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Personal Views Personal views

Insight alone was not enough

BMJ 2000; 321 doi: (Published 23 September 2000) Cite this as: BMJ 2000;321:773
  1. Michael Riddall

    Three years ago the General Medical Council (GMC) suspended me from the medical register for one year for the emotional abuse of a therapeutic relationship with a 17 year old man. The original charge had included the words “and sexual,” but this was dropped.

    I wish that the health committee had been empowered at the time of my initial suspension

    My mistake was to think that insight alone was enough, and that my job satisfaction could be based on the special understanding that I felt I had with each patient—an understanding of his or her problem, illness, personality, or own view on life. The majority of my patients collaborated eagerly with this approach, but I suspect that those who did not found me extremely irritating.

    I drank heavily, spent life savings, developed overinflated ideas of my own abilities

    Although I paid lip service to discussion and audit, my real feelings on talking about one of my patients with a peer or senior colleague were those of resentment at the intrusion, and my contempt for the restrictions on time that I could give to patients because of the funding limitations knew no bounds.

    I paid no attention to the fact that my colleagues were subject to the same restrictions, nor how they coped with them, nor that they might have been able to help me to do so. I simply regarded them as being insufficiently caring.

    The pressures, however, were there, and in my secluded mental state it was inevitable that they would build up to a point where something had to give. In the event a particular patient turned up who had, or seemed to have, so much in common with parts of myself that had long lain dormant that my feelings became too special and led me to fail to judge where the boundaries of professional behaviour lay.

    I was referred to the GMC's health committee on the grounds that my fitness to practise might be seriously impaired by a mental condition. The health committee only has powers over a doctor who is actually in practice at the time, and it met to discuss my case a year later, the next working day after my period of suspension automatically expired.

    I suggest that the procedures should be re-examined

    The committee confirmed my unfitness to practise and extended my suspension on health grounds for a further year and on review for another 12 months. I have now been restored to the register with substantial conditions and a further review after eight months.

    The health committee's process of assessment, review, supervision, and treatment forced me to confront things about myself that were essential to continuing good medical practice. The most important was that I had not paid attention to the consensus on what is acceptable and ethical as professional behaviour and that doctors who risk censure put not only their own reputation on the line but also, by association, that of the whole profession. This in turn may damage the need of patients to be able to trust their doctors.

    Lacking insight as I did during the initial year of disciplinary suspension, I behaved extremely destructively towards my family. Believing myself to have been unjustly treated, I drank heavily, spent life savings, developed overinflated ideas of my own abilities, was unreasonable and prone to volcanic outbursts of anger, and blamed everyone but myself—especially my wife— for my own failing.

    Only when the containing and guiding influence of the health committee came into operation did the procedures begin which have, I hope, brought me to my senses, or are in the process of doing so. And the consensus has been that I was indeed unwell at the time of my transgression.

    In retrospect I wish that the health committee had been empowered at the time of my initial suspension. I believe that my rehabilitation could have been achieved with less destruction to myself and others. My testimonials suggest that I was a committed and effective psychiatrist, and if things had been different I might not have been prevented from practising for such a long time.

    It may be that because of its procedures the GMC had no choice in the matter, but if that is so I suggest that the procedures should be re-examined.


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