Last year (2022) the GMC announced a review of the Good Medical Practice guide – the first time in nearly ten years. The updated guide is due to be published this summer and should reflect lessons learnt from some of the more egregious examples of medical misbehaviour seen in the intervening years. It is widely acknowledged that poor standards of behaviour by healthcare professionals affect patients both directly and indirectly – and examples of such are by no means confined to the UK. Considerable research on the subject has been conducted across the world and the rather depressing conclusions reached are broadly similar – many health systems are characterised by an endemic culture of bullying and harassment.
Hierarchical structures not compatible with 21st century healthcare
Expectations of how medical professionals should conduct themselves when dealing both with colleagues and patients have changed over the decades, from a strictly hierarchical ‘I say, you do’ approach to one that is more inclusive and compassionate. However, it obvious that not everyone got the memo. The last decade and beyond has been peppered with initiatives from the government, royal colleges and various other bodies designed to improve patient safety, the success of which has been distinctly patchy. What is clear is that a safe environment for patients depends on a few things done well: good leadership, good communication between medical teams, and a positive and caring culture.
This is what the Good Medical Practice guide is supposed to foster: by setting out clear guidelines of how doctors should behave, no one should be left in any doubt about what is expected of them. The guide itself is divided into ‘four domains’, a structure which appears to have been retained, covering working with colleagues (which refers to anyone doctors work with and not just other medical professionals); working with the public; professional capabilities; and maintaining trust.
Putting the patient at the centre of care
Achieving better outcomes for patients is the principal (and one might argue, only) objective of the guidance. The draft guide refers to ‘toxic’ workplaces and the deleterious effect they have on both staff and patients and gives explicit instructions on how doctors should behave: no bullying, exploitation, discrimination, abuse or harassment should be tolerated by anyone, including those observing such behaviour. A number of new duties are being introduced, particularly in relation to how doctors communicate with their patients, including an instruction that they ‘must provide safe and effective care’ regardless of whether the consultation is conducted remotely or face to face.
The second domain, working with the public, specifically references patients’ rights and introduces a new duty that doctors ‘must try and find out what matters to patients’ so that they can make informed decisions about their care. The guide also introduces a zero-tolerance policy for sexual harassment and a duty to make reasonable checks that any information given (whether verbal, written or digital) is not misleading.
Bad behaviour has consequences
All in all, it would appear that the guide has strengthened the standards against which doctors must measure their performance and behaviours. As I have noted in blogs passim, bad and / or inappropriate behaviour towards colleagues always has consequences for patients; unhappy staff leave, vacancies become hard to fill leading to even greater pressure on those remaining and higher anxiety levels - a vicious circle from which it is difficult to escape. I’ve also written in the past about the endemic blame culture that acts as a major barrier to improving patient safety; in a culture with good communication, good leadership and a desire to get things right, mistakes should be viewed as an opportunity to learn, not to berate.
The guide, updated to reflect the sensibilities of the 21st century and imposing greater duties of care on doctors, should lie at the core of everything they do. It ‘puts the patient at the centre of care’ and states quite clearly that it ‘is not a set of rules. We expect medical professionals to use their judgment to apply the professional standards in practice’. In a change to the 2013 version of the guidance, the GMC has replaced its existing ‘threshold statement’ and replaced it with: we act ‘where there is a risk to patients or public confidence in medical professionals, or where it is necessary to maintain professional standards’.
Given the ongoing crises faced by the NHS, including strike action, it is difficult to see anything changing immediately. Most doctors and other health professionals will do their level best to follow the guidance, but others will simply find the standards too daunting, given the imbalance between resources and expectations, and either muddle through with their fingers crossed or just leave. As for patients, they just want to see lessons learned, an explanation given and an apology.