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How the Seven Principles of Public Life Conflict with a Doctor's Duties - Dr Mark Burgin

19/08/21. Dr. Mark Burgin BM BCh (oxon) MRCGP considers how expectations about public figures cause perverse behaviour and make them ineffective in their work.

Doctors are one of the pillars of society and are held to much higher standards than the public both in terms of their professional regulations and general expectations.

Is it reasonable to expect a person whose job is difficult enough to start with start with have additional regulations applied?

My opinion is that any regulations should be necessary and proportionate and should be effective in achieving their purpose.

Simply having a rule does not mean that it will be followed, or that having followed it the purpose of that rule will be achieved.

Selflessness

Few if any humans are able to continue to do an activity unless it has some benefit for themselves, so the idea of selflessness is an ideal not possible in reality.

My version of this would be an alignment between the professional and their role, for instance a doctor who enjoys using their skills to help their patients.

The doctor appears selfless but is actually getting rewards from solving their patients’ problems and helping them lead happier lives.

If the professional stops being aligned to their role then they have a reason to consider changing their role rather than trying to fake selflessness.

Integrity

Defined as being honest and having strong moral principles, integrity has a dark side that people do not wish to talk about.

Following all the rules to the letter can make a professional difficult to work with when their colleagues and patients are used to a more liberal interpretation of the rules.

In medicine there are no rights and wrongs only shades of grey, so a doctor who is unable to be flexible will generate stress and complaints.

True integrity involves recognising where to make exceptions for the good of a patient and not following rules when the rules are wrong.

Objectivity

Whilst an admirable quality in a surgeon most patients want their GP to consider things that cannot be measured such as their personal view of the world.

Having prejudices or bias is rarely helpful but having a subjective point of view does not mean that a doctor cannot help their patient.

In fact, it is the subjectivity of medicine that allows a GP to make sense of a patient’s story and understand why they are affected in the way that they are.

Subjectivity is at the heart of the biopsychosocial model because there is no objective measure upon which to assess the patient experience.

Accountability

A doctor is accountable to at least 7 authorities which could potentially investigate a single mistake one after the other, taking decades to resolve.

There is a point at which accountability becomes a punishment in itself, even if the doctor is blameless, they can be left financially ruined.

This appears to go against natural justice but also seems to conflict with society’s own needs for doctors to be available to make patients better.

I cannot help but think that a system that was quicker and used more common sense would achieve more accountability with less side effects such as defensive medicine.

Openness

Doctors are trained not to talk about their mistakes but learn from them, this is a rational approach given what has been said about the current systems of accountability.

Clinical negligence lawyers are often concerned that a defendant has not written a duty of candour letter and refuses to share what relevant training they have had.

I agree with doctors that they need a safe space to talk about their mistakes but equally I feel that refusing to engage completely gives a bad impression and is not good for the doctor.

Much openness is simply accountability in another form, doctors should tell their story about what happened even if that means the claimant wins the case.

Honesty

Dishonesty is the number one issue in front of the MPTS (the GMC’s tribunal) because the GMC applies the highest standards upon doctors.

Any ambiguity or minor error or minor delay is seized upon so that doctors under investigation feel they must deliberately lie to avoid being attacked.

Informal language often is less precise than a formal witness statement for legal purposes and a reasonable approach needs to be taken to allow doctors to express themselves.

There are a few doctors who are truly dishonest, for instance in trying to hide a crime, and they deserve harsh treatment.

Leadership

Although many professionals are multi-talented and make exceptional leaders there are many who are less good and should concentrate on their day job.

It is unlikely that the medical establishment could cope with ¼ million doctor-leaders and certainly do not need that number.

There are some doctors who through hidden disabilities would suffer disadvantage if forced in a leadership role, although give extraordinary service in other areas.

Leaders (like soldiers) should be volunteers not conscripts and should focus upon what they are good at rather than one-size-fits-all.

Conclusions

The seven principles of public life are incorrectly named because they do not contain any fundamental truths because there are always exceptions.

Although they contain some grains of truth they should not be taken to extremes and the professional should remain open to arguments.

Authenticity describes better how the great public figure should carry out their duties because it includes things like honesty and openness and integrity.

It also recognises that the person is human and can be accountable for their mistakes where they have lost objectivity, become selfish or stopped leading.

Doctor Mark Burgin, BM BCh (oxon) MRCGP is on the General Practitioner Specialist Register and audits medical expert reports.

Dr. Burgin can be contacted This email address is being protected from spambots. You need JavaScript enabled to view it. and 0845 331 3304 website drmarkburgin.co.uk

Image: public domain from https://pixabay.com/en/doctor-medical-medicine-health-563428/

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