Pandora Needham, Postgraduate Medical Dean (North Region), has recently opened her box and set loose a fury of furies. A number of medical bloggers and other commentators, wide-mouths, forum sharks, hucksters, ne’er-do-wells and other assorted busybodies, including Dr No, have asked the obvious question: why open the box at all, and why now? Had the box remained shut, the unfortunate events of a few years ago would have remained locked in the box of history, gathering dust. By publishing the article which opened the box, Pandora on the face of it shot herself roundly in the foot.
Faced with curious, even bizarre, behaviour by those in high places, Dr No usually falls back on an old and trusted maxim of his: never overestimate the intelligence of one’s superiors. Many will have achieved their eminence not by wit or brains, but by a ruthless and relentless – as Pandora might say – ‘process’ of shafting and backstabbing hapless individuals who stand in their way. Once they have achieved prominence, the narrow corridors of power blinker their thinking still further, and they become overwhelmed by a tide of certainty in their own competence. Indeed, Pandora reveals this very trait towards the end of her article: ‘I did the right thing: I’m sure of that, and that’s all that matters to me’.
Of more interest to Dr No is the rare insight the article – a Personal View in the British Medical Journal – gives us into the mindset of those doctors who would rather control other doctors than get on with the proper business of doctoring: seeing patients. Doctors of the controlling tendency naturally gravitate to positions that extend their scope to control. They are to be found in abundance in deaneries, in the medical colleges, and often as medical directors. And they will naturally be drawn to the General Medical Council, with its wealth of opportunities, shortly to be vastly extended by the introduction of medical revalidation, to control, shop and shaft former colleagues on an unprecedented scale. These doctors are the doctors who will become the Council’s Responsible Officers: the eyes, ears and executors of the Council’s will.
Ironically, those who seek to control often have their own need to be controlled. And so it is that they sit happily in hierarchical orders, comforted by the sense of structure, by their authority over those below, and by their allegiance to those above. Independent thought and individual action is anathema: it is the system, the state, that is paramount, and must be protected at all costs. Miscreants, deviants, let alone those who express dissident views in colourful language on restricted websites must all be controlled, or rather ‘helped’ and ‘supported’ in Pandora’s Orwellian-speak. Those who remain unrepentantly deviant will, after ‘due process around clinical governance’, be terminated.
As in any totalitarian regime, the state keeps, and needs to keep, detailed records on all its subjects. Pandora wraps this up in a sickening caring and sharing ‘package’:
‘In medical education we take this duty of care to our trainees seriously. It is a journey that we share with our doctors in training. Just as with our patients, records are kept from medical “birth” (entry to medical school) to medical “death” (retirement from practice) to support those who need it…’
Big Brother, you see, needs to know all about you, from the cradle to the grave, so that it can travel the caring and sharing journey with you. Quite how caring and sharing translates, as it did for Dr Scot Jnr, the dissident doctor at the heart of this story, into immediate suspension, is quite beyond Dr No.
Unless, that is, these doctors who need to control, and be controlled, have a particular mindset. A mindset that abdicates professional conscience in favour of professional authority; a willing allegiance to the absoluteness of that authority; a mindset that places duty to authority, not duty to people, above all else.
Half a century ago, Adolf Eichmann at his trial in Jerusalem evoked exactly these principles of unswerving allegiance to authority to excuse his heinous crimes. Pandora makes much play of similar reasoning in her article: she mentions her ‘duty of care’ no less than four times in her short 782 word article, as if to say ‘I had no choice; I had to follow my duty. I was just following orders’.
The similarities do not end there. Not only does Pandora know she ‘did the right thing’; much of the tone of her article is that she has been punished and victimised for doing what she ‘knew’ to be right. At his trial, Eichmann said: ‘I am not the monster that I am made out to be. I am the victim’ – words that could just as easily have been found in Pandora’s article.
Pandora’s mindset is Eichmann’s mindset. Once revalidation kicks in, there will be many more Eichmanns, some newly loaded, others reloaded, swirling around the medical world. They will see it as their ‘duty’ to deport doctors. It will not be a pleasant world.
Dr No,
You have exceeded yourself much like a cream cake.
I believe the Deans of the profession wish to exert superior “control” because without it there may just be freedom of thought. I also believe Needham got caught in Paice’s rather disgraceful web and clearly has not been bright enough to extract herself.
A few issues
1. What was Paice doing wondering around Doctors.net.uk when she should have been doing what the tax payer pays her for ie working? Who paid her to go trawling around a private company’s website seeking out “intemperate” posts. This is not the first time of course, Paice has attempted many things in the past in relation to the MMC.
2. Paice and Needham have never justified their grounds of suspension. For instance, lets ask the question – why was Scotty suspended if the Rules specifically state that it cannot be done unless there is a patient safety incident. If Needham states she was right – let us hear why that was. Obviously, she feels unable to argue that point.
3. The fact the suspension was lifted clearly meant that they had all made a spectacular mistake. So, where is the accountability for that mistake?
4. They cite a potential breach of Good Medical Practise. The Medical Act though specifies that if there is a potential breach, the two deans MUST refer the matter to the GMC. There was no such referral. Moreover, the GMC never took up such a complaint against McJobby.
We conclude from the above that it was never a breach of GMP. It was never a violation of DOH Guidance and neither did his conduct impinge on patient safety or clinical work. We can apply the Remedy UK judgement here R v GMC Ex Parte Remedy UK where the proximity between the conduct and clinical medicine was imperative for an allegation to amount to a capability of misconduct. There was no proximity in the case of McJobby. We therefore conclude that both Deans misdirected themselves.
The biggest and probably the worst mistake made by McJobby was to be a large chicken and grovellingly issue an apology as soon as the going got tough. This is wrongly interpreted by the GMC and other authority as an admission of fault. It of course isn’t any such thing because there was no fault in the first place. In the meantime, McJobby cowers away from prying eyes as opposed to standing up and being counted. I always felt he was subsequently rather quiet for man with such colourful criticisms initially. This shows us that it is very easy for deans to be granted control. They do it by tyranny and instilling fear.
Needham currently wishes to garner the sympathy of her senior friends and colleagues. The BMJ piece is filled with emotional clap trap. If we wrote something like that, the GMC would think we were all having a nervous breakdown. Of course, while the world sympathizes with these crocodile tears, has anyone considered the impact on Dr McScotty’s career? Of course, to these Deans a junior doctors career is easy to dispense with – without a second thought.
The bottom line is Paice and Needham were never able to justify their actions in case law and evidence. They continue to say they were “right” because they insanely believe that anything they do is by default “right”. Of course, what the GMC fails to understand is that both Paice and Needham may well be manipulating the rules to suit their cause thereby placing junior and vulnerable doctors at a severe disadvantage.
Dr Rita Pal
Declared Conflict – Paice was spectacularly wrong on my whistleblowing issue. She doesn’t talk about that anymore because she believes it is in the past. Lets ask her how many people died in the hospital with a inordinately high death rate during that timeframe? This was a patient safety issue. While she was keen to refer McJobby for a suspension, no one responsible for the patient safety issues were ever suspended or held accountable. To her, etiquette is clearly more important than patient safety.
This doesn’t just apply to doctors, you know. My managerial hierarchy consists of one failed physiotherapist, one failed audiology technician and one failed nurse.