Issues with reflective learning still unresolved
26 Mar 2018
The controversial case of Dr Bawa-Garba continues to seriously concern the medical professionals. Leaders in the profession are considering calls from doctors to disengage with reflective writing, for fear that this may be used against them in any future legal proceedings. The GMC, however, has warned against any such disengagement.
Dr Bawa-Garba was erased from the medical register, pursuant to the GMC deciding to appeal the decision of the Medical Practitioners Tribunal Service (“MPTS”). This appeal resulted in the High Court erasing Dr Bawa-Garba from the medical register, as a result of her criminal conviction for gross negligence manslaughter. This controversial decision was made despite evidence of the doctor’s remediation and her years of subsequent successful clinical practice.
Reflections according to Good Medical Practice
The code of conduct for doctors, ‘Good Medical Practice’ requires doctors to participate in regularly reflecting on their standards of practice and the care they provide. Clinical and educational supervisors regularly encourage doctors to record their reflections. Doctors are all acutely aware of their requirement to revalidate with the GMC. The doctor’s annual appraisal is an intrinsic part of the revalidation process and this requires a doctor to record their reflections on their practice.
Politicians state that they are keen to foster a culture whereby all healthcare professionals follow their ‘duty of candour’ openly acknowledging, where appropriate, when things have gone wrong. However, there is a growing fear that in the wake of the Dr Bawa-Garba case, that doctors will seek to practise defensively and will stop shy of recording reflections, for fear of the personal consequences in any legal proceedings.
Reflections as evidence of mitigation
The GMC state they do not require reflective statements from doctors as part of their fitness to practise investigations. However, when considering the question of whether a doctor’s fitness to practise is impaired and if so, what the appropriate sanction should be, the GMC always look for evidence that the doctor has insight into any proven or accepted failings. In reality in fitness to practise proceedings, reflections often feature as a critical aspect of the mitigation for the doctor and without them, the doctor runs a significant risk that the GMC will assert that they lack insight.
Whilst in the case of Dr Bawa-Garba the reflections of the doctor were not put before the jury by the prosecution, it is entirely possible that the prosecution legal team had access to this documentation. If so then it may well have informed their cross-examination strategy of the doctor.
The consequences of this case appear to be far from over.