When pressure is to blame for doctors behaving badly | Clare Allan

The GP who told his patient to go ahead and kill herself seems to have been failed by a system that can’t cope with mental health issues

A woman with a history of mental health problems goes to the see her doctor and asks for a sick note because she is frightened of giving evidence at a rape trial. She tells the GP she is feeling suicidal and he tells her to go ahead and kill herself. “If you don’t know how to do it,” he says, “it’s on the internet how to do it.” Unbeknown to the doctor, the patient has recorded the conversation. A complaint is made and the Medical Practitioners Tribunal Service (MPTS) suspends the doctor for three months.

I was shocked when I heard this story, which has been widely reported. A three-month suspension seemed a remarkably minor sanction for such a serious breach of medical ethics. Moreover, the fact that the woman had felt the need to record the conversation suggested this wasn’t the first time the doctor had behaved unprofessionally.

Anyone with a mental health problem will know the difficulty of being believed when making a complaint, especially where it’s your word against that of a professional. It is so easy to dismiss a complainant as paranoid, mistaken or “borderline”. And if you keep on complaining, you are likely to be diagnosed with a personality disorder. I should be joking, but I’m really not.

So my feelings were three cheers for the patient and one big boo for the MPTS for failing to take appropriate action. A statement that the doctor’s behaviour amounted to “serious professional misconduct” was hardly underlined by a paltry three-month suspension. The fact that the doctor failed to apologise or even to attend the tribunal was, I felt, significant. It seemed to accentuate his lack of respect for the patient. Anyone can lose their temper; the crucial thing is what they do about it.

But having read the tribunal papers, it is clear to me that the situation is a lot more complex than the version that was reported. And while I feel for the patient, I also have some sympathy for the doctor. What he said was completely unacceptable; surely no one disagrees with that, even the doctor – though the lack of an apology unfortunately means that this has to be an assumption. However, what emerges from the papers is the pressure, both general and particular to this patient, that the doctor must have felt under.

Although the patient told the tribunal that she had previously had a good relationship with the doctor, this was contradicted by several pieces of evidence that she had in fact been repeatedly abusive towards him and threatened on several occasions to go to the press.

She had threatened to kill herself only after the doctor had refused to give her a sick note unless she paid for one privately. Whatever the truth of the matter, the doctor clearly felt she was trying to blackmail him. The tribunal also noted that the doctor “was working on a daily basis with patients from a very deprived area, with a high rate of drug and alcohol abuse, who could be difficult, abusive, aggressive and manipulative”.

Though I find this language problematic (who can’t be manipulative, after all?), it does seem clear that in such an environment there was likely to be a considerable gulf between the life experience of the doctor and that of the patient. Such gulfs can be bridged, but to do so does take time. Time to develop a relationship, to learn how to communicate, build trust and understanding. Time that isn’t available in a GP’s seven-minute average appointment slot.

Though neither the doctor nor the patient comported themselves with much distinction, it seems to me that both were failed by a system that is simply not suited to dealing with mental health issues. It is surely time we did something about this.

Contributor

Clare Allan

The GuardianTramp

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