London Med Student

A medical student’s take on university life and becoming a doctor

Placement: should I stay or should I go now…

By London Med Student - 14th May 2012 12:14 pm

It’s that time of year again.

It’s the time when every medical student gets slightly more neurotic. Exam time is approaching. It’s the time when our thoughts turn solely to exams and achievements - minor obligations such as food and dressing take second place. (I have seen a friend sit in the library for 3 hours wearing mismatched shoes, and another about this time of year switches to ready meals as cooking “takes up too much revision time”.)

Conversations gradually become more about whether people have started studying yet, how long we are spending in the library, what books we are using. The FAQ question of our university website explodes with panicky questions about whether we’ll be tested on certain things, how we can possibly be expected to know this much detail, and varying subtleties of the question “what will be on the exam?”

Most of the medical students are academic beings - we’re used to cramming, long hours in the library (or bedroom, if we prefer isolation) for weeks on end, studying hard. There’s a particular tension now that I have reached clinical years, as we are expected to be on placement right up until the week before exams. What I want to do is hole myself up in the 24-hour library, work antisocial hours and drink enough caffeine-based beverages to risk developing palpitations.

What I am expected to do is carry on going to placement for 3-4 days a week (and lectures 1 day a week), getting my logbook signed for attendance to prove I am doing so. I have even been booked in for extra ‘consolidation and review’ sessions in non-placement time with a GP practitioner - where as far as I gather I am supposed to discuss revision topics with the GP, of my choice, with no formal structure arranged. This would be more enticing if A) The GP appeared to want to do it, and B) Travel to the practise didn’t take about 3 hours out of my day.

I’m not really sure what the ideal situation is here. I’m sure clinicians would advise that I attend as much placement as possible - saying of course, that the more conditions I see, the better informed I will be to remember them, and that I need to practise my history and examination skills (which also constitutes OSCE practise). But I’m also acutely aware of the inefficiency of placement - I can wait hours to see a relevant or interesting case, during which I could have done a lot of notes in the library. ‘Yes’ doctors need clinical experience, but I need to be well-read as well, and I struggle to muster the enthusiasm to study after a full day in hospital - a problem I’m sure every generation faces.

Each one of us makes our own decision on the balance here I think. Some students go to placement as little as possible all year anyway, never leaving their preferred mode of learning. Some will do as they’re told and instead add in the study hours in the evening at the expense of something else, some will make excuses to get placement and clock up study time. Personally, I think I’ll go to placement until I really start to panic and then retreat with my books to a quiet corner and calm down!

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NHS reforms: what the next generation thinks

By London Med Student - 18th April 2012 10:01 am

I haven’t said much about the NHS reforms because I don’t know that much. Like the Birmingham medical student interviewed for The Guardian, I have generally taken the view that if many of my senior doctors are worried, I am worried. There hasn’t been much talk about it at my medical school: Medsin-UK wrote to the dean, as well as the BMA reps I believe, but I haven’t heard much else.

Personally I attended a protest outside St Thomas’s hospital, along with members of Medsin-UK, as well as the demonstration at Whitehall, where we blocked Whitehall, marched down the Strand … and were ‘kettled’! I was surprised it wasn’t in the news the next day.

Now that the reforms have passed I guess we (as the next generation of doctors) are going to have to fight to keep things within the NHS, although I’m not sure how many of my fellow students are particularly alarmed. Some of them welcome the competition or are from other countries so take the view that our NHS still constitutes much more accessible healthcare than in other places, but was unsustainable.

Along with many things that don’t seem to properly have been considered within the scope of the NHS reforms, I’m not sure that medical education will do too well out of it. With private contractors taking on specific services, what are their obligations within these contracts to teach us? Has this been provided for? Considering how difficult it can be to persuade doctors within our own teaching hospitals to teach us, I can see this getting harder with doctors not even working within the NHS.

I have already experienced this in a minor fashion - last year I took a module in healthcare on prisons, and we normally visit Brixton Prison as part of this. The healthcare services within Brixton Prison have now been taken over by Care UK, who had no interest in allowing us to visit and work with them. We had to go elsewhere for the project.

I don’t think it will be helpful if care truly is ‘cherry-picked’ by private clinics, as many people are concerned about. This could lead to few NHS providers doing certain procedures, and then where do we go to see these things? Either we’ll have to accept we can’t see them within our own hospitals or the medical schools will have to negotiate with even more healthcare providers … something they struggle to organise at the moment as it is!

And how will doctors be paid to teach us outside of the NHS? Already apparently the funding for that is strange, with payment only covering seminars run by doctors, rather than the necessary ‘apprentice-style’ teaching in which we actually get to do the key things of observing consultations and undertaking examinations and procedures. Seemingly the culture of the NHS and hospitals keeps this going at the moment, but there will be no obligation for independent/private clinics to do so. (Especially if we are seen as an inconvenience to patients, they could want to keep us away to have an edge over the competition.)

I think the loss of the safety net of the NHS will be a big problem for us. With no culture of teaching to encourage this to continue, no existing framework of teaching organised within these new clinics and potentially lowered or non-existent financial rewards for letting us get involved, we might be looking at fewer opportunities to gain experience.

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Hit and miss approach to gaining experience

By London Medical Student - 23rd March 2012 3:32 pm

In my medical studies, I’m expected to do three main things: see different clinical cases, get a general idea of how healthcare works, and do academic study. Unfortunately, it’s not really very easy to fit these things around each other.

The problem is the unpredictability of healthcare. It’s often a case of deciding between waiting around in the hospital until something interesting happens, or cutting my losses and spending my time reading in the library. The ideal third option - choosing when to go into the hospital to have a guaranteed good few hours of seeing cases and getting experience - basically never happens. Partly due of course to the unpredictable nature of when patients will arrive and with what - you don’t know frustration until you’ve come in specifically to see a booked operation on your day off, to find the patient has been transferred to another hospital! But also there’s the organisation of the hospital that doesn’t factor us in.

Being a medical student is synonymous with waiting around. We turn up to clinics and wait for the doctor to arrive, an hour later. I’ve waited for timetabled clinics that were cancelled, turned up for teaching when the entire staff of a department are away on training days (why no-one tells us these things I don’t know). You can end up placed with a doctor who isn’t teaching you anything. I recently spent a morning shadowing an SHO and helped her clerk a patient. We wrote in the notes for her, fetched her the relevant swabs and bits of kit she needed to examine, I even answered her bleep to let her carry on with the patient uninterrupted. An hour later we left the patient and I said to the doctor - “So, what do you think was going on with that patient?” She just looked at me and said: “I don’t know.” No explanation of her thought process, her examination findings, nothing. What was the point of me being there?!

We try to do our best to be efficient. Students swap tips about what to go to and what not to bother with (“go to his clinic, he’ll let you examine so many patients”, “don’t go to that ward round, the doctor won’t even speak to you”). Personally I’m happy to just go in regularly to get an experience of a ward and how it’s run, get to know the staff and patients. But that doesn’t really work in the time-frame we have. You have to weigh up the chances of getting good clinical experience with the need to sit and study for exams.

I have a logbook of cases to see and things to do by the end of the rotation and I end up chasing sign-ups…I’ll have taken loads of histories on my renal ward but not have performed a rectal exam on anyone, so have to keep going to places where I can try and get that done, and potentially miss valuable experiences elsewhere to wait for this one thing. Colleagues of mine have been to the same clinic several days in a row, not learning anything new, just waiting for the thing they need to do. It gets to the point where you will pop in to a clinic/theatre/ward, do the procedure, get signed off and leave again!

Perhaps it’s the sheer number of medical students in my (very large) medical school. We’re timetabled to go in to different places on different days to minimise our impact, but that also means that you don’t get several chances at seeing what you need to see.

Personally I’d prefer to be in one place, on a regular basis, and have the staff know who I am. Maybe even expect me to contribute in some way, like clerking before ward rounds? It would make me come in and do things that’s for sure!

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“I need a part-time job to fund medical school”

By London Medical Student - 5th March 2012 1:49 pm

An article in the Student BMJ this month said there’s been a rise in prostitution amongst medical students - linked to the increase in tuition fees and living costs. At my medical school I am not personally aware of any fellow students doing sex work, but I am aware that many of my fellow students - myself included - are struggling to fund ourselves through our last few years of study.

Tuition fees are not an immediate problem - those are generally paid for with loans and so we ‘just’ have the debt to face when we qualify (my tuition debt alone will be over £13,000, not including interest). The issue is, we just aren’t given enough money to support ourselves during the course and our meagre savings are running out.

The NHS pays for the tuition after your 4th year of study, but accessing this involves applying for a means-tested loan on your parents’ income. Then the Student Loans Company assumes that you got given a grant for living costs by the NHS too, whether or not they agreed to pay that as well as your tuition. Many of us have been left with reduced loans at a time when (after 4 years of university) we really can’t afford to be now getting less money. And at the end of the course, we have electives to pay for too!

Like me, a lot of us are funded, at least in part, by our parents - commonly parents will cover rent or something like that and leave their child to fund the rest. If students don’t have that I honestly don’t know how they cope - with rent in London at an average of £120 a week and a typical maintenance loan for a year in London being ~£4,000 (~£3,000 elsewhere), well, that doesn’t even cover the rent! And then we wonder why students from low-income families are still not applying to medicine (even with potential extra grants). And yes, that ~£4,000 a year means I will also have a £24,000 maintenance loan debt when I graduate, not including interest.

All in all, I’ll be about £40k in debt by the time I finish. So, I’m currently trying to find a job or way to get myself extra money. My first problem is trying to find a job to fit around variable placement hours - sometimes I don’t know my timetable for the next week. I’ve found a flexible job doing open days at the university, but they email out the jobs during clinic hours, so they often go before I know about them. Our work also ideally needs to be good rates of pay for the few hours we can do around placement, extra-curriculars and study time.

Mentoring work is well-paid and I’m trying to get a job as a science tutor. We can’t all wait though - I had a friend who needed work so urgently that she was working as a nanny morning and evening, seven days a week for several months; needless to say she had problems attending placement during that time. Her tutor’s reaction was to reprimand her for working too much, but what else could she do?

Another popular option for students is clinical trials. We already know enough about them to not be scared of them, and they often give you large amounts of money, especially when they involve an inpatient stay or a procedure. A recent trial recruited by circular email around our University involving lung biopsies apparently has a huge waiting list. I have applied to many trials recently; including a trial initially without biopsies, but have now requested to give the skin biopsies as I realised that significantly increased the remuneration.

So, perhaps the answer is to sell our bodies (or pieces of them at least) after all.

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New ’situational judgement’ approach too narrow

By London Med Student - 13th February 2012 10:34 am

Our careers advisor filled us in a few weeks ago on the new process of applying to the foundation schools, as I will be in the first batch of applicants. The new scheme has eliminated the white space questions, replacing them with a Situational Judgement Test of multiple-choice questions based on dilemmas we may face as an F1. The SJT counts for 50% of the points, with the other 50% based on academic performance and papers published, etc.

The few example questions for the SJT seem fairly difficult, which I guess it is designed to be. It’s very hard to know exactly which of several relevant answers are the most ideal. I find it a bit odd being asked questions about my behaviour as an F1 which feature things such as problems with handover and paperwork, something I clearly have very little experience of as a student. I spend my time in hospital trying to see patients and doctors with pressing paperwork tend to ignore us in order to get it done. However I will say that at least the SJT rewards those who get themselves into clinics - those students who have a general experience of the hospital will do much better than those who only go in when they have to.

But only half the test actually takes my achievements into account. So everything I have worked for so far in medical school - my ranking in my year and SSC marks - contributes to less than 50% of my overall points. The rest of this 50% comes from additional degrees (marks vary depending), and then a maximum of two marks from having a paper published, and/or presenting at a national conference, and/or winning a national prize (e.g for an essay). (And if you don’t have any of these already, it’s pretty much too late to get something published before the deadline).

Nothing else I have done counts. Not the audit I worked on, not my diploma that I did alongside my studies, not being president of an award-winning volunteering society, not raising hundreds of pounds for RAG. Not my BSL or first aid qualifications. I can’t even mention these on the form, because there is nowhere to put them. It’s especially annoying that I have thought these things would help my application for the last few years, but suddenly I’m getting the message that I shouldn’t have wasted my time.

I should have spent the last four years in the library, getting myself into the top decile of the year, because that’s what the marks are for. I don’t think that is right.

The most intelligent doctor isn’t necessarily the best doctor - we need to be good all-round, we need to have some life experience. I’m aware that people manipulated the white space questions (a lot of societies got started just for someone to become president of it) but are hypothetical scenarios really a better measure? Surely consistent, honest effort should be rewarded somehow.

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I don’t see the relevance of Frida Kahlo…

By London Med Student - 22nd January 2012 8:32 pm

I don’t know how it is for other universities or other courses, but for me very few teaching sessions are well-defined; I don’t really know what these ‘seminars’ or ‘tutorials’ are supposed to be, as it’s never consistent.

I just turn up and take what I get…sometimes it is essentially a lecture, or sometimes if it’s genuinely a ‘tutorial’, we’ll be going through a piece of work we are supposed to have already completed.

Sometimes seminars are interactive-style lectures, which can range from a (doctor) teacher talking at us with the odd question thrown in, to a teacher grilling you over a subject in detail (painful, but it makes you learn it) or if you’re really unlucky, a teacher playing ‘guess what I’m thinking’ and asking you vague questions repeatedly until you finally say what they want to hear.

What's Frida got?

What's Frida got?

These are all relatively okay, but there’s a new breed of teaching style emerging that is becoming much more prevalent within the medical school, and infuriating me more and more often. And that is the ‘break-out session’.

As far as I can gather, modern teaching ideals say that sitting us all in a lecture to be fed information is bad and wrong, and everything should be interactive and have feedback and involve discussions of how we feel about the subject. So instead of say, sitting 400 people in a lecture theatre to listen to an expert explain a subject to us, they split us into small groups, put us into a variety of junk-filled classrooms and make us spend an hour with a chirpy medical educator who spends the first 10 minutes asking us to brainstorm what we already know about catheters. NOTHING. That’s why I’m here…

Don’t get me wrong, I’m not opposed to group discussion/communication practise. There’s some instances where the medical school does it really well - I love it when we get the chance to talk to the actor patients, or ‘expert patients’ (usually someone living with a long-term condition), because we get clear, personal feedback on how we are doing, and useful insight from an outside person.

But often I feel that it is forced unnecessarily, or with no clear guidelines to what we’re doing and why. Earlier this year, I found myself sitting with four other people looking at a Frida Kahlo painting and discussing the answers to a list of questions about how this reflected her feelings about her medical conditions.

“I guess she feels…sad?” Sorry, but without someone with some kind of arts or humanities background to help me, I’m not really going to have a clue. And what does it matter what I think actually? Unless the medical school is worried that I’m incapable of feeling and empathy (and don’t worry, I always cry at the end of Gladiator) I find it highly unlikely that a patient is going to present to me with an abstract self-portrait of her body for me to interpret.

“Hmmm, there’s a lot of heavy brush-strokes in this…perhaps she’s got MS”.

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Reform opposition masking budgetary constraints

By Matthew Shaw, co-founder of Remedy UK - 27th April 2011 9:47 am

Remedy UK is pleased to have been invited to be a part of the NHS Future Forum - a special group which the government will consult over improving the Health and Social Care Bill.

We hope that this will be an opportunity for junior doctors to plant a foothold on a secure training structure for the future.

The Health and Social Care Bill creates two particular problems for doctors in training which we would like addressed. Fragmentation of clinical services will make it much harder for doctors to arrange training programmes.

We expect to see a lessening of the role of deaneries, which have always been fatally compromised by their internal conflicts between their educational goals and their SHA paymasters. We are keen to see the Royal Colleges given a stronger voice in maintaining professional standards, and we consider that they can best ensure that doctors-in-training are sent to the most appropriate training units.

We also want mechanisms in place to avoid the hands-off management style which could relegate manpower planning to the whims of market forces. We will be fighting to ensure that universal training structures and standards are preserved and that better mechanisms exist to plan workforce numbers. The government must not wash its hands of this responsibility and apportion blame to someone else if things don’t work out.

Last month Remedy affirmed our view that there is some good in the Health and Social Care Bill, as well as some bad, and we emphasised that the budgetary constraints - NHS chief executive David Nicholson’s challenge of £15bn efficiency savings by 2015 - have been receiving insufficient attention.

The email responses we received unsurprisingly ranged from very positive to very negative (the balance was about 3:2 towards the negative) and we have taken note of these comments. But we firmly believe that that are hard decisions to be made about rationing and constriction of services, and these decisions should be made by doctors. Not by local politicians who are looking for the next vote.

We look forward to taking part in the improvement of the Bill and defending the ability of doctors to get world class training in a new NHS.

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Obituary: Dr Peter Gooderham RIP

By Richard Marks - 15th February 2011 11:08 am

We were deeply saddened to hear of the death of Edmund Peter Gooderham on the 9 February. He died suddenly and unexpectedly a few days after his 46th birthday. Peter was a great supporter of Remedy and had been a key advisor to our legal team. A man of incandescent wit and unquestionable wisdom, he will be sadly missed.

Peter’s father was a vet and his mother was a medical social worker, and after school he chose to go to Cambridge to study medicine. He spent his third year studying Social and Political Science, and developed a life-long interest in these fields.

He qualified in 1988, and set out on a career in General Practice, but his interest in law got the better of him. He decided to study for an Open University Law degree in his lunch hour rather than doing crosswords. He completed his LLB in 2002, and the following year he gave up clinical work (he later voluntarily relinquished his GMC subscription) to take up an academic law post in Cardiff. He then moved to Manchester as a lecturer, where he taught on healthcare ethics and law. He studied for a PhD that he submitted; the thesis currently sits with the examiners.

His great knowledge of jurisprudence was matched by his relentless passion for doing the right thing and using the law for moral crusades. His well-refined sense of right and wrong was a great driving force; he was one of life’s true visionaries and inspired those around him to keep going.

He took a great interest in the pressure group Remedy’s legal case against the GMC involving the architects of MTAS. He had first-hand experience of many inappropriate referrals to the GMC. He felt that the GMC should have taken a different stance on this particular case, and was a firm advocate of accountability and personal professional responsibility. He was convinced that we were doing the correct thing, provided a great deal of background information to our legal team, and quite enjoyed the ‘whiff of mischief’.

He was incensed when the GMC won the case in court, and strongly pressed Remedy to launch an appeal. He then co-authored an article in the BMJ which pointed out the absurdity and inconsistency of the decision.

Peter was a strong advocate of the rights of doctors who had raised concerns about shabby treatment of patients. He felt that many of these ‘whistleblowers‘ had had their lives wrecked for doing the proper thing, and that the protection that existed for these doctors was virtually non-existent. He campaigned for a change in the law and the culture of the NHS. He was also a campaigner on issues of patient confidentiality, and he told a House of Commons committee that he did not want information about him to be placed upon an electronic database.

He dabbled with politics, regularly attending party conferences, and was selected to be a prospective parliamentary candidate. But he resigned his membership when David Cameron said that he wanted the Tories to be “the party of sunshine”.

Many doctors contacted Peter for medicolegal advice, particularly those who were referred to the GMC, and he gave advice to them freely and promptly. He was a regular contributor to the chat forums on DNUK where he posted under the pseudonym of Blue Dragon. The wise and knowledgeable advice that he gave so freely, often with incisive dry humour, was greatly appreciated. The breadth of his knowledge spanned across clinical specialities and other non-clinical disciplines - a rarity these days. He was the sensible side of the Dr Rant team, and wrote many articles on their blog about the way that the NHS should be run.

He met Sarah Tiley when he was at medical school. He proposed to her on Barmouth Railway Bridge (Peter was a great train-lover), and they married in 1993. She is now a GP in Shropshire. They shared many activities together, including an interest in rugby and cricket. They would sometimes go to all five days of the Trent Bridge match, and in the winter would listen to the cricket on the radio. Peter was a great fan of the outdoors, and enjoyed gardening, hill-walking and observing nature; they were planning a trip later this year to travel the length of the Outer Hebrides culminating in a couple of nights of luxury on Skye.

He is survived by both his parents, and his step-father who was a child psychiatrist.

A genuine and lovely man, intelligent humorous and human, we send our deepest condolences to his friends and family.

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Time to honour the Bristol whistleblower

By JJ Oliver - 1st September 2010 9:42 am

How would you feel if you moved to a new hospital and discovered that their mortality for the cases you were doing was twice the national average? Would you try to get things changed? And if you succeeded then would you expect to be treated as a saint or a sinner?

Twenty two years ago Dr Steve Bolsin found himself in this position when he took up a post in childrens heart surgery. After many years of struggle he got things changed - but at a huge cost to himself. Now it is time for British medicine to acknowledge the contribution of this unsung hero.

Dr Bolsin was appointed as a consultant anaesthetist in September 1988. Almost immediately he realised that there were problems in Bristol with the conduct of open heart surgery in children. He was particularly concerned about the long duration of surgery and bypass, and the consequent effect on postoperative outcomes. He soon raised this with his professor and his departmental chairman.

The Professor of Anaesthesia in Bristol recalls that Dr Bolsin had: “…expressed his concerns to me about problems in managing small babies following cardiac surgery… He was concerned that the mortality in this group of patients was much higher than he had been accustomed to… I advised him that rather than create waves with little credible evidence, he would be better advised to collect prospective data on babies and children who he anaesthetised for cardiac surgery in Bristol.”

Bolsin carefully audited the process, and continued to draw attention to the problems. In one of his letters he pointed out that the mortality for open-heart surgery in babies was “one of the highest in the country”. He expected that this letter would get a positive response. But instead of a commendation, he received a rebuke, and was sent away to collect more data.

Further data collected over the next three years showed the same patterns. He audited not only the anaesthesia and intensive care, but also at the work of the perfusionists and surgeons. The findings repeatedly demonstrated that there was a high mortality for children having major heart surgery.

At no stage was he told that he was wrong or mistaken in seeking to gather information, and he received assurances that the matter would be looked into. But nothing changed.

Between 1992 and 1995, he became progressively more desperate. He secured the help of senior doctors in other hospitals, the press and the Department of Health. For this he was rebuked, being told that he should not take information to ‘outsiders’ and that he should ‘keep his head down’. As the data he collected become more solid, his working environment became increasingly hostile.

A compounding factor was the uneasy relationship between anaesthetists and surgeons. He found that the surgeons ruled the roost, which made it difficult for any anaesthetist to appear critical of a surgeon.

After many years of adversity his data was finally acted upon. The death rates for children’s heart surgery in Bristol were dramatically reduced as a result of his determined efforts.

He also catalysed the development of a new process in medicine - clinical governance. It’s now used routinely to study and improve medical care across the country. And he was elected as the first national audit coordinator for the Association of Cardiothoracic Anaesthetists of Great Britain.

But here the tale turns sour. His career took a major nose dive, and he found himself unable to work in the UK. He eventually moved to Australia. He’s a forgotten hero of British medicine and, having recently had a quadruple bypass of his own, must wonder whether it was worth it.

The great and the good tell us that we should be impartial and committed, and that Good Medical Practice is based around the concept of integrity. The reality of whistleblowing is that the brave honest and committed doctors who attempt to change things risk professional suicide and spending the rest of their careers in the wilderness. Yet the smiling face of the Professor who Bolsin originally turned to for help is captured forever on an oil painting that hangs in the royal college.

Fortunately the British have a way to recognise and acknowledge the significant contributions that Dr Bolsin made to patient care. The Honours System exists for precisely this purpose. A group of his friends and supporters are now in the process of completing an application for him.

Remedy believes that the awards mechanism of the establishment should be used to bestow honour upon those who truly deserve it. We would wholeheartedly support this application, and invite our supporters to do the same. And there is a Twitter Group to support the campaign.

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Calling on the GMC to re-define misconduct

JJ Oliver, Remedy - 30th April 2010 2:15 pm

The Remedy judicial review being heard on 11 May could drive a coach and horses through the meaning of misconduct, and the meaning of unfitness to practice.

Doctors who are involved in management will be anxiously awaiting the verdict, since they may find themselves personally liable for their managerial decisions in future. And appeal lawyers across the country will be looking to the judgement to see whether the GMC has opened the floodgates for them.

Doctors are always happy to whinge about their managers, but serious action against doctors in management is rare. The GMC has only taken action in a handful of cases. One such case was that of Dr Roylance - the chief executive caught up in the Bristol babies cardiac surgery storm.

The MTAS recruitment process was a unique disaster. Some of the superlatives used at the time still stand out; it was described as the “biggest disaster” in a generation, and the anger it generated has still not subsided. So when Remedy wrote to the GMC asking for the senior doctors responsible for it to be referred to a fitness to practice committee then they hoped that the case would be duly investigated.

But the GMC politely declined the opportunity to hold such an inquiry. At this point Remedy reached for their lawyers, and challenged the GMC to defend themselves in court.

The case raises significant issues well beyond the events of 2007. At the heart of it lies the prickly and complex issue of what constitutes unfitness to practice. What sort of actions outside the clinical arena will render a doctor unfit to practice as a medical practitioner? The GMC have defended themselves on the grounds that: 

Whatever the conduct of [The Proposed Defendants] with regard to MTAS, I do not consider that it can sensibly be said to impinge on their fitness to practise as medical practitioners.

Yet this seems to be at odds with many previous rulings. There are many doctors who have been removed from the medical register for what has been referred to as “bringing the profession into disrepute” and for “conduct unbecoming of a doctor”. And if, for example, the doctors under investigation had knowingly breached the laws affecting international medical graduates then would the GMC still be arguing that this had no effect on their ability to work as doctors?

There has never been a case of deficient professional performance brought against a doctor for managerial issues. If Remedy is successful then this verdict will send a cold chill down the spines of medical directors and doctors working for health authorities - especially in an era of financial uncertainty.

The case is being heard in the High Court on 11 May - five days after the general election. Remedy has created a Facebook group for supporters of their case. If you agree with us, please attend court or, failing that, express your support.

This verdict is going to be studied by medico-legal bodies for many years to come.

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