of lies. This sort of beauracracy should be changed. WHO WILL BELL THE CAT.
Everyone wants to look after their own selves. There should be more support and help for people who go through this.

You acknowledge the figure is crude, and it has multiple variables that could be contributing including the elephant in the room that struggling doctors are more likely to get reported.

And yet you dismiss this and say 'something is going on'

Well it is.
Because once you acknoowledge those factors you simply have to realise being investigated - whether by GMC or criminally is stressful and some people will respond by self harm.

To stop having fitness to practice proceedings that are designed to keep patients safe, so that doctors don't harm themselves is a bit much.

I agree that there should be more support for doctors being investigated by the GMC. The system needs to treat us with respect, dignity and individuality - the same as how we are expected to treat our patients.

Clearly there is a problem here! The statistics are very disturbing, and I feel that these people deserve the best possible support during the very stressful period whilst being under investigation.
This is obviously not happening.

" No doubt some of the doctors will turn out to be bad’uns, but there will also be the innocent who – had they survived – would have been cleared, and those suffering from mental illness which, while it may even have contributed to their death as to their falling foul of the GMC, is hardly cause to turn a blind eye to their fate."

Is it just me or does anyone else also hope that this was just an unintentional, unfortunate choice of words...

"No doubt some of the doctors will turn out to be bad'uns"... hardly if they've died and their files have been closed will they. But why write something so utterly superfluous and judgemental? What is this sentence supposed to mean anyway? That it would have been more acceptable if just doctors who turned out to be bad'uns, whatever that's supposed to mean, died while being investigated?
"But there will also be the innocent... and those suffering from mental illness" and we can't have the innocent die on us. Only to the "bad' uns" is it acceptable to turn a blind eye.
What a crying shame it's so difficult to differentiate.

If you don't mean that sentence as you've written it, get it out of there. If you do mean it as it's written, then I'd suggest you write about cars instead.

Dr/Mr Haring - Dr No appreciates your concern but suggests the quote you provide needs to be read in context. In particular, immediately before the quote you provide the post reads:

"No doubt the Lord-of-the-Flies elements in society will claim good riddance – them quacks must have been bad’uns, otherwise they would never have got caught up in Stilton’s machinery. But that is itself an extraordinarily harsh judgement."

Dr No suggests we are in fact 'on the same hymn sheet' - both of the view that there is no place for summary judgements here, no place for harsh calls of 'good riddance'.

What Dr No was trying to address is the inescapable (and often raised - see for example the comment at 26 Oct 2013 @ 10:19am above) point that some doctors are bad doctors, and some form of regulation and removal of these bad doctors is clearly necessary. It is however all too easy to get into 'no smoke without a fire' and 'if you can't stand the heat in the kitchen' not to mention tarring all with the same brush type positions but Dr No suggests these assessments are far too simplistic. For any true villain there likely be many more who range from innocent (and perhaps on the wrong end of a malicious complaint) through varying degrees of dysfunctionality, often through no real fault of their own beyond the fact they failed to master and maintain the mask of the heroic super-doctor, to the hopeless. These people in the main are not villains, they are the jetsam of a profession that has abandoned them to a cruel sea of fear and uncertainty.

And then there is the Wendy Savage factor (any doctor judged on their five worst cases usually looks pretty grim) - we are all fallible, and as a result vulnerable. Let he/she who is without sin cast the first stone...

You're doing it again. You don't get it do you?
Let me try again. When it comes to doctors dying in an above average number, while being investigated by the GMC, even mentioning the obvious fact that there may have been "bad doctors" among them is completely irrelevant. Of course some of them may well have been "bad doctors", or "true villains" as you for some reason choose to call them. But that's not the point. Even a Harold Shipman should not have to die as an indirect result of being investigated.

When you write things like "What Dr No was trying to address is the inescapable... point that some doctors are bad doctors, and some form of regulation and removal of these bad doctors is clearly necessary" but it's the good ones who we feel sorry for, it suggests that for some reason it's acceptable for the "bad doctors" to die, as long as the "innocent" are absolved.

Let's get this straight. It's absolutely unacceptable for any doctor to die while being investigated, irrespective of whether they are Josef Mengele or Albert Schweitzer. Of course the process of investigation is absolutely necessary, but it needs to not lead to doctors dying. So why even bring up the idea of a differentiation between bad and good doctors? It should be completely irrelevant to this discussion.

It's a real pity you somehow manage to turn a serious issue into something like a melodramatic film script, with the use of terms like "bad'uns", "villain" or "innocent". These are sweeping, highly judgemental terms, used by you to describe your own point of view, after referring to what you believe the "Lord-of-the-Flies elements" in society are thinking, which by the way, is itself a rather condescending idea, devoid of any evidence.

Hello Mr Haring,

We now have over 1760 signatures.http://epetitions.direct.gov.uk/petitions/54034

GMC has existed for over 150 years as you may know. Some doctors died during their investigations but some shortly after charges against them were found not proved. Some doctors died shortly after their FTP found charges against them proved. Stress has profound effects on the body and we do not know the exact number of the doctors whose death is related to the GMC investigations since GMC was established. I estimate that at least 2000 would have died over more than 150 years. Doctor's training costs about £250,000. That is about half a billion pounds just in training cost. There are other costs that are incalculable, for example, various effects on patients, family, friends, close associates and businesses doctors supported.

You are right, if I understood you correctly, that we have to guard against being judgmental. If one knows anything about justice one would know that there are many miscarriages of justice. The truth is we do not know if there was any substance to allegations against those 100 doctors who died while investigated by GMC before there were any findings through the Fitness To Practice hearings. What we do know is that GMC as a public body is authoritarian and out of control. Here is Doctors4Justice report to Parliamentary Health Select Committee:
http://www.publications.parliament.uk/pa/cm201213/cmselect/cmhealth/566/...

I did not expect that medical professionals would come out in great numbers to support this petition for various reasons. One of those is prejudice against those facing GMC investigations. I agree with your excellent point that it is unacceptable that this level of deaths occurred. In the case of our petition there is complete absence of any findings against those doctors. However, I also understand Dr No's approach, if I understood him correctly, that using language which is provocative it makes others define precisely what is the attitude we should have: non-judgmental, as you say.

It is also known that ethnic minority doctors are more likely to face disciplinary procedures in NHS, for example, and that most of the doctors erased from their register by GMC are of ethnic minority. This may explain why The Royal College of the General Practitioners (RCGPs) has not signed up to the petition or British Medical Association. RCGPs face a judicial review by British Association of Physicians of Indian Origin (BAPIO) over allegations that there was racial bias in MRCGP's examinations of doctors. Greater good got lost because of the conflict of interests.

GMC have now embarked on public relations exercise to prove that they are thought of as a fair regulator by doctors. They have commissioned an "independent study" and will be asking 7000 of their registered doctors what they think of GMC. A bit like asking virgins to write sex manual. They would also ask minority groups what they think, so they say.

Some doctors said that they are frightened to sign the petition! But the petition is for Department of Justice and signatures are not published, GMC does not see them. So, I do not buy into those excuses.

Here is Escape The Fate track Ungrateful:
http://www.youtube.com/watch?v=C3knlAC08ao

The truth is, it quiet doctors/ not of higher ranking are investigated. The top bosses know how to get out of any situation.
The burnt is on innocent doctors, who are tortorured in the system, working at the junior level. These are doctors from abroad, being treated so badly. Lies are told about them in investigations. LIES YES LIES. They cannot prove that they are bullied, and victimised. There barbriac behavior. Bullied by seniors. No wonder when they are not supported, they feel so helpless, that they take extreme steps. Hoping their selfish co-workers are humans.

I AGREE,There is racialism.The doctors who go through the investigation are of ethnic minority. They have no support. There is no fairness. People of ethnic minority are investigated more, because they are working at junior level. The truth is people in power do torture these junior, who cannot prove the bullying.
The crooks, know to find their way out. They are liars and have power.
Like people who did the shooting, because they had the Gun, in Nairobi Mall. These corrupt guys have power and use it in very clever way.

Terror is a second name for GMC. I am not yet sure if GMC has benefitted anyone.

i have seen one of my close friends going through it. its a pure inhuman process.
no wonder related to high death and suicide rates.
who shd regulate GMC..
they need to understand that not all doctors are Shipmen and stop consider them like one.

I think it is time for us doctors in Britain to at last look after ourselves.It is the continous protection of the systems and patients which is always the priority but when you think who is looking after me when I have the day from hell and want to bang my head against the wall and wish I was not alive.This is the reality I have seen lots of colleagues who are so depressed but they can not say it to anyone as it soon goes on their records.We live in time of bullying from consultants and pressure from work and the constant pressure of demands and new legislation which make things worse in the name of HIGHER STANDARS in medicine which is pure pollitics in fact and nothing to do with improving midical standard.I love medicne always loved it I was high flyer in medicine and finished my medicla college with 95% overall success rate but since I moved to U.K.I faced racism(word I hardly had heard before leave alone experiencing it, gender descrimination, bullying , nasty and impolite and rude consultnats .You name it.
Still we keep quiet cause if you open your mouth not only YOU but your career is finished and for a doctor losing their career is worse than death.So I dont wonder these doctors committed Suicide.We need to stand up for ourselves other wsie we all will be stepped upon as we go along

Dont try hard to shine with your shekespearean sonnets, this does not make you a good doctor.Good doctor is brain not language.....

One of the underlying themes of so many notifications to the regulator is the abuse of the system by sophisticated management or jealous colleagues. For example (all these were reported to the regulator)
1. Clinician did not follow up on a mammogram 11 minutes after another colleague followed up on it.
2. Clinician reported because of his accent.
3. Clinician reported for failing to see a patient when he was on call. BUT, he wasn't even on call.
4. Clinician reported for failing to order a prescribed medication when he had in fact ordered it twice.
5. Clinician became depressed due to receiving five false allegations and was then sectioned by the organisation that reported him under the mental health act. And then reported again for health impairment.
By default, I became a collector of these kinds of false and vexatious allegations. Numerically the list now stands at 23.I know of three clinicians who became suicidal.
Sadly, this will not get any better this side of 2100. there appears to be a political will and a media frenzy against all health professionals.
But the system is open to abuse. Got a difficult, highly skilled or an unpopular clinician? Well, stick a few allegations in under the protection of 'reasonable belief' and make their life hell and the problem go away.
As individuals, we need to start thinking about legal insurance that goes beyond the norm and covers for these eventualities and we need to be writing clinical notes for the judge and no one else. Defamation is possible within the limits of statutory time as is suing for lack of procedural fairness and natural justice. Many of these allegations get reported without any investigation or without seeking the alternative view of the defendant.
I have no faith in the GMC investigating itself about suicide. another 0800 telephone counselling service is not the answer.
My email is Dylan.rossi68@gmail.com. if anyone wishes to discuss or be put in touch with more information.

The truth ,
There is racialism. During the investigations, they speak lies. False reports against the poor doctors produced. There is victimisation. Doctors from Ethnic miority and females are tortured more. There is sexual comments passed.
False report for the investigations are produced.
This should end.
There should be fairness and Medical slavery should not be tolerated.

m

It is quiet doctors from overseas. Medical slavery should be ended.
FALSE REPORT ARE GIVEN AGAINST THEM
There is VICTIMISATION AND BULLYING.

Doctors working at junior level are tortured. They are from overseas. They will remain juniors and be bullied.
There is sexual discrimination also.
This sort of Medical slavery should end.

WHEN IS THIS RACIALISM GOING TO end.
Medical slavery, bullying sexual differentiation. To face all this without support of any kind.
Well I know it because I have experienced it.

No wonder people committed suicide. Bless their souls.
They are not insects. They have feelings.
The consultants very cunningly get out of all this, because they speak lies. poor staffgrades, who are made the scapegoat.
They are liars.

GENDER Discrimination should end.
Bullying and Victimisation SHOULD END.
cONSULTANTS SPEAK LIES ABOUT STAFFGRADES, BECAUSE THEY ARE BETTER EXPERIENCED THEN BETTER PAID Consultants., but staffgrades are always juniors.

this should end.

I suggest the person above googles dr leong ng and his articles on psychological false imprisonment. OTDs are over represented in notifications to the board in every jurisdiction where white male Anglo Saxons hold most of the power. Some more examples of notifications that I am aware of:
1. Notified for treating sinusitis with amoxil.
2. Notified for failing to write clinical notes when she did.
3. Notified for taking her own prescribed medication sent to her own clinic with her own patient label stuck on the box.

The seriousness of these kinds of allegations cannot be understated. They damage the individual often for years - some of these were made in 2012 and there has still not been an outcome. they cause massive damage to reputations, earning capacity and future practice decisions, professional confidence and employment prospects. All the above could have been dealt with in the time it takes to make a phone call, but all the above were notified to the board without any local level investigatory procedure.

For those of you who think you will bail out and flee to Australia, be warned, it is even worse there. Look up Thomas Kossman and Christoph Ahrens to see how good surgeons were treated by the establishment there.

All in all, a frightening time to be at the clinical coal face. I for one am certainly giving serious consideration to a change of career.

Drs are not just subjected to FtP hearings! Don't forget Interim Order Panels (IOPs) these can be as stressful as FtP and lead to the imposition of Undertakings which can be difficult if not impossible to get removed. I think if the FoI request was widened to include IOP's & Undertakings we may see even higher numbers of deaths/suicides!
I have not been able to find obituaries for the 6 doctors named by the GMC who dies before their hearings? They claim that of these 6 only 3 took their own lives. What is missing is how many of the remaining 84 doctors who died during or after a FtP hearing took their own lives? Does anyone know if there is data from 2012 onwards?


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