Published: 11/08/2005, Volume II5, No. 5967 Page 17
The GMC won its challenge to the Leslie Burke ruling but its action proves that it does not stand up for patients, says Joyce Robins
The General Medical Council has recently changed is strapline. It now reads: 'Regulating doctors, ensuring good medical practice'.
'Protecting patients' no longer figures.
While it argues that good practice inevitably results in protection of patients, expunging the word will cement the view held by most patients and emphasized by the Shipman report that the GMC has always put doctors first. Perhaps, in view of such bruising criticism, the slogan had become an embarrassment The GMC is between a rock and a hard place, trying to satisfy everyone. The medical press is full of letters from doctors saying that the GMC treats them unfairly. It is, after all, funded by doctors who expect it to uphold their interests, but it would be hard to find a patient who shares that view.
GMC president Sir Graeme Catto recently said that the patient has to be at the centre of the GMC's work, and also across healthcare regulation as a whole (Feedback, pages 20-21, 21 April). But its High Court challenge to the Leslie Burke ruling, which enables patients to insist that artificial nutrition and hydration should be provided as long as they are sentient, says otherwise. And the GMC is insisting that its revalidation proposals for doctors are 'fundamentally sound', when months of evidence and analysis at the Shipman inquiry branded them unfit for purpose. Both stances suggest that doctors, not patients, are still at the heart of GMC decision-making.
When it first lodged its appeal to the Leslie Burke judgment, the council claimed it was seeking clarification.
This would have been sensible and proper. In fact, it was obvious that it wanted the judgment overturned - something the Court of Appeal did on 28 July. The GMC believes it is unacceptable that patient autonomy should ever challenge that of doctors.
Unfortunately when doctors talk to lawyers, patients get short shrift.
Patient Concern was granted leave to intervene in the appeal. We uphold the principle of patient choice. Patients may differ from doctors in their evaluation of personal quality of life and they, not doctors, must be allowed to judge their 'best interests'. We do not have the right to demand any treatment we see fit, but we see artificial nutrition and hydration as in a different category to other treatment. We should be able to ensure that we are not given a death sentence by being deprived of food and fluid.
As far as revalidation is concerned, we were promised a process that would demonstrate that a doctor is fully up to speed. Few patients fear 'another Shipman', and in any case it is probably impossible to legislate for a madman.
But at the inquiry, Royal College of GPs past president Dame Leslie Southgate said 'there are poorly performing doctors out there who are harming patients'. We must be protected from this minority and the inquiry findings make it clear that revalidation by no means provides an evaluation of a doctor's fitness to practice.
The GMC has not delivered for patients.
Its actions and rhetoric do not tally and the movement towards patient choice and autonomy is leaving it behind. This is a serious matter for everyone, because if we cannot come up with a better system of both guiding and regulating doctors, we shall all be the losers. We must have confidence that our doctors are competent and we must be able to trust that their interests will not triumph over ours. Without that bedrock, the function of every trust will be impaired as the levels of patient satisfaction drop.
Joyce Robins is co-director of Patient Concern, an independent watchdog for NHS patients. She took part in the Shipman inquiry discussion on complaints against and regulation of doctors.
The next HSJ Debate, in which the GMC's Sir Graeme Catto opposes the case for 'citizen-led' medical regulation, will be published in next week's HSJ.