Intended for healthcare professionals


Doctors’ personal reflections should not include case details, says new guidance

BMJ 2018; 362 doi: (Published 12 September 2018) Cite this as: BMJ 2018;362:k3890
  1. Clare Dyer
  1. The BMJ

Doctors recording their personal reflections on lessons learnt from their practice and clinical outcomes should anonymise patient information and should focus on learning for the future rather than the details of cases, new guidance suggests.1

The joint guidance for doctors and medical students comes from the Academy of Medical Royal Colleges, the Conference of Postgraduate Medical Deans (COPMeD), the General Medical Council (GMC), and the Medical Schools Council.

It follows a furore over the case of Hadiza Bawa-Garba, the trainee paediatrician found guilty of gross negligence manslaughter after the death of Jack Adcock, 6, from septic shock. Her reflections were appended to a statement from a hospital consultant who was a witness for the prosecution in the crown court case.

Many doctors were unaware that their reflections are not legally privileged and can be requested by a court if deemed relevant. Some vowed not to record their reflections honestly in the future, although these are required for training and revalidation.2

The new guidance reminds doctors that recording their reflections is not the same as reporting serious incidents, which should be dealt with by other means in line with local practice. Factual details should be recorded elsewhere, and reflections should focus on learning rather than a full discussion of the case or situation.

Anonymised information should be used wherever possible in reflections, the guidance says, so that no individual can be identified. Simply removing the name, age, address, and other personal identifiers is unlikely to be enough.

Existing guidance from the Academy of Medical Royal Colleges about entering information on e-portfolios recommends that doctors involved in serious incidents should put the details on paper while their memories are still fresh, “but formally documented reflection is probably better done after some consideration.”

Doctors with concerns about the content of reflections should seek advice from a supervisor or appraiser, the guidance says. If a court seeks disclosure of a learning portfolio its owner should ask for advice from an employer, legal adviser, medical defence organisation, or professional association.

The GMC repeats its assurance given in the wake of Bawa-Garba’s case that it will not seek access to a doctor’s learning portfolios when investigating fitness to practise. It will be for the doctor to decide whether to provide reflections as evidence of insight and remediation.

Carrie MacEwen, chair of the Academy of Medical Royal Colleges, said, “Being able to reflect on all aspects of clinical care is important to improve the way we look after patients. This guidance and the reflective practice toolkit developed by COPMeD and the academy,3 which we are publishing in parallel, should reassure all doctors that it is possible to record events in a way that optimises learning and promotes active change in practice based on this learning.”

Colin Melville, GMC director of education and standards, said, “Reflecting on experiences, both good and bad, is hugely important. The GMC doesn’t ask doctors for reflective notes to investigate concerns; in fact, we have called for those notes to be given legal protection.

“However, we know there is some uncertainty around reflection, and this new guidance provides practical support to help doctors and medical students.”


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