Chris Lancelot: An open letter to the new GMC chairman

Dear Professor Rubin,

Congratulations on your election as chairman of the GMC. Unfortunately, this is something of a poisoned chalice because the GMC is unpopular in the eyes of almost everyone. Doctors hate it because it threatens their careers: complaining patients feel it is on the side of the doctors. Yet this same unhappiness rarely surfaces over the non-medical justice system. Yes, we all know the law is an ass, but UK courts are generally held in high regard. So why is the GMC different?

My own view is that the GMC is too adversarial and patronising. One colleague under preliminary investigation (over a single alleged missed diagnosis) received a letter concluding that 'there is no realistic prospect of establishing that your fitness to practise is impaired'.

He felt relief but not exoneration. The implication remained that the case had been dropped not from lack of guilt but from lack of evidence. The complainant doubtless felt the GMC believed the doctor was guilty but that it couldn't be bothered to take things further. Here neither side is satisfied: both become stressed, angry and disillusioned.

As incoming chairman how might you ameliorate this state of affairs? Why not instigate an initial, mandatory yet informal 'truth and reconciliation' meeting where doctor and patient get together in a non-minuted, GMC-mediated discussion to which the public and press are not admitted?

Giving the clinician a chance to explain (and if appropriate, apologise) might take much of the sting out of the situation - on both sides. No one should expect doctors to be perfect. We all know that an inappropriate turn of phrase or a clash of culture can inadvertently give offence. Similarly, the difficulties of diagnosis or choice of therapy may need a more detailed explanation for the patient or their relatives.

Only if this meeting fails to achieve consensus should matters go further: and no doctor should have to declare themselves 'under investigation' until after this point.

A pre-hearing such as this would allow feelings to be vented, errors to be corrected, apologies to be made (if appropriate) and would leave all sides feeling that truth, honour and justice had been well served. How about it, Professor Rubin?

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