Professional Values Discussions with Colleagues

Peer Discussions Among Doctors in GMC CasesThe Importance of Discussions of Professional Values Among Doctors in GMC Cases

Shared professional values are an important aspect within medicine. They are shared by doctors, nurses, and other clinical practitioners and lay people allied to medicine. While there may be some differences between the professions, based on their respective roles, there will still be core values that are shared by all, such as the need to act with integrity.

Doctors who are facing GMC fitness to practise proceedings should ideally undertake discussions with their peers about professional values, with a focus on the matters that are of concern to the GMC: what went wrong for them, or what was deficient in their practice or personal life, that led to the concerns being raised.

A doctor might be prosecuted in the criminal courts for drink driving, or domestic violence; or make clinical errors or errors of judgment in medicine. They might attend work while unfit due to ill-health, causing a risk of harm to others. The ways in which a doctor can fall below the standards expected of them can be wide-ranging and numerous, but all clinicians will need to work to the shared professional values expected of them.

Some of those values are adumbrated in the professions’ codes of conduct, such as Good Medical Practice (for doctors). Yet, the codes are not the only litmus test or standards for measuring good conduct. There will, on occasions, be shared values that are not expressly stated in the codes of conduct – perhaps more nuanced in a given situation – but which all doctors will still need  to adhere to in a given situation. There may be an overlap with organisational values, too. Such professional values will often apply whether working collaboratively or autonomously. 

Who to have the discussion with

It is important to choose appropriately qualified people, of sufficient seniority, for the exercise to be worthwhile. They do not need to be specialist educators or tutors, as the exercise is about speaking to fellow professionals in the same area of practice.

Peer discussion is deemed to be an important aspect of remediation, and the demonstration of insight. Such discussions should therefore include a focused analysis of the subject matter that has led to the referral to the GMC. This does not require a detailed root-cause analysis, albeit that can be of help in identifying features of the concerns that require remediation; but certainly an analysis of the professional acts or omissions that would likely not be supported by a reasonable body of registered medical practitioners would be necessary.

Content of Discussions

During such discussions, a doctor does not need to accept the validity of the concerns raised (the allegations) to be able to talk in-depth about what is expected of a doctor in a professional context, while bearing in mind and touching on the subject matter of the alleged conduct. They can still say, “if a doctor were to have done X, they would need to demonstrate E,F, G, and it would have been suboptimal or inappropriate to have conducted oneself in X (above) way. It can be useful, too, to focus on the development of insight, by using the flowchart on our other page: How to Show Insight in GMC Cases

The GMC and MPT tribunals can be critical of doctors who do not undertake this step as part of the process of remediation.

What are professional values? There may be broad consensus on some professional values, and less consensus on others. But what are the core-values of a professional? What do professionals expect of one another? What do employers expect of professionals? What do the public require of professionals? These are all questions that the peer discussion should include in a general sense, and with a focus on the conduct of concern. One helpful question to ask oneself is: What is it to be a professional?

Academic Identification of Professional Values:

Mpatisi Moyo et al wrote about professional values in their essay Healthcare practitioners’ personal and professional values, as follows:

‘Both the personal and professional values of healthcare practitioners may influence their decisions on patient care (Gross and Robinson 1987; Smith et al. 1991). Personal values guide people’s behaviour and choices in their lives as individuals (Rokeach 1973; Schwartz 1992), whilst professional values guide their behaviour as a member of an occupational group (Eddy et al. 1994). Professional values are deliberately selected by the occupation as those values that shape the group’s identity, principles and beliefs (Frankel 1989). These values enjoy high consensus on their importance within the group, and are generally defined within their code of ethics (Frankel 1989; Hussey 1996).’ 

Healthcare practitioners’ personal and professional values. Mpatisi Moyo et al. , Adv in Health Sci Educ (2016) 21:257–286 DOI 10.1007/s10459-015-9626-9. (If you download the article, you can find a list (in table 2) of some of the common professional values that doctors have identified. However, it is not necessary to download this document (as they charge a fee), to be able to undertake the focussed discussion.

Discussion Points should include but can be wider: 
What are the shared values that professions subscribe to? What has the doctor done that undermines these values? What is the impact of their having not adhered to appropriate professional values? What is the impact  Does this go beyond GMC Good Medical Practice (GMP): https://www.gmc-uk.org/professional-standards/professional-standards-for-doctors/good-medical-practice
Reflecting on the past conduct and the values that were not met:
Do actions and omissions of the doctor in their private life or public life affect public confidence in and standing of the profession? How? What is the doctor’s take on this? How will the doctor ensure that they will adhere in the future to the core professional values? Especially where they have in the past not lived up to the spirit or tenet of those professional values. What are doctor’s thoughts on this? How do we individually and collectively work towards identifying professional values, and live up to them? IS much effort required to live by them? If we do not live up to them, will our colleagues and patients want to work with us?
Learning Points Arising: What are the learning points arising: What discussions took place on matters of generality, and matters relating to the behaviour underlying the conviction? Has further reading been suggested? Has there been discussion about academic or other writings?
Evidencing Discussions: The creation of a document that records the headlines of the discussions between peers is important. This can be a short paragraph within a testimonial or a free-standing document. The more detail the better. It is helpful to have more than one discussion with peers, and with the same peer. Tribunals might enquire of a peer the amount of information the doctor has disclosed, so as to analyse how much insight a doctor has.
Written evidence of such discussions having taken place (compiled by the doctor and their colleagues) can then be submitted to the GMC, to demonstrate that the doctor under scrutiny has thought things through properly, and not reflected on matters in isolation. Such an approach will usually provide ‘clinical governance model’ reassurance that a doctor has properly analysed the concerns raised, rather than paying lip service and looking at things in isolation.
It is therefore important that a full and detailed discussion takes place with a peer, without minimising responsibility, where a doctor admits the full case brought against them. Written evidence of such discussions having taken place (compiled by the doctor and their colleagues) can then be submitted to the GMC, to demonstrate that the doctor under scrutiny has thought things through properly, and not reflected on matters in isolation. Such an approach will usually provide ‘clinical governance model’ reassurance that a doctor has properly analysed the concerns raised, rather than paying lip service and looking at things in isolation.
Further Assistance with Professional Values Discussions
This is an introduction to the topic of professional values. We can provide more detailed guidance on request. Contact Doctors Defence Service on 0800 10 88 739 for more details.