In a curious move, because to many it will suggest the GMC perceives itself to be on the back foot, Stilton yesterday had published in Pulse an article in which he attempts to portray the GMC as a listening organisation which ‘accepts there is a lot more to do’. Or, to put it another way, on the matter of its regulatory functions, the Council accepts this is ‘an area where more can be done’. Pulse’s standfirst boldly promises an explanation of ‘how the body is ‘improving fitness-to-practise regulations’ – this being, after all, and as the Council accepts, ‘an area where more can be done’ – but in the body the article fails to keep its promise. Instead, Stilton delivers a peevish nit-picking lawyerly rebuff to two recent articles, and a bizarre waffle on why GMC punishments are not punishments. These, however, are diversions. The real message, the payload, part-hidden as it is, is much darker. It is that age old defence against charges of involvement in state sponsored evil that has become known, since the Nuremberg trials, as the Eichmann Defence: ‘only following orders’.
This is not unexpected. Last month, after the GMC released its report detailing the number of deaths among doctors undergoing FtP investigation, Dr No suggested the GMC would use either the Denning Defence (better to convict a few innocents than let one guilty go free) or – as appears to be the case – the Eichmann Defence. It gives him no pleasure that his prediction appears to have come to pass. What it does suggest, though, is just how far the GMC is from taking responsibility for the sinister reality of its conduct, and how keen it is to absolve itself from any blame. For those wondering what happens next, it also tells us that no mere tinkering at the edges will do, wholesale reform is needed, and that means action by Parliament.
Hints of dodging the blame are there from the start and indeed again at the end: the airy blandishments about ‘a lot more to do’ and ‘an area where more can be done’. The implication is that plenty has been done (but there is always more that can be done). Such breeziness may work in a local council update on filling in the potholes, but it fails utterly to strike the right tone when the subject involves hundreds of deaths. The peevish nit-picking is neither here nor there, since it misses the more important point about the first article, which the second relies heavily on (Dr No welcomes both as important contributions), which, despite itself noting the risk of doing so in a cross-sectional study, manages to promote assocaition to causation in the very title: ‘The impact of complaints procedures on…doctors’. Though there is no doubt that complained about doctors are sicker, we don’t know – despite anecdotal accounts and intuitive hunches – where on the causation spectrum these doctors lie. This matters, because if complaints cause illness, then the complaint procedures, notably the GMC’s, are vituperative, and need wholesale reform. If, on the other hand, ill-health causes the conduct leading to the complaint, then the doctor should be nowhere near the regulator, but should instead be under the care of a competent doctor able to manage such complex patients.
The Eichmann Defence itself is part hidden in the rambling and contradictory ‘our punishments are not punishments’ section, but before we come to that we might do well to remind ourselves of Eichmann and his defence. Eichmann was, it is said, the man who made the trains run on time. Interestingly, the GMC has a similar interest in timing. Right at the start of it’s accountability hearing earlier this month, the GMC boasted that is now has 91% of its trains (inquiries) running on time, beating its 90% target. No one can object to trains/inquiries running on time, but to focus on the timings is to miss the bigger matter of what was in the trains/inquiries.
Both Eichmann knew and the GMC know what was and is in the trains/inquiries, and in both cases death was and is an outcome. Before someone starts shrieking, Dr No is not conflating millions of Holocaust deaths with 114 FtP deaths: instead, he pleads that any wrong death, even just one wrong death, is unacceptable; it is the moral objection to wrong death not the numbers that matter here. Eichmann’s defence was that his position was a ‘misfortune’ for which he was not responsible. Speaking after the guilty verdict but before sentencing, he said “It was my misfortune to become entangled in these atrocities. But these misdeeds did not happen according to my wishes. It was not my wish to slay people. The guilt for the mass murder is solely that of the political leaders…I would stress that I am guilty [only] of having been obedient, [of] having subordinated myself to my official duties… I did not persecute…with avidity and passion. That is what the government did.’ This, and much else of what Eichmann said, is of course normally abbreviated to ‘only following orders’.
What does Stilton have to say in is ‘our punishments are not punishments’ section? Is he ‘only following orders’? It seems, from what he says in the article, more than likely (Dr No quotes the whole paragraph, to avoid any charge of selective quotation):
“So the claim that we want to punish and punish more is quite wrong. We have always accepted that the effect of the fitness-to-practise process created by Parliament can be punitive, the point we have sought to make is that the purpose is not to punish. It is to protect patients and the reputation of the profession.”
Now consider this: why has the apparently superfluous phrase ‘created by Parliament’ been inserted?