GMC assessment of Fergusson case was not at fault

BMJ 2001; 322 doi: https://doi.org/10.1136/bmj.322.7282.359 (Published 10 February 2001) Cite this as: BMJ 2001;322:359
  1. Wendy Savage, honorary professor, Middlesex University
  1. London N1 8HN

    EDITOR—As an elected member of the General Medical Council who has just become a screener but who had no involvement with the Fergusson case, I disagree with the criticism by Jarvis of those who instigated the GMC conduct procedures.1

    The screener must decide whether a complaint raises a question of serious professional misconduct. If so, he or she must then refer the case to the preliminary proceedings committee, which will decide whether it should be referred to the professional conduct committee. If not, the screener's judgment must be endorsed by a lay screener. If the lay screener disagrees, the case will go to the preliminary proceedings committee. There is no requirement for cases to be dealt with by a doctor from the same specialty as the doctor complained against before or at the professional conduct committee. Expert opinions can, however, be sought at any stage. No gynaecologist may thus have seen this case before it reached the professional conduct committee, and there was no gynaecologist on the panel that heard it.

    Rather than criticising those who considered that Fergusson's conduct raised a question of serious professional misconduct, I would question the decision of the panel that he was not guilty of serious professional misconduct. Although I accept from reading the transcripts that Fergusson may have thought he was acting in the patient's best interests, this needs to be set against the patient's reaction. By 1990, when the Department of Health had changed the standard NHS consent form, unanticipated surgery other than that needed to save a patient's life could clearly not be carried out. The events had a devastating effect on the patient, who had consented to hysterectomy only in what she was told was the rare event that the uterus might be perforated. She never consented to oophorectomy. The mitigating factors were that the doctor had had an otherwise blameless career and acted in good faith but the underfunding of the NHS system left insufficient time for him to spend with the patient. He had to rely on doctors in training to obtain consent and did not know the patient's views accurately, although a medical student tried to raise her objections when major surgery was contemplated.

    The most appropriate GMC response in such cases is probably to admonish the doctor (as in the case of John Studd) or to take no action, accepting that the process of appearing in front of the professional conduct committee is sufficient to protect patients in the future and to reinforce the need for doctors to obtain informed consent. Some women, however, may not agree. Many still see our branch of the profession as paternalistic and dismissive of women's views.


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