Reflective notes can protect GPs and should not be feared, says MDDUS

Doctors should look at reflective notes as something that can protect them rather than seeing them as a potential threat, a medico-legal organisation has said.

Reflective notes (Photo: iStock)
Reflective notes (Photo: iStock)

In its submission to the GMC-commissioned independent review into gross negligence manslaughter (GNM), the Medical and Dental Defence Union of Scotland (MDDUS) has advised members to continue to engage in reflective practice - arguing it can ‘provide a degree of protection’ for doctors who face possible investigation over fitness-to-practise matters.

Doctors’ confidence in reflective practice has been severely undermined in the wake of the case of Dr Hadiza Bawa-Garba, a junior doctor who was convicted of GNM and struck off the medical register following a high court appeal by the GMC. Dr Bawa-Garba and her legal team have since successfully overturned the ruling.

Although reflective entries from Dr Bawa-Garba’s e-portfolio were not used as evidence against her, notes made by her duty consultant on a meeting he had with her after the incident formed part of his witness statement.

Some GPs began to boycott reflective notes following the decision to strike off Dr Bawa-Garba and a survey conducted by GPonline found that 70% of GPs believe it is no longer ‘safe’ to reflect in writing.

Reflective practice

Many organisations, including the BMA, have called for written reflections to be granted legal protection. However, this was dismissed as ‘not workable or appropriate’ by the Williams rapid review into GNM earlier this year.

Arguing in favour of reflective notes, MDDUS joint head of medical division Dr John Holden said: ‘MDDUS has advised its members for many years to engage in reflective practice. We believe that this raises standards, ensures doctors meet their regulatory obligations and can provide a degree of protection in the event of criticism of a doctor’s actions.

'Medical professionalism requires that doctors learn from their experiences and put patient safety, care and quality improvement first. It is important that doctors are able to reflect honestly and openly without fear of it being used against them and MDDUS liaises closely with stakeholders to protect its members interests.'

The MDDUS has previously advised doctors to ‘appropriately anonymise their reflections’ to ‘minimise the risk of proper reflection being used to criticise the practitioner’.

Dr Holden concluded by voicing support for the development of guidance on reflective practice, which is being produced jointly by the GMC, the Academy of Medical Royal Colleges (AoMRC), the Conference of Postgraduate Medical Deans (COPMeD) and the Medical Schools Council organisations and is due to be published later in the year.

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