A cautionary tale for potentially dishonest doctorsBMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1298 (Published 23 May 2022) Cite this as: BMJ 2022;377:o1298
There is a scene in episode three of the BBC series “This is Going to Hurt” where the central character, a junior doctor called Adam, is walking briskly in an underground station. As he is about to exit the station, he stumbles upon a person collapsed on the ground. A passer-by yells “Hey, someone, find a doctor, she fainted.” Adam walks past the increasingly chaotic scene when, with a heavy sigh, he turns back towards the patient. Maybe, I thought, he remembered paragraph 26 of the General Medical Council’s guidance “Good Medical Practice,” which states that doctors “must offer help if emergencies arise in clinical settings or in the community.”
As Adam approaches the patient, another person rushes to the scene. “Are you…,” asks Adam. “A GP” comes the reply. Relieved, Adam says that he is a “Dentist. Trainee dentist.” and rushes off, leaving the GP to assist the patient.
Adam’s quick-witted reply is humorous but, in real life, it could land him in trouble.
Contrary to his claim, Adam was no dentist, trainee, or otherwise. Putting aside concerns about criminal breaches of the Dentists Act 1984, which prohibits people from holding themselves out as a dentist and using the title “dentist” (“either alone or in combination with any other word”) unless registered with the General Dental Council, Adam deliberately misled a GP colleague and the members of the public who heard his lie.
For doctors, dishonesty lies at the severe end of the spectrum of sins and can lead to suspension or erasure from the medical register. If someone reported Adam to the GMC, there is little doubt that the allegations of misconduct would include reference to the GMC’s Duties of a Doctor, in particular “Be honest and open and act with integrity” and “never abuse your patients’ trust in you or the public’s trust in the profession.” The Medical Practitioners Tribunals, who make independent decisions about doctors’ fitness to practise, often remark in their written judgments that the doctor’s dishonest conduct violated a fundamental tenet of the medical profession and brought the profession into disrepute.
The key word here is “trust.” Dishonesty tends to damage trust and trust is the bedrock of medical ethics. Without trust, society’s faith in doctors will collapse and so will the sanctity of the doctor-patient relationship. Most doctors, I suspect, will know that dishonesty towards patients and relatives is ethically prohibited in nearly all situations, but fewer doctors are aware that this duty of honesty extends to colleagues and others beyond the clinic, from the postman to the plumber.
I have had medical clients in trouble with their regulator for dishonesty towards their home insurer, the police about a minor traffic offence, a marketer on Facebook, and a receptionist at a clinic. In each of those cases, no patients were involved. There was no risk of physical harm to anyone, nor any concerns about clinical competence. Yet, the doctors were under investigation because their dishonest conduct injured the general respectability of the profession.
The take home message for doctors is to be scrupulously honest, in and out of work, unless the situation obviously allows for ethical dishonesty, as in a game of poker. Doctors should be aware that what they consider a “white lie” or harmless fib may not be interpreted as such by others. In this sense, doctors are always “on ethical duty,” upholding the high standards of conduct expected of the medical profession.
This rule applies also to social media, where some doctors—like Icarus—fly perilously close to the sun. Adam’s dishonesty in the underground station would probably never be detected. On social media, where statements may be exposed for the world to see, the likelihood of detection and reporting to the GMC or one’s employer is higher.
In my experience, many doctors under investigation for acts of dishonesty, especially if these took place in a non-professional environment, are surprised by the dramatic consequences of their deception. Forced to reflect on their actions, most do eventually appreciate why honesty is held sacred by their regulator, but best to acquire this insight before any wrongdoing rather than afterwards, hence this column.
Competing interests: none declared.
Provenance and peer review: commissioned, not peer reviewed.