Ensuring the welfare of doctors under investigation

In the interest of doctors’ mental health should fitness to practise hearings be held in private until professional misconduct or poor professional performance have actually been proven?

Dr Stephen McWilliams, Consultant Psychiatrist, Saint John of God Hospital, Stillorgan

November 18, 2022

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  • How sad to read the coroner’s verdict last month on the death of Dr Michael McPhillips,1 a respected UK-based consultant psychiatrist. Under investigation by the General Medical Council when he died, he apparently informed the police of his intention to kill himself, just four days after receiving an email from the GMC with details of the complaint. He left six suicide notes addressed to family and friends and, according to the coroner, several of these made reference to his fear of the fitness to practise tribunal being held in public. The coroner gave a verdict of suicide and remarked: “I have no hesitation in concluding that the information in the content of the communication from the GMC did contribute to Dr McPhillips’ state of mind and therefore contributed to his death”.

    According to a GMC report, 29 doctors died while under investigation or monitoring in the three-year period from January 1, 2018 to December 31, 2020.2 During this time, the GMC conducted 5,370 investigations. Of the 29 deaths, 20 were natural while at least five were confirmed suicide. A high rate of suicide among medical doctors was also highlighted by Casey and Choong, who asserted that professional regulatory investigation is a risk factor.3 Aside from the coroner’s duty to identify such deaths, they argued that the GMC has “a demonstrable duty of care towards doctors” requiring the modification of existing operational procedures.

    In Ireland, the Medical Council receives several hundred complaints about doctors annually. Many doctors regard such a complaint as the most traumatic experience of their professional life regardless of the outcome. Doctors speak of a sense of isolation, lack of support and damage to their self-esteem and self-confidence. This is particularly true when doctors know the complaint may lead to an embarrassing fitness to practise hearing in public. It is hard not to escape the idea that, even if you are not found to be “guilty” (an awful term that unjustly criminalises our profession), media reporting and the internet will ensure that the complaint is one of the main things people will know about you in the future.

    This is not good for doctors or patients. Bourne et al studied 7,926 doctors, of whom 2,257 were subject to a current complaint and 3,889 had been complained about in the past.4 They found that 16.9% of the current/recent-complaint doctors reported moderate/severe depressive symptoms while 15% reported moderate/severe anxiety. This was compared to 9.5% and 7.3% of no-complaint doctors respectively. Current/recent-complaint doctors were more than twice as likely to report suicidal ideation. The level of distress correlated with the severity of the complaint. In the aftermath, more that 80% of doctors reported defensive practice by overprescribing, over-referral and ordering more tests, while up to 50% simply avoided high-risk patients. Over 80% believed the complaints process would improve with transparency, managerial competence, and the right to claim lost earnings and take action against vexatious complainants.

    Most complaints are dismissed within three months, while there is an obvious need to protect patients, maintain professional standards and provide accountability. But the Medical Council also has a broader ethical responsibility to protect society’s access to quality healthcare. Overstressed doctors emigrate while others choose to retire at the earliest opportunity. Does a constant fear of the humiliation of public fitness to practise hearings really contribute to a well-staffed, confident, competent medical workforce? Why can the hearings not be held in private until professional misconduct or poor professional performance have actually been proven? No just and empathic society should tolerate anything less.  


    2. General Medical Council. Report of doctors who have died while under investigation or during a period of monitoring. (3 March 2022)
    3. Casey D and Choong KA (2016). Suicide whilst under GMC’s fitness to practice investigation: Were those deaths preventable? Journal of Forensic and Legal Medicine. 37:22-27.
    4. Bourne T, Wynants L, Peters M, Van Audenhove C, Timmerman D, Van Calster B, Jalmbrant M (2015). The impact of complaints procedures on the welfare, health and clinical practice of 7926 doctors in the UK: A cross-sectional survey. BMJ Open. doi: 10.1136/bmjopen-2014-006687
    © Medmedia Publications/Hospital Doctor of Ireland 2022