Dr No doesn’t really do duty of care. Instead, he just cares. When he sees a patient, he does what he does simply because he cares for his patient, just as he always has, and always will. He suspects – but isn’t over-bothered, perhaps even doesn’t care – that what he does in fact more than satisfies any duty of care baloney, which in the real world he steers clear of, finding it to be tedious, tiresome, distracting, legalistic, defensive, job-serving, and all about doing the minimum to cover one’s back, rather than aiming to go the extra mile and do the best for one’s patient. In all this, Dr No is no doubt frightfully old-fashioned, maybe even old-fashioned enough to trigger the crackle of snapped pencils in the legal offices of his professional indemnity society. But Dr No remains resolute. True care is always better than duty of care; for the former is human and comes from the heart, the latter formulaic, and from the law.
Professor Gillian Needham, the Frau Oberstgruppenführer of the North of Scotland Deanery (deaneries are responsible for junior doctor training), on the other hand, has the hots for duty of care. In fact, so hot is she on duty of care that she included it verbatim no less than four times in her recent short I-was-only-doing-my-job-when-I-fried-Dr-Scot-Junior-that’s-why-I-can’t-
tell-my-side-of-the-story-woe-is-me-for-I-am-the-victim Personal View in the British Medical Journal. These four direct inclusions are shored up by numerous oblique references and derived duties. Indeed, so bound by her duties does the Frau Oberstgruppenführer appear that one fears that her decanal journey was possessed of even less options than that of a well-trussed chicken facing an open oven door.
It is somewhat ironic therefore that by airing her Personal View, while at the same time attempting to satisfy her mountain of duties of care, including not least that of not exposing her trainee (‘Telling my story ran the risk of exposing one of my trainees, and that would clearly have been a breach of my duty of care’), she, and the BMJ, who have resolutely published with all the subtlety of a bull dumping dung, have not only re-ignited the bovine methane on Scot Junior and the Jobbygate affair, but have also given rise to a simple internet trail that leads straight to Scot Junior’s door.
Dr No finds it inconceivable that the Frau Oberstgruppenführer did not know that Scot Junior’s identity was already tucked away in a quiet corner of the public domain (and were she for a moment to say that she did not, Dr No would counter that she ought to have known), and thus, as sure as night follows day, re-igniting the story by publishing her Personal View would inevitably greatly further expose Scot Junior: a outcome that, in her own words, ‘would clearly have been a breach of my duty of care’.
And that’s the beauty of doing one’s duty of care the Machiavellian way. One can say loudly and publicly that one has followed one’s duty of care – even when in so doing it becomes crystal clear one doesn’t care a William.
Of course, this duty of care didn’t prevent her from insinuating that Dr McJobbyGate may have had some kind of [unidentified] mental health issues – she did this to all and sundry. It has already been ruled that written material cannot be assessed as such. This has been outlined by the Royal College of Psychiatrists and also my own case R v GMC Ex Parte Pal. As the GMC attempted to do that, the judge cited their conduct as “totalitarian”. This means that Needham’s conduct is probably that of a totalitarian regime [merely by extrapolating precedent].
The Northern Frau did have a duty of care to ensure she was following Department of Health guidelines on the management of such doctors. She had a duty of care to ensure procedures were followed. She did not do so.
Her Personal View – and I understand she is traumatised by the entire incident, is essentially her struggling conscience wishing to make peace with herself. She committed a startlingly spectacular blunder but is unable to say she was wrong. Despite case law, protocols and guidance that goes against the actions of Paice and Needham, they still stand and shout that they were right from the roof tops. Of course, just because they say it is “right” does not necessary mean they are. It is simply that they believe that Deans must be believed whatever rubbish they sprout.
Rita Pal
“essentially her struggling conscience wishing to make peace with herself. ”
I don’t think so, I think it is quite the opposite actually. Simply because that BMJ letter is so self directed, it shows no remorse whatsoever, quite the opposite too since she still questions ScotJRs mental abilities three years on, not even caring if his identity is gets in the lime again as Dr No said, and what that can mean harm wise to his career too. This is clearly an attempt to wipe her sheet clean so that she can continue her climb on that heavenly ladder! Don’t forget that in 2008 she was on a 2 year leadership course and was rumoured to become the next CMO! It seems that that aspiration is somewhat down the drain now!
not an impressive performance by a ‘leader’ at all! Really!
The self-justification in Needham’s article is so one-eyed that I find myself wondering if someone at the BMJ REALLY doesn’t like her, and published this to let her hoist herself with her own petard.
The rapid responses are a very interesting read. I am struck by their reasoned tone, and general agreement. And by the fact that no-one at all has yet supported Dr Needham.
The latest letter by P.S. Jones has a particularly magisterial and withering closing.
The Rapid Responses have largely missed the point. I have no idea whether this is largely due to a total lack of interest or a failure to analyse what McJobbygate actually means to the wider profession. The clearance by the GMC essentially vindicates Needham. Technically she is not at fault. This tells us that few are concerned about this total lack of accountability for something that is blatantly wrong.
According to the GMC
1. Deans can flout the Department of Health guidance on suspensions and never be held accountable.
2. Deans can speculate upon the mental health of a doctor just by one flamboyant post and lets face it Needham at the time had not established whether it was McScotty at the computer terminal or the local half swearing short skirted prostitute using his password in a internet cafe.
3. The damaging impact of [2] is quite clear – Professor Crisp of the Royal College of Shrinks once stated that diagnosis should not be made on written material. There is the resultant stigma of “lunacy”, the potential and threat of a immediate GMC health gulag investigation etc etc.
4. That junior doctors careers mean nothing to Deans – they are indispensable.
I have long stated that the Deans hired in our profession have no specific training in managing their juniors, often believe that they are God and even when they are wrong, they have no insight. While Needham is getting it in the neck by the blogging vamp nest, Paice – the real culprit escapes criticism in this soap re-run.
Paice was given a award by that seedy little Indian organisation Bapio. It is even more interesting that Bapio members are also case examiners and serve in the GMC’s esteemed tower. http://www.londondeanery.ac.uk/global-news/double-honours-at-the-2010-bapio-annual-awards. See Madok http://www.bapio.co.uk/content.php?PageId=6 – the rather large dictabird from Birmingham who also serves on the GMC council. The more worrying issue is that the GMC case examiners made a decision contrary to GMC jurisprudence. The next worrying issue is that the vast majority of the medical population is oblivious to this.
Rita Pal
From link to rapid responses proided by Dr Aust, Dr Jones says:
“the way in which a doctor expresses their personal views may call into question their professionalism and their fitness to continue in their post”
Well, Dr Jones doesn’t like to link freedom of expression to professionalism, but I do. I do not think that any professional has the right to cause ‘hurt’ by excercising their own negative views publically regarding others, be it a colleague or a patient. Scot JR was wrong because he did cause ‘hurt’, but then he appologised and kept his head low since. By excercising her freedom of expression, Prof Needham is in effect doing the same ‘offence’ JR did, ie, she herself is now causing ‘hurt’ to JR for an offence he was punished for already. That is even more damaging since what she wrote can harm his career again. She has no right to do that, but the problem is, he is no high profile, and no one cares! That IS wrong!
-Well, Dr Jones doesn’t like to link freedom of expression to professionalism, but I do –
You do?
1. The GMC has no definition for “professionalism”. The analysis is therefore a “subjective” as opposed to an objective one. This is open to errors and a situation where the goal posts are moved depending on what a Dean wishes to achieve.
2. The GMC’s guidance on free speech does not link the two.
3. We conclude that doctors have a same right to free speech as the average man on the street unless it impinges on clinical practice.
Case law on this point
Sedley J in 1999 pointed out “free speech included “not only the
inoffensive, but the irritating, the contentious, the
eccentric, the heretical, the unwelcome and the provocative, provided that it did not tend to provoke violence.Freedom only to speak inoffensively is not worth having” .
Scot Jnr was discussing matters in his own free time. If your argument is that Deans should rule a doctors free time, then perhaps all of you who have ever done anything kinky in your bedrooms should be suspended forthwith. Each time any of you swear privately at your friends should be deemed “unprofessional”. Now
that would not be popular at all.
As for the apology – it was an error on Scotty’s part. He was influenced and threatened by his career and of course defaults to what the establishment wants him to do – i.e beg while they beat him to a pulp. This is then shown to the others around as a way to control the profession. It is quite effective really because most quiver in fear at the sight of Paice and Needham anyway.
Rita Pal
But JR was not referred to the GMC Rita, and ‘professionalism’ also means you don’t need to impose a punishing system for every big and small but use courtsey and common sense too. Otherwise, there is no difference between the educated and those not, hence the term ‘professional’ becomes obsolete.
Free speech is meant to improve not hinder, hence needs to be polite, even while being critical. Actually, more so in this case if it is to achieve any positive results. Positive and rude do not marry well because they are opposites, hence will never attract.
Professionalism rule 2; Rudeness loses rights, respect gains them.
Excuse me, JR was referred but let off by the GMC, thanks for reminding me 🙂
I recently returned from three weeks leave and was casually leafing
through the accumulated BMJ’s when I came across Dr Needham’s personal
view and somehow got the impression that I was not getting the full
picture, which led to a sudden spontaneous urge to do something that I’ve
never done before which was to “google” around for some further
information. This was not, I confess, for the purpose [as half-suggested
by Dr Needham, of whom I had never previously heard] of finding out what
scurrilous rumours had been put around regarding herself, but with the
[admittedly somewhat salacious] idea of finding out what awful things
that the obviously unhinged junior doctor in question must have been doing
as she grappled to deal with his psychotic and/or criminal behaviour!
Well! You can believe my subsequent astonishment when I realised the
truth and I wholeheartedly concur with all the opinions of all the other
respondents so far [does no-one at all out there have anything
whatsoever to say in support of Dr N?] and, contrary to one of the last
[of very many] seemingly unjustified assertions that Dr Needham makes, I
think that I can work out exactly what went on, and I say it stinks!
Which is ironic because, paradoxically, the one thing I cant seem
to extract from the internet is the actual, full and unexpurgated version
of what poor Dr Scotjunior actually wrote that plunged him into such an
utterly Kafka-esque nightmare. I still can’t bring myself to believe that
all he did was to refer to someone as a s*** in a blog, but I say without
hesitation that if that’s true then it just goes to prove that he may well
have been correct after all, and the BMJ should acknowledge this [in so
many words, of course!]
PS. since the BMJ have ignored the invitation to “retract” contained in this “rapid response” [and many others] I thought I might send it to your blog
Anon – thanks for you observations and comment from a fresh perspective.
Dr No has it on good authority that Dr Scot Junior’s original forum post, which triggered all that followed, was addressed to a named individual, was personal in its comments, and was scatological in content. It was notably emotional in tone, but whether it even gave any grounds for suggesting mental illness is another matter altogether. Indeed, were such language to do so, then for starters we would have to say Dr Rant (whose posts frequently address named individuals, are personal in their comments and scatological in content) is apparently about as mentally ill as can be, not to mention countless other bloggers to numerous to mention…
There are two key questions here:
1. To what extent can one infer mental illness from a few brief written words? This is a clinical question, and the answer, except in the most exceptional circumstances, which may never exist, is not at all. All one is observing is the product of a mind at a moment in time. Without context, background and history, let alone a mental state examination, it is impossible to form any reliable opinion. Dr No does concede that in exceptional cases, there may be a case for further enquiry. But those cases will be very rare, and the circumstances truly exceptional.
2. To what extent does posting a personal scatological attack on a widely disliked high profile figure in one’s profession meet those exceptional circumstances? Dr No’s answer is not in the slightest. Dr Scot Junior was clearly very angry, furious even, but he had very good reason to be angry, even furious. There is however nothing overtly psychotic in the post. It is just good old fashioned plain offensive; and as such gives no grounds even to contemplate mental illness. It was merely ill-advised, possibly not in the best interests of his future career prospects, possibly even rude behaviour – but it is not, absolutely not, reason to suspect mental illness. And he was perfectly entitled – however ill-advised – to say it, because, whether the powers that be like it or not, we attach great importance to free speech.
By the same token, Needham of course also has the right to free speech. But if Scot Junior was ill-advised, then what does that make Needham? As others have said, she would have been better advised to let sleeping poo lie.
“Professionalism rule 2; Rudeness loses rights, respect gains them”
The GMC has never been insistent on “polite” language. It is but an invention of those of you who are public school educated irks. I say this with the greatest respect because some doctors with the worst language [ depending on cultural issues] make some of the kindest and best doctors.
Take these doctors – despite swearing, they are fairly good at what they do http://archive.student.bmj.com/issues/00/01/reports/1611.php.
The dark days of medicine are upon us where “opinion” now has to be framed in a way that is acceptable by those who rule.
As for the BMJ – they have been banning all rapid responses from me since the dawn of time. Old Tony is a conceited little idiot who lacks any imagination. Fiona Godlee shouldn’t be in the job. She only got picked because they didn’t want to give the editorialship to Kamran Abassi – a asian [ Good God!]. If we compare the JRSM and the BMJ – the JRSM is of a far higher standard. The BMJ lags somewhere between the layers of the gutter and they have lost touch with most sectors of the profession.
RE -Scot Jnr and the GMC. There was no referral.
As for Needham et al – there will be no Rule 12 because Scot Jnr has decided he wishes to be the usual cowardly little junior doctor. If he wanted to be that – he shouldn’t have made the comments in the first place. Having made them, he failed to stand by his own free speech and issued a grovelling apology which made matters worse for him. We shall see how he survives appraisals and revalidation.
Of course, in the absence of action, there will be no challenge and the profession [ and thankgod I no longer belong to it] will simply go from bad to worse.
RP
By popular demand, I have tried to create a factual website with the basics. It won’t be updated very often but I think its quite useful. I hope a few doctors find it of use.
Field Fisher Waterhouse and Blackstone Chambers continue to crow about their victory in the 2009 case on their respective websites. One of these days, the smile will be wiped off their faces. What is interesting is their failure to feature Pal v GMC 2004 on their websites. Perhaps that was because it settled in my favour! Darn.
Score Pal 1 GMC 1 . To be continued…..
http://palvgmc.blogspot.com/