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.
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/