GMC finds doctors not guilty in consent caseBMJ 1995; 311 doi: http://dx.doi.org/10.1136/bmj.311.7015.1245 (Published 11 November 1995) Cite this as: BMJ 1995;311:1245
Three psychiatrists were found not guilty of serious professional misconduct by the General Medical Council, the body that regulates British doctors, last week in a case that centred on the issue of patient consent and confidentiality (see editorial, p 1240). The complainant had been the subject of a case report submitted by the doctors to a specialist medical journal, and she claimed that the report contained so much detail that she could be identified from it.
The report, which concerned people with bulimia nervosa who bleed themselves, was entitled “Blood-letting in bulimia nervosa” and was published in the British Journal of Psychiatry (1993;162:246-8). The authors were consultant psychiatrist Dr John Eagles and psychiatric registrar Dr Jon Richard Parkin, who were both working at the time at the Royal Cornhill Hospital in Aberdeen. The article also acknowledged thanks to Dr Alistair Palin for “allowing us to report on one of his patients.” Consultant psychiatrist Dr Palin also worked at the Royal Cornhill, and he was the third doctor involved in the hearing.
The complainant, known throughout the three day hearing as “Miss C,” claimed that Dr Parkin had asked to interview her for some research work on blood letting in bulimia. She said that he had also mentioned that he might get a paper out of it, and she had given her verbal consent to certain details of her condition being used for this research. She told the hearing: “I was not bothered at this stage because I trusted these people to portray accurately the facts and to disguise my identity.”
After publication of the article--which also contained case reports of two other patients with a similar set of symptoms and behaviour--a story appeared in the Aberdeen Press and Journal newspaper. This newspaper story was read by a friend of Miss C, who immediately recognised her from the personal details. Miss C then obtained a copy of the British Journal of Psychiatry and read the whole article written by Dr Parkin and Dr Eagles.
The case report on Miss C, as well as describing her as “a 26 year old preregistration doctor,” outlined details of her bulimia nervosa and blood letting and contained information about a rare form of macular degeneration that was affecting her eyesight. It also questioned the authenticity of a particular claim made by Miss C to her doctors.
Miss Rosalind Foster, representing Miss C, said that the particular constellation of her symptoms made Miss C “well nigh unique.”
Miss C told the General Medical Council's professional conduct committee: “I would absolutely not have given the go ahead to the article which appeared. I was very shocked, very angry, very upset. Several things stated in the article were untrue. They were really hurtful and judgmental because they blocked out everything I had based my healing and therapy on because it was based on trust.”
Doctors expressed sorrow
All three doctors appearing before the committee expressed their sorrow at Miss C's distress and acknowledged that close personal friends and health care workers looking after Miss C could probably have identified her from the case report. But they said that details of personality were highly pertinent to psychiatric case reports, and Dr Parkin said that he believed that Miss C had given her verbal consent to his writing a case report on her. He added: “Having gained consent to use details from the interview she had given for the purpose stated, I assumed I would be able to also look at her notes.”
Much of the evidence on behalf of the three doctors was heard in camera because of the intimate details of Miss C's history, which were necessary to the case.
Professor Gerald Russell, an expert on eating disorders and especially bulimia nervosa, was called as an expert witness to the hearing. He said that in his view the article in the British Journal of Psychiatry was original and that all the details given on Miss C were relevant and necessary.
Although the article appeared in February 1993, it was first submitted in June 1991, and a second revised draft was submitted and accepted during the first half of 1992. Professor Russell said: “In those days it was unusual to seek consent from a patient before publication of an article. But the rules have changed so much in the last five years. Now you should obtain a patient's consent. You might show them a draft of the paper and negotiate if necessary if there are sections to which the patient objects.”
Mr Adrian Whitfield QC, representing Dr Eagles and Dr Parkin, suggested to the committee that Miss C was not really complaining about the absence of consent but was complaining about “the way in which aspects of her lifestyle were discussed.” He told committee members that the fact that the article in question had “such a tragic and upsetting effect on Miss C must not form part of your deliberations.” He also asked the committee to consider whether the information “gratuitously or unreasonably permitted identification,” suggesting that it did not.
The committee heard how the issue of consent and anonymity had come to the fore since the article was written in 1991. There had been several updates both of the General Medical Council's guidance to doctors on confidentiality and of the instructions to authors published in the British Journal of Psychiatry.
In reaching its verdict the committee agreed that “the information contained in the paper was such that it enabled Miss C to be identified.” This had not been admitted by any of the three doctors. But the committee considered that the facts of the case were insufficient in the cases of all three doctors to support a finding of serious professional misconduct.