It all began with a letter, a thick white rectangular envelope landed on my desk. The words all blurred in front of me: ‘complaint’, ‘allegation’, ‘investigation’. All related to me. At first it felt unreal, but slowly I began to understand that my professional life was about to unravel.
I have been a doctor for over 20 years and never considered any alternative career. I passed my MRCGP with distinction, gained more letters after my name and greatly enjoyed my career in general practice. My feedback surveys suggested that patients were satisfied with my care and colleagues were happy to work with me. I had not received any serious complaints until this time.
Last year I saw a patient and made an error of judgement. The patient went on to have an acute event the following day, despite an entirely normal exam during the consultation.
I fully appreciate that the patient has their own experience and story to tell but I am writing this to inform and to support doctors who may be going through something similar. It is also important for me to state that the patient is now well and has made a good recovery.
The initial complaint
A complaint was made by the patient’s partner to the practice but also simultaneously to NHS England and to the GMC. The wheels had been set in motion. There were mountains of paperwork from the three organisations that needed to be completed within tight timeframes. I had to balance this with continuing to work and manage family life and dealing with the shock of the complaint.
It was a bewildering time. All of the email correspondence from the GMC included sources of support in a list at the end. The intent, I suppose, is to soften the blow. However, throughout the whole process, lasting 10 months in total, I never heard the voice of any GMC representatives, the only form of communication used was email. This had a dehumanising effect.
I would send emails to them, but would often be left waiting for several days for replies. What’s more, on the majority of occasions, emails were sent to me either late on a Friday evening or on the evenings before bank holidays or school holidays. I felt powerless to action these and was left to ruminate over whole weekends about an email as there would be no recourse until at least Monday.
I am fortunate that I have a supportive family and could immerse myself in family life and battle through the weekend. I thought about doctors who did not have this support and wondered how they would cope in the same situation.
Added to all of this were some GMC IT issues that delayed the whole investigation by an additional five weeks, so the uncertainty and anguish were unnecessarily prolonged.
Despite family, friends and a full, active life, this was an all-consuming, deeply distressing experience. I could not imagine living though such a time without support or the feeling that I had someone on my side.
The reaction of colleagues
I was advised by the GMC to inform all of my colleagues about the investigation. As a portfolio locum GP this meant sometimes having to inform strangers, with varied results. On a few occasions my phone calls and emails were left unanswered. This of course made me feel even more doubtful of myself and increased my anxiety levels as I was trying to second-guess the negative thoughts of these GP colleagues.
However, one occasion does stand out. I called a GP who I had not previously met to inform him of the investigation before I could book some locum sessions at his practice. His reply was: ‘I am happy for you to work here, I always support colleagues’. This simple sentence lifted me. He possibly does not remember the discussion, but I certainly do. His words and manner helped me to put the investigation into perspective and realise that the world was not against me.
Meanwhile, a colleague from the university told me that she was happy to continue working with me and would personally ensure my role continued. She was so kind and I felt humbled by her unwavering support. Again, she may not remember this discussion but the impact on me is unforgettable.
How the investigation affected me
Continuing to work during the investigation brought its own stresses. I found myself checking, double-checking, triple-checking notes. I became terrified of mistakes and my clinics ran over significantly.
On more than one occasion I woke up at night, ruminating over consultations and writing panicked emails to practice managers in the early hours about perceived omissions. I could not bear the thought of making any more errors and my peace of mind had been destroyed. I knew I needed to find methods to deal with this.
I sought help through the BMA Doctors Support Service and the GP Health Service. The initial appointments were scheduled quickly, and within four weeks of the start of the investigation I had regular input from both. I found the support from both sources to be invaluable as I was able to vent my feelings and share my fears freely and without judgment.
Some of the sessions had an optimistic tone and but during some I just cried, unable to express how miserable I felt. I had confided in my immediate family and two close friends about the investigation but I had chosen not to discuss it with my wider circle.
Being a GP is a job, but it has also become an integral part of my character. Friends would confide in me and tell me personal details when asking for advice and I did not want their faith in me to be eroded.
To all intents and purposes I put on a front of ‘nothing to see here’. This had a significant impact on my stress levels and I noticed several episodes of palpitations, migraines and interestingly, a text-book case of telogen effluvium which began exactly 92 days after the start of the investigation. One day I stood up after a three-hour clinic and the fabric on the back of my chair was not visible due to the hair fall!
Coming out the other side
This leads me to the more positive and sustained outcomes of the investigation process. I knew I had to learn how to manage the uncertainty and stress I was feeling. I had always been quite a sedentary person, but I began to exercise regularly - I started running each morning and taking daily brisk walks, something I continue to do. This, along with family support, helped me to maintain my mental health and keep resilient and I am truly grateful for the help I received during this most challenging period of my life.
I am also slowly beginning to re-gain some of my shattered clinical confidence after two unexpected events. Firstly, my uncle lives abroad and I diagnosed his haematological cancer in the very early stages based on his symptoms alone. He has now been fully treated and has as a good prognosis.
I also assessed, assisted and stabilised a gentleman who had a cycling accident near my house. I handed him over to the paramedics and he was extremely grateful for my help. The feeling of satisfaction after this event helped me to remember why I had chosen to become a doctor all those years ago.
This brings me to the final positive outcome. I decided to discuss the communication, IT issues and all the various delays with a GMC liaison adviser, who I found to be helpful and proactive. In particular I expressed my concerns for doctors who did not have a close support network surrounding them.
The GMC has since altered the timings of calls and emails and said it will be more mindful of weekends and bank holidays. It also now makes a telephone call at the start of an investigation as opposed to an email, in order to build a constructive relationship between the doctor and the case investigator and to minimise the feeling of isolation. I hope these changes will benefit all doctors who have to go through this process.
When I finally received the letter to state that the case had been closed with no further action, I felt relieved, but surprisingly did not feel as happy as I had imagined I would.
I realised that although the case was closed, I am not immune to future complaints or even to future GMC investigations. So sadly I cannot end on a truly positive note. I will continue to work hard, aim to minimise any chance of errors, improve my knowledge and maintain a good attitude, but I cannot be sure that I will never be in a similar situation again. I suppose none of us can.
The GMC introduced changes in the way it handles cases where doctors make one-off clinical mistakes in April this year, which aim to reduce the number of full investigations in such situations. Read more about this here.
There is medico-legal advice from the MDU on what to do if you receive a GMC complaint here.