Intended for healthcare professionals

News

Doctors increasingly practise “defensive” medicine for fear of litigation, says regulator

BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h87 (Published 08 January 2015) Cite this as: BMJ 2015;350:h87
  1. Adrian O’Dowd
  1. 1London

Doctors are becoming more cautious and are practising “defensive” medicine to prevent litigation after treating patients and to avoid investigation, MPs have been told.

The General Medical Council (GMC), the doctors’ regulator, said that doctors were only too conscious of the possibility of patients taking legal action against them or complaining to the GMC. At the parliamentary Health Committee’s annual accountability hearing for the GMC on 6 January MPs asked how the regulator could avoid creating an environment in which doctors practise defensive medicine.

Terence Stephenson, GMC chair, giving evidence, said, “My own experience is that medicine has become more defensive over my practising lifetime, and that is driven more by fear of litigation than fear of being reported to the regulator. Colleagues are conscious that, from their practice, they can be vilified in the press, they can be reported to a lawyer, and they can be complained against, to their trust.

“There are things in our strategy that help. For people under procedures, we have a service run by the BMA to provide counselling and support, and we have a very strong principle of being innocent until proven guilty. We also have a helpline that people can call.”

A fellow witness was Niall Dickson, chief executive and registrar of the GMC, who added that the regulator wanted a better relationship with the profession so that the GMC’s various roles were appreciated beyond carrying out its fitness to practise proceedings.

“There is a tension between our need to protect patients around fitness to practise issues but also our need to engage in the education of doctors; that is to say, [to] have a relationship with students and increasingly our relationship with postgraduate doctors,” said Dickson. “We are not quite the knight in shining armour, but we are the people who do intervene in order to make sure those doctors have the right environment and have the right support.”

Judith Hulf, senior medical adviser and responsible officer at the GMC, also giving evidence, said, “We’ve made substantial progress over the last three or four years in communicating with doctors. We should be encouraging medical students to be very conscious of all the safety strategies that they need to learn, but to know that they have a robust regulator who will defend their professional standards and work.”

MPs asked the witnesses about trends in complaints being made against doctors and whether fitness to practise case numbers had started to level out or slow down.

Dickson said, “The fitness to practise numbers have continued to go up, not by the same levels they were when we were talking about 25% a year, but the last rise from 2012 to 2013 was about 6%. It’s still going up, and between 2010 and 2013 we have seen a 64% increase in the complaints that we receive, which is very significant.”

In 2013 the GMC received 10 012 inquiries about doctors, most (8591) of which were complaints raising concerns about a doctor’s fitness to practise.

“Within that, we’ve seen an increase in the serious complaints as well,” Dickson added. “That sounds bad, but if we are able to encourage the proportion of complaints to be the serious complaints, those are the ones we really should be dealing with and that are right for the GMC to deal with.”

The regulator said that it had put an additional £2m (€2.6m; $3m) into dealing with another increase in serious fitness to practise cases last year.

Notes

Cite this as: BMJ 2015;350:h87

View Abstract