Further Guidance on Reflective Writing in GMC / MPT Cases

Reflective Writing in GMC / MPTS Cases – Matters to Include

Many GMC registered doctors find it difficult to carry out the task of writing a reflection about their wrongdoing, and on the remediation that they have undertaken.

In other pages, Doctors Defence Service has set out the steps that a doctor might take to reflect, and on the remediation that might be undertaken, in GMC and MPT cases. In this article, we list specific elements that a doctor might include in their written reflection.

Failures to adhere to the standards expected of a doctor can come about by act or omission, due to nefarious, negligent, ill-considered or incompetent conduct. The GMC will scrutinise which apply in the given circumstances, and then seek to understand why the sub-optimal conduct came about. It is helpful for a doctor to have discussed such matters with their legal representative, but it is also important that doctors discuss matters with their peers.

A doctor should therefore hold various discussions with other clinicians (and lay people, where appropriate) about their misconduct or alleged behaviour. This can include speaking with registered professionals, tutors, course delegates, friends, family.

Matters such as dishonesty, or the crossing of professional boundaries, require extensive discussion with others. In-depth discussions of professional values, formally evidenced in some way, can go a long way to show that a doctor is engaging properly and not merely paying lip service to the fitness to practise process.

Workplace Pressures; Domestic Pressures

A doctor should look at the pressures that they were enduring at the time of their wrongdoing (or alleged conduct). They should identify and explain them, and then work through them, identifying how they can prevent such pressures from coming about again. The flip side of this, is that where pressures do arise, the doctor must not buckle to such pressures again. How the doctor evidences this will be fact-specific to the history of events, in part. But it will also require an analysis of the personal vulnerabilities of the doctor, in relation to the circumstances that they were in, so as to ensure that new and different pressures will not also lead to poor judgement.

Personal pressures and external pressures might come in different guises, which have an impact on the doctor’s resilience or analytical abilities. Such pressures should be identified and work undertaken to reduce the risk of their coming about again, where possible. Where the likelihood of such pressures is not open to being ameliorated, the doctor will need to develop an action plan and take appropriate steps to become more resilient, or change their job or role. Becoming more assertive may also be necessary in some scenarios, and an assertiveness course may help, in that regard.

A doctor should not just write a one-off reflection, as that would generally be deemed to be insufficient. A doctor should also attend more than one course,  on matters directly relating to the allegations. A one-off course is likely to be seen as merely paying lip service to the fitness to practise process requirements. Time affords manifold opportunities to embark on and complete significant remediation, but where a doctor fails to take up such opportunities they are likely to be deemed to have not demonstrated sufficient investment in the process. In turn, this increases the risk of an adverse outcome, at whichever stage the doctor’s case case reached.

It is important to identify the relevant passages of Good Medical Practice that have been breached by a doctor, and to ensure that any remediation undertaken evidences a greater understanding of a doctor’s specific and general obligations, within the professional structures in which they are engaged. If a doctor can also show that they have become a champion in improving local or national standards, in the area of concern that they are remediating, and which is evidenced in a sufficiently cogent way, this will likely assist them. Greater weight is likely to be given to a doctor’s evidence, if they have multiple examples of remediation.

Date Stamping of Reflections

The GMC and MPT tribunals like to see reflections that carry dates, so that the evolution of thinking and the amount of time spent on the subject, can be scrutinised. This can be of great evidential value. A doctor who cobbles together a brief written reflection, a few days prior to the date that it needs to be submitted, is unlikely to be able to deliver the content and quality that is needed.

Doctors Defence Service advises doctors and physician associates on reflective writing and steps of remediation. Contact us without obligation via our Contact Form, or call us, without obligation and in strict confidence on: 0800 10 88 739

See our main page on: Remediation

And our page on: Reflective Writing