Professionalism Flashcards
When the GMC was first formed, what powers did it hold and what was its stance on self-regulation?
Powers:
- registration of doctors
- approved & inspected medical schools
- doctrine of clinical autonomy (only doctors have enough expertise to monitor and control the work of other doctors)
Self-regulation:
- interests of the profession seen as the best interests of the public
- dependent on professional norms
- relied on individuals internalising and cooperating with collective norms of professional group and aligning their conduct with the profession’s standards (via socialisation, not by curriculum - therefore not formally examined)
i.e. the GMC used to assume that any individual admitted to the profession could be assumed to be of good character and competence
Only involved in “serious professional misconduct” = advertising, unlicensed abortions, or adultery with wife of medical partner
What are some arguments for self-regulation of the medical profession?
- high degree of skill & knowledge needed that non-professionals cannot evaluate/regulate
- professionals are responsible, therefore can be trusted without supervision
- profession itself can be trusted to undertake proper regulatory action
What are some arguments against self-regulation of the medical profession?
- self-serving & strategic, not virtuous (financial reasons)
- overly insular & arrogant
- “old boys culture”; no reporting on colleagues, stick together mentality
Give a brief outline of the consequences of the Bristol Inquiry.
1984-1995
29 babies died, 4 brain-damaged
- undermined confidence in ability of profession to regulate itself: secrecy & resistance to external scrutiny, criticism, or control
- long-lasting effects on paediatric cardiac surgery
Give a brief outline of the consequences of the Alder Hey Inquiry.
Organs of babies retained without knowledge or permission of parents
Lead to formation of Human Tissue Act
Complaints not followed up, lack of supervision, no reporting by colleagues
“Arrogance & Indifference”
Give a brief outline of the consequences of the Harold Shipman murders.
~236 murders
Convicted of obtaining controlled drugs by deception, possession of controlled drugs, and forging prescriptions in 1976 but the GMC did not take further disciplinary action
Set up single-handed practice in 1991
Murdered elderly women with morphine overdoses
Local GP & local funeral parlour raised concerns
Police & GMC did not find any evidence
Shipman arrested for forging a will, not struck off until convicted
What are some common factors in the recent medical scandals?
- staff who were informed found it difficult to act
- patients who told health care professionals often greeted with disbelief or discredited (esp. psychiatric patients)
- whistleblowers not always believed
- NHS disciplinary procedures found to be “cumbersome, costly, & inhibiting” —> often people are “managed out”
- difficult to recognise some “bad apples” e.g. Shipman
What are some rules on professional propriety which effect the action of people in scandals?
- doctors discouraged from raising concerns about each other
- etiquette rule forbidding close monitoring of other doctors
- shared sense of personal vulnerability
- high costs associated with sanctioning
- problems associated with quality of evidence and absence of supportive processes
- credibility gap, patients not believed
What are some informal ways problems are dealt with by management?
“terribly quiet chat”
“protective support”
“diverting patient flow”
“push out”
Does not work on the bad apples
What changes were made by the GMC in an attempt to improve self-regulation?
Tomorrow’s doctors (1993 & 2009)
Medical Professional Performance Act (1995)
GMC given jurisdiction to consider whether a doctor’s standard of professional performance is seriously deficient
When was self-regulation of the medical profession ended?
White Paper (2007)
- civil, not criminal, standard of proof required
- independent GMC members
- overseen by Professional Standards Authority for Health and Social Care
Give some examples of concerns related to professionalism.
- misconduct
- poor performance
- criminal conviction/caution in the UK
- physical/mental ill health
- decision by regulatory body either in the UK or abroad
Give some examples actions which may be taken by the Medical Practioners Tribunal Services.
- agree undertakings with the doctor
- place conditions on registration
- suspend their registration
- remove from medical register
What is revalidation? What are the aims of revalidation?
Have to revalidate every 5 years to stay on medical register
Components:
- participate in annual appraisals that have good medical practice at their core
- maintain a portfolio of evidence of continuing professional development, quality improvement activities, feedback from colleagues & patients, review of compliments & complaints
Aims:
- assure patients
- maintain & improve practice
- provide support to doctors in keeping their practice up to date
- identifying concerns about doctors at an early stage
- encouraging patient feedback
- drive clinical governance at local level & improve standards of patient care
Define managerialism. Give some examples in relation to the NHS.
Belief in the value of professional managers and the methods and concepts they use
Associated with hierarchy, accountability, measurement, and belief in the importance of tightly managed organisations as opposed to individuals or groups which do not resemble organisations.
e.g. administration & management, consultants, clinical excellence awards, implementation of government policies, compliance with guidelines and clinical governance
