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Medico-legal - Guide to being a whistleblower

Blowing the whistle is never easy but keeping patients safe comes first, says Dr Stephanie Bown.

Whistleblowing can be difficult can be difficult, stressful and isolating
Whistleblowing can be difficult can be difficult, stressful and isolating

Whistleblowing is not res-tricted to the actions of a small number of individuals involved in high-profile cases, such as consultant anaesthetist Dr Stephen Bolsin. In the 1990s he was widely credited with uncovering the higher than normal death rate of babies undergoing open-heart surgery at the Bristol Royal Infirmary.

A doctor's personal wish to protect patients by 'blowing the whistle on poor practice' is reinforced by a professional duty. The GMC is very clear that doctors must protect patients from risk of harm posed by another colleague's conduct, performance or health.

The doctor's duty to put patients' interests first, and to act to protect them, must override any personal and professional loyalties.

Issues to consider
Talk to anyone who has been personally involved in raising concerns about a colleague and, without exception, you will hear how difficult, stressful and isolating it can be.

Whistleblowers rarely, if ever, feel that their concerns are welcomed and there are too many examples of individuals being suspended, dismissed or otherwise ostracised for this responsibility to be taken lightly. However, the Public Interest Disclosure Act does provide some employment protection in certain circumstances.

Primary care
If raising concerns is challenging within the hospital sector, it is even more so in the primary care setting.

Complexities for GPs include the potential impact on business interests and relationships. You may also, of course, have a personal relationship with the doctor concerned.

Regardless of whether this relationship is a history of conflict or an equally long friendship, it could adversely influence the objectivity of your assessment of a problem.

You will also be anxious about the possible impact on your employment, references and professional reputation.

Raising concerns
Be clear, honest and objective about the reason why you are concerned. You should acknowledge any personal background you have with the colleague and focus on the importance of patient safety.

Raise your concerns promptly with the appropriate person. This might be another partner in the practice, the clinical governance lead at the primary care organisation (PCO) or, if you are in training, your trainer or director of postgraduate general practice education.

You should keep a record of your concerns and the steps you have taken.

If, despite raising your concerns through the appropriate internal channels, you have good grounds to believe that the patient is still at risk of harm, you should take advice from your medical defence organisation or a professional association before you take any further action.

It may also be necessary to contact an appropriate body - the PCO or the GMC - to investigate if you believe the local responsible person or body is part of the problem, if there is an immediate risk to patients, or if you have raised concerns locally but are still not satisfied that adequate action has been taken.

If concerns are about you
So how should you respond when roles are reversed and the concerns have been raised about you?

Firstly, try to maintain your professional composure. The most effective way to dispel misplaced concerns about your practice is to respond constructively, objectively and calmly, taking into account all the evidence that is available to you.

Do not hesitate to contact your medical defence organisation for advice at the earliest opportunity.

In those very rare circumstances where wholly unfounded allegations are brought against you, it may be useful to reflect on what the GMC expects:

'You must treat your colleagues fairly and with respect; you must not bully or harass them or unfairly discriminate against them, by allowing your personal views to affect adversely your professional relationship with them. You should challenge colleagues if their behaviour does not comply with this guidance.

'You must not make malicious and unfounded criticisms of colleagues that may undermine patients' trust in the care or treatment they receive or the judgement of those treating them.'

Key principles
While raising a concern is never easy, and is not to be taken lightly, there are key principles that will enable you to fulfil your professional obligation to the GMC, your patients, your colleagues and yourself.

These are to behave as you would expect to be treated yourself - and if someone raises a question about your competency, be prepared to address those concerns constructively, before you cry 'conspiracy'.

SCENARIO

Vulnerable position
A recently appointed salaried GP is consulted by a young woman who says that she usually sees the senior partner, who is currently on leave.

She explains that following a bereavement nine months ago, she has been receiving emotional support from the senior partner, who usually visits her at home after surgery once or twice a week.

She is asking for sleeping tablets to tide her over until he returns. The salaried GP is concerned about the level of dependency and professional boundaries, but is also concerned about how to raise this and the consequences of doing so.

On the face of it, there has been no wrongdoing, but professional boundaries may have been stretched and the doctor is putting both himself and the patient in a very vulnerable position.

What to do
The GP should try to identify an appropriate and trusted colleague to discuss the concerns with. Ideally, this would be another partner in the practice. They should find a way for their concerns to be raised with the senior partner on his return, either by or with a senior and trusted colleague within the practice.

If this is not possible, or if the GP's concerns are not taken on board, they may need to take advice outside the practice, for example, from an experienced GP at the LMC or a senior doctor in the primary care organisation.

 

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