In 2014 the GMC commissioned a review of those of its investigations over the previous eight years which had concluded with the suicide of the doctor. It found there had been 28 reported cases of suicide or suspected suicides amongst doctors undergoing a fitness to practise investigation over that period. It found the rates for suicide were higher amongst healthcare professionals than the general population. You might think this is hardly surprising, given the enormous commitment the profession requires from healthcare professionals whether in their training, their practice or their CPD. To have all that achievement called into question in an investigation would surely agitate the most resilient of characters, and cause a measure of despair for nearly all?

The GMC’s review was limited in that it did not attempt to estimate the number of unsuccessful suicide attempts, nor the incidence of mental illness associated with its investigations. It pointed out that the doctors most at risk of suicide were those with pre-existing mental health problems, perhaps implying that the GMC cannot be held fully responsible for these tragic outcomes. But doctors with no pre-existing mental health problems might very well have other significant pre-existing problems in their life. To add a career-threatening investigation to the other burdens of life might well be too much for some to bear. For others, the investigation itself might be sufficient to throw an otherwise stable personality into disarray.

The risk that an investigation might of itself cause or contribute to a significant mental illness is not hard to see. The question is whether the GMC and the other professional regulators and their Tribunals which ultimately make the decisions in fitness to practise investigations sufficiently take these human considerations into account in the way they work. After all, since an investigation might conclude with exoneration, it should in the public interest surely be conducted in a manner which mitigates the risk of lasting physical or psychological harm to that professional.

Sadly, in my own practice I have seen several examples of a certain heartlessness in the system. One unforgettable example was that of my client who had been managing his alcohol addiction successfully for some time, helped by restrictions on his registration which, among other things, required medical supervision. When he suddenly relapsed, his registration came under threat of suspension. He told me he could not cope with the ignominy of suspension and that such an order would mean the end of his life. I informed the Tribunal of this and argued that a suspension would be disastrous for my client and was unnecessary in any event, since any risk to the public could be perfectly well managed by strict conditions. My plea fell on deaf ears, with the Chair even commenting that the doctor’s rehabilitation was an irrelevant factor in the Panel’s decision making. My client was duly suspended and, sad to say, a few weeks later was found dead in his house. He had not exaggerated the risk to himself which, in my opinion, far exceeded any risk to the public.

That is an example of a doctor with a pre-existing mental health condition coming to grief as a result of these processes. Another case I recall concerned a skilled consultant with no previous mental health history. He, as a result of a toxic working environment, found himself the subject first of a Trust investigation and then a GMC investigation. These investigations lasted more than seven years (sadly, not an unusual circumstance in my experience). The consequence was anxiety, depression, suicidal thoughts and physical illness requiring hospital admission. Maybe it was the prolonged mental burden which led him to make serious errors of judgement in the course of the Trust investigation? We put forward psychiatric evidence about his state of mind at the time but it was rejected by the MPTS (the Tribunal). He was erased, arguably not for the matters originally under investigation, but for the serious error he made in the course of the four year Trust investigation. Happily this client is still alive, but his reflections are that his complaints of undue stress made to his Trust employer and the GMC were disregarded. I am left wondering whether the public has been well served by the loss of a skilled, hard working practitioner who, under prolonged and undue pressure, did not behave as he normally might have. In my opinion the panellists disregarded the contextual issues which lay behind the concerns that had been raised.

It is common for the MPTS and the GMC and indeed the other professional regulators to say they are looking for evidence of insight. This caused particular difficulties in one of my health cases, in which my client had been specifically medically advised to promote his health recovery by thinking positively, looking forward and not dwelling on the past. But he also needed to meet with GMC appointed medical health assessors to consider his fitness to practise and they insisted he had to reflect on his errors so as to demonstrate insight, thereby jeopardising his mental health to satisfy the GMC and MPTS.

More importantly, my cases have sometimes led me to wonder whether the professional regulators including the GMC investigators or MPTS panellists themselves have enough insight into the people they are concerned with. When the current Fitness to Practise Rules were introduced in 2004, the GMC was under pressure to show itself an effective regulator of the medical profession. After several medical scandals, the worst of which was the notorious Shipman case, the GMC stood accused of being a brotherhood which protected its own with unduly lenient sanctions. Its anxiety to correct this widely held impression no doubt informed the manner in which investigations were subsequently carried out.

But the fact the GMC 2014 review was commissioned at all surely indicates concern in some quarters that the approach may not yet be quite right. Doctors are after all human beings with human frailties. They usually want to do their best. It is not clear to me what the result of the review has actually been, but I have noticed more recently that sometimes the GMC’s correspondence with the doctor is strangely familiar. For example, I have seen letters open with, “How are you? I hope you had a lovely holiday and are feeling well.” This feeble attempt at warmth and friendliness may be well intentioned, but it soon reveals itself to be superficial when the tone changes. Doctors are not fools and I suggest that a more insightful approach to the human being at the heart of any investigation would serve both the public and the profession much better.