Category: General Medical Council

News last week that there were 17 deaths in or following police custody in 2014/15 in England and Wales has rekindled outrage at the scandal and led to the usual political wails. Theresa May, announcing an inquiry into the deaths, said they ‘represented failure’. Well, that’s one way of putting it. Others rallied round ‘one death is a death too many’. Had Stilton been asked for comments, he would have said the deaths ‘absolutely represented failure,’ and that ‘one death absolutely is a death too many’. Sotto voce, he may have added, ‘we absolutely have been here before,’ because of course the GMC has had a hand in the death of similar annual numbers of doctors under FTP investigation, but from a far smaller population at risk. We should also note Stilton does not count year-and-a-day deaths, ie those occurring after FTP investigation. As a killing machine, or if you prefer a negligent machine that allows deaths, the GMC is far more lethal than the police. For once Stilton would be in error to say the GMC absolutely is more lethal, were he ever to admit such a thing, because in absolute published numbers the police are equal to, or slightly ahead of the GMC, but in relative, pro rata, terms, the GMC’s FTP processes are more lethal than police custody processes. If the police’s grim reaper is a scythe on open land, the GMC’s grim reaper drives a combine harvester down narrow streets.

Good medical practice, perhaps, but bad English. Absolutely Stilton’s announcement of his latest hair shirt guidance for doctors, absolutely jointly produced with the Nursing and Midwifery Council so that it applies to nurses and midwives as well, is focused, if that is not too strong a word, on the duty of candour, more generally understood as the duty to be honest. It tells clinicians, with a ringing third degree participle prolapse, that ‘When something goes wrong with a patient’s care, doctors, nurses and midwives should: speak to the patient, or those close to them, as soon as possible after they realise what has happened.’ Wily clinicians, and those liable to be bent by their learned friends, are thereby provided with a useful loophole. So long as the patient hasn’t realised something went wrong, there is no need for the clinician to embarrass themselves. Piling Pelion on Ossa, the next point reverses the prolapse. Clinicians, the announcement says, should ‘apologise to the patient – explain what happened, what can be done if they have suffered harm and what will be done to prevent someone else being harmed in the future’. From where Dr No is sitting, it seems they absolutely don’t know who they are, and if they don’t know who they are, the what hope can there be for the rest of us knowing who we are, let alone what we should do?

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’.

Once upon a time there was a turkey farm that grew so large that no one had ever seen one so vast. There were so many turkeys that, over time, the turkeys began to specialise in what they did. There were turkey-surgeons with white plumage, who operated on other turkeys. There were turkey-physicians, with fancy black and white plumage not unlike a human frock coat, who were called in when no one knew what to do. The turkey-physicians didn’t know what to do either, but were very good at making it look as if they did, which made everyone feel better. There were turkey-apothecaries, always busy in their brown aprons, handing out this pill and that potion. Over time, the turkey-apothecaries renamed themselves turkey-GPs, which made them feel more important, but no one else was fooled, and the turkey-GPs carried on doing what the turkey-apothecaries had always done, the over-worked under-appreciated back bone of Turkey Farm. There were even mad turkeys, as they were affectionately known, whose plumage tended to look as if they had been dragged through a hedge backwards, whose job it was to lock up deranged turkeys. No one liked locking up fellow turkeys, but sometimes it had to be done, and it was the mad turkeys who did it.

Any lingering hope that Parliament’s Health Committee could hold the GMC to account at its annual accountability hearing earlier this week over doctor suicides while under GMC FtP investigation has now disappeared as sand in the desert. Though delayed for a few days, the transcript of the hearing is now available online. It makes grim and depressing reading. On the matter of FtP doctor suicides, the Chair of the committee – a doctor – came to the proceedings with a regrettably light grasp, if that is not too strong a term, on the facts. Stilton, the GMC pongo who answered the questions on these deaths, turned out to have an even lighter grasp. Indeed, so poor were these grasps that Dr No has no hesitation in saying that they were, and are, an insult to democratic process.