A Psychiatrist In Fife #2
Summary
A psychiatrist in Fife #2 follows on from my previous post, in which I discuss a discriminatory incident that occurred with a psychiatrist, who had never met me or spoken to me, and who wrote a letter, claiming that my facial pain is fictionalization. He sent this letter out to multiple agencies. The unfounded letter profoundly affected how I was viewed by medics in Scotland. This post discusses the ethics around the issue of psychiatrists evaluating a patient without meeting them, and what actions I took to challenge this discriminatory incident.
My Primary Action
I discovered that this psychiatrist was acting as a locum psychiatrist for the local mental health team in Fife. I immediately withdraw from the mental health services there. It was too dangerous to remain open to a team, who had a leader at its helm, who was this perilous. I had to withdraw to prevent anymore discriminatory letters being published about me. I relied, instead on the wonderful help of the non-statutory support sector.
Sci Gateway
It was terrifying residing in a country with this discriminatory letter on my file, because it was visible to any professional who logged into my medical records. Sci Gateway is the national system in Scotland that integrates primary and secondary care systems. In England, when you go to see a consultant, unless they really root around, the only information in front of them is the GP referral, and any investigations done at that hospital. In Scotland, the consultant has both your secondary care and GP records in front of him. I wanted to leave Scotland, but I couldn’t, due to the national lockdown.
Good Medical Practice 1
Good Medical Practice States that a Doctor Must;
Treat Patients and Colleagues Fairly and Without Discrimination
59) You must not unfairly discriminate against patients or colleagues. You should challenge colleagues if their behaviour does not comply with this guidance, and follow the guidance in paragraph 25c (see section Domain 2: Safety and quality) if the behaviour amounts to abuse or denial of a patient’s or colleague’s rights. [1]
(Paragraph 25c – If you have concerns that a colleague may not be fit to practise and may be putting a patient at risk, you must ask for advice from a colleague, your defence, or us.)
Good Medical Practice 2
Good Medical Practice States that a Doctor Must;
Act with Honesty and Integrity
71) Be honest and trustworthy when writing reports, and when completing or signing forms, reports and other documents. You must make sure that any documents that you write or sign are not false or misleading.
a) You must take reasonable steps to check the information is correct. [2]
This letter, written by the psychiatrist, is a radical departure from Good Medical Practice. It is not honest or trustworthy. He has written and signed an extremely misleading document, that led to me being denied medical treatment for my facial pain because of it. He didn’t take ‘reasonable steps to check that the information is correct.’ That would have involved him meeting or speaking with me, which he didn’t do. Good Psychiatric Practice, which sets out standards of practice for psychiatrists, ‘is aligned to the General Medical Council’s (GMC’s) Good Medical Practice, the standards for all medical practitioners.’[3]
My GP and the Community Psychiatric Nurses, neither complied with GMC guidance. They all knew that what this psychiatrist had said about me in his letter was not true. They also knew that his actions had both caused me harm, and not followed guidance. None of them, however, challenged it, as advised above in point 25c. They stayed quiet, and turned away from me. It bloody hurt.
A Canadian Optician
I came across a case in Canada, where a psychiatrist had written an evaluation about an Optician, without meeting him. The Opticians College had requested this evaluation. I found out that the psychiatrist’s determinations were reached by a review of the optician’s emails to the college. The Optician reported the psychiatrist to the Medical Regulator in Canada, who concluded that the psychiatrist’s conduct was ‘appropriate.’
If the Canadian regulator found the actions of that psychiatrist ‘appropriate,’ then the UK equivalent; The General Medical Council, would likely conclude the same thing for my case. The term ‘appropriate’ acts as an umbrella under which supervisory bodies appear to excuse and defend poor conduct. The parameters of the term are wide and lenient. I was not therefore, hopeful about reporting my grievance to the General Medical Council.
The Goldwater Rule
The Goldwater Rule, which is observed the USA, asks psychiatrists to refrain from diagnosing a person without meeting and examining that person as a patient.
The Goldwater Rule is a statement of ethics first issued by the American Psychiatric Association in 1973 restraining psychiatrists from speculating about the mental state of public figures. The rule enjoins psychiatrists from professionally diagnosing someone they have not personally evaluated.
Psychology Today
The activating force behind The Goldwater Rule was during the Presidential campaign in 1964, when Senator Barry Goldwater was running against President Lyndon Johnson. FACT magazine, solicited and published psychiatric opinion about Barry Goldwater, which proved highly embarrassing for the field of psychiatry.
Reflections
From the research that I did into the legalities of what this psychiatrist had done, I found that his damning letter that he had written about me had definitely breached Good Medical Practice, and it was possibly a breach of two of my human rights. However, there was no rule or law in the UK that says it is illegal to diagnose a patient without meeting them. Unethical? Definitely yes. But, illegal? Unfortunately, not. Not in the UK, anyway.
General Medical Council Complaints
The General Medical Council, (GMC) is the national regulatory body for doctors who are registered in the UK. Their role is to protect public safety and uphold public confidence in the medical profession. The GMC only deal with serious complaints about doctors, that might require a doctor’s registration to be restricted or removed. They don’t get you an apology or a review of your case. They look at a doctor’s fitness to practice.
The GMC will investigate complaints about; ‘1) serious mistakes in carrying out medical procedures, 2) failure to examine a patient properly, 3) fraud or dishonesty, 4) discrimination, 5) serious breaches of a patient’s confidentiality, and 6) any serious criminal offence.’[4] If the GMC finds a doctor unfit to practice, they can issue the doctor a warning, agree for the doctor to retrain or refer the doctor to a tribunal. The tribunal can decide to a) put conditions on a doctor’s registration, b) suspend the doctors name from the register, and c) remove the doctors name from the register entirely.
I questioned whether my complaint about this psychiatrist was serious enough for the GMC to consider. The Citizens Commission on Human Rights thought that it was, and they kindly wrote me a letter of support. I sent in a concern to the GMC, on the grounds of discrimination. The tenet of my complaint centred around the fact that the psychiatrist had written a discriminatory letter about me, without meeting or speaking to me.
The Triage Stage
The General Medical Council triage team asked to see a copy of the psychiatrist’s ‘alleged’ letter. I hadn’t actually seen it myself. I requested a copy from my GP. When I read the contempt with which he spoke about me, I felt dirty. I stood in the car park of my GP Practice in complete disbelief.
The psychiatrist did admit in the opening sentence of his letter that he had never met me, but the shock, was the condemning tone of his letter, and the agencies that he had copied in. I felt deeply humiliated. He also made a comment about a recent MRI scan of mine. He was a locum psychiatrist. It wasn’t his role to comment on radiology data.
Provisional Enquiry
The General Medical Council, (GMC) decided to open a Provisional Enquiry into the psychiatrist’s actions. ‘A provisional enquiry involves obtaining targeted information to help inform a decision about whether the concern raised amounts to an allegation that a doctor’s current fitness to practise is impaired and therefore requires a full investigation. It is limited to gathering one or two discrete pieces of information.’ [5]
The GMC applied for my notes from the psychiatric ward where I stayed for two weeks. They told me that they would write to the psychiatrist, and that they would be informing his Responsible Officer about the complaint. This was an encouraging start, but I was not hopeful about a positive outcome. The GMC were already using words like ‘acceptable,’ and ‘appropriate.’ The definition of those terms, within complaints processes, is murky. I wasn’t under any illusions.
GMC Victim Support Service
The General Medical Council’s (GMC)Victim Support Service offers a 24-hour helpline for anyone who has an investigation or Provisional Enquiry open about a doctor. It provides support re the investigation process. I received nine months of support from the GMC Victim Support Service. I was assigned a wonderful worker, who phoned me weekly. Their support helped me to process the shock attached to this violation. It is a wonderful service. They truly understand how it feels to be a victim of abuse of power. I am extremely grateful to the GMC Victim Support service, for the time and space that they gave me, to process this violent attack on my integrity.
Foot Notes
[1] The General Medical Council; Good Medical Practice, March, 2013, www.gmc-uk.org/guidance
[2] The General Medical Council; Good Medical Practice, March, 2013, www.gmc-uk.org/guidance
[3] The Royal College of Psychiatrists; Good Psychiatric Practice, 2009.
[4] The General Medical Council; How To Raise a Concern about a Doctor, www.gmc-uk.org
[5] The General Medical Council; Guidance for Decision Makers on Provisional Enquiries, www.gmc-uk.org
Recommended Articles
The GMC- Our Role In Protecting The Public.
How To Raise A Concern About A Doctor
An Introduction to Clinical Ethics in Psychiatry
Is It Ethical For Doctors To Diagnose Patients They Haven’t Examined?