Urgent reform urged as doctors under investigation report suicidal thoughts and quitting medicine

Medical Protection has called for radical reform to how the General Medical Council (GMC) investigates doctors, as new research reveals significant numbers are experiencing suicidal thoughts or quitting medicine as a result of their investigation.

In a Medical Protection survey of nearly 200 doctors who have been investigated by the medical regulator in the last five years, 78% said the investigation had a detrimental impact on their mental health and 91% said it caused stress and anxiety. 8% of the 197 doctors surveyed quit medicine due to the investigation, and a further 29% considered leaving. Nearly a third (31%) said they experienced suicidal thoughts during the investigation.

In the survey, 69% of doctors said the length of the investigation impacted on their mental health most, with some lasting years. 64% said the tone of communications from the GMC affected them most. Doctors commenting anonymously spoke of a ‘guilty until proven innocent’ tone in the initial GMC letter.

Medical Protection, which protects the professional interests of over 300,000 healthcare professionals around the world, including support with regulatory investigations, called on both the GMC and the Government to take ‘every possible step’ to reduce the number of doctors needlessly dragged through this process and improve how investigations are handled.

Dr Rob Hendry, Medical Director at Medical Protection, said: “We understand the GMC exists to protect the public, and must investigate serious complaints. But there is no reason why it cannot operate and communicate with doctors under investigation with more compassion. Finding out your fitness to practise is being called into question can be devastating, and it is easy to see how quickly a doctor’s mental health could deteriorate if they feel they are considered ‘guilty’ from the outset.

“The GMC has made many improvements to its initial communication with doctors, but more is needed. For example, the first letter to a doctor could alleviate some anxiety by setting out the GMC’s legal requirement to investigate all complaints and its policy for dealing with any malicious complaints – which are a huge source of stress for doctors and can take months to resolve.

“The language in the GMC letter and case examiners report when an investigation has been closed with no further action, can also have a detrimental effect on a doctor’s mental health. Many felt it implied ‘we’ll get you next time’ and I have heard doctors describe this as feeling like they have the sword of Damocles hanging over their heads.

“Above all else however, the Government and the GMC must ensure fewer doctors are dragged through this extremely stressful process unnecessarily. For the Government this means progressing GMC reform with urgency to give the regulator more discretion to not take forward investigations where allegations clearly do not require action.

“Reform should also reduce the number of doctors who are pursued by the GMC on the vague and ill-defined basis that action will ‘protect public confidence in the profession’, when investigations should surely be focussed on doctors who potentially pose a risk to patient safety.  

“The GMC also needs to communicate more clearly that it has been set up to deal with serious concerns, to help reduce the large number of referrals it receives about doctors that do not come close to requiring a sanction.

“One doctor quitting medicine, or worse, experiencing suicidal thoughts due to a GMC investigation is one too many - the GMC and the Government must take every possible step to address this issue.”

END

Notes to editors

•  For all recommendations to the GMC and the Department of Health and Social Care, visit: https://www.medicalprotection.org/uk/media-policy/campaigns/gmc-investigations
• For full Medical Protection survey results contact: [email protected]
• In March 2022 the GMC reported that 29 doctors died while under GMC investigation or monitoring over the three-year period 1 January 2018 – 31 December 2020. The cause of death of 20 were from natural causes; six were of external causes, of which five were confirmed as suicide; and three were from unspecified reasons: GMC publishes report on deaths during investigations - GMC (gmc-uk.org)
• In 2016 Professor Louis Appleby worked with the GMC to review the fitness to practise process and its impact on doctor’s mental health: Putting mental health safety at the heart of the fitness to practise process – Improving medical education and practice across the UK (wordpress.com)
• ·        Government plans to amend the Medical Act so the GMC can reform the way it regulates doctors have been delayed and the timescale for next steps is unclear. In a 2021 consultation document, the government stated that they planned for this legislation ‘to come into force in the spring of 2022’. Most recently, in February 2023, it stated that ‘we intend to start working with the NMC and the HCPC, alongside the GMC, to develop reformed legislation for their professions over the next couple of years’.

 Anonymous comments left by doctors who took part in the Medical Protection research:

 “I did feel my life was not worth living after how much I had dedicated to being a doctor. To now have it all called in question and jeopardised was devastating.”

“Occasional thoughts that if I was no longer here this would all go away.”

“I was on antidepressants but suicidal thoughts were impossible to keep out.”

“From the first notification by the GMC of an investigation till after the tribunal I had regular suicidal thoughts.”

“Despite 3 years psychotherapy, I feel permanently damaged and half the person I once was, my confidence is gone, I am afraid of my own shadow.”

“The only effect of the GMC investigation was to make me re-evaluate my relationship with medicine as a whole. I previously lived to work, but now I look forward to the time I leave the profession and can request voluntary erasure.”

“Every day greeted me with a wave of despair. Every email ping made me jump.”

“I contacted the GMC after the result of the investigation happened - it said I had nothing to answer to (after about 18 months). They said that support was no longer covered. This actually was the time I needed support most as I was so angry with what had happened.”

“Even in the end the tone of the outcome stated something along the lines of not enough evidence rather than innocent.  It remains a feeling of - we are waiting to get you next time.”

“There is very little communication from GMC, until the end of the investigation, and even then there is no offer of support or understanding that their process may be quite detrimental to the wellbeing of the doctor.”

“It took a lot of counselling to come to terms with this, even though no fault was found. The language in their comms is abysmal - we didn’t get you this time but we are watching you.”

“The letter made me feel guilty and that I was not good enough to be a doctor even before i had been listened to or investigated. Wish the process was more open minded in its approach rather than starting with the premise that you are not fit to practice.”

“In my case the investigation was entirely unjustified - there was no wrongdoing or risk to patients and the complaint was very clearly malicious. Better triage of trivial, vexatious or malicious complaints would be an easy improvement for the GMC.”

“What reassurance can I get that I will not be put through this nightmare repeatedly every time a someone decides to consult Dr Google and disagree with my clinical judgements made in best interests?”

“The GMC is at present acting as a well-meaning but poorly informed vehicle for disappointed patients to vent their anger on a medical expert since the complaint alone causes real damage even when groundless.”

“The complaint against me was bizarre but was taken as gospel by the GMC. My career of 20 years and thousands of patient encounters felt reduced to, and threatened by, intense scrutiny of every second of a 5-10 minute encounter.”

“I have never been part of a more one-sided and biased process. It made me very keen to leave the profession and I now can`t wait to retire.”

“I felt that the hearing was very adversarial. I felt like I was in a court of law being cross examined by a barrister. I was tearful, remorseful, and frightened.”

“I cannot imagine how a doctor who is not legally represented would manage with such a difficult and aggressive process.”

“Zero thought / consideration for the accused who, in the eyes of the GMC are assumed legally guilty until such time as they can legally extricate themselves. I've left medicine.”

“Often I got no updates. One of the major blows was when I contacted the GMC, months after the preliminary inquiry started and expecting it would be concluded soon, only to be told that essentially nothing of substance had been done.”

“I felt that I had no idea what was going on at points. My investigation ultimately took over 1 year before being closed. I would regard it as one of the most stressful years of my life. The tone of the investigation and the lack of human approach was notable.”

“The case was closed without any action after two years, which I felt was far too long to investigate what emerged as a straightforward investigation.”