When he received an email from the GMC to notify him of a fitness to practise investigation, Richard* was distraught.
The incident under scrutiny had been upsetting and led him to think deeply about his own practice and make improvements. However, that was two years earlier. By the time the GMC launched its investigation, Richard was approaching retirement and suddenly found his life in a tailspin.
"I think because it was so unexpected, I had a pretty instant and visceral emotional response – I think terror best expresses it," he remembers. "I had no immediate friends and colleagues who had been through a GMC investigation, but of course you always read the horror stories and expect something ghastly to happen.
"I had been thinking about giving up clinical work, but to possibly have my practice terminated for me rather than ending it on my own terms was pretty unpleasant and it felt this could be an ignominious end to my career."
Richard describes the six months as 'purgatory' as he struggled to live with constant anxiety about the possible outcome. "My MDU adviser said the investigation would most likely come to nothing but it could go all the way. And that's horrifying because I had no way of knowing. I just had that uncertainty hanging over my head the whole time and it really, really affected my life."
It wasn't long before the situation started to take a toll on Richard's mental and physical health. "I was a wreck," he recalls. "I couldn't work well and so I voluntarily withdrew from clinical practice because I didn't think I was safe. My sleep was disturbed. My days were disturbed. I was drinking too much and I was probably a complete nightmare to live with.
"I am usually quite resilient, having spent a lot of time in the military and served in places like Iraq, Afghanistan and Bosnia. However, this whole business was actually more terrifying. If you are a soldier, there is a kind of counter-intuitive camaraderie with your adversary as they are engaged in the same business for the same reason, albeit on different sides. This felt like being alone and almost powerless as people were making decisions and judging you."
Although Richard eventually heard from the GMC that it was concluding its investigation with no action, his brush with the regulator has left him with some long-term side effects. "Of course, it was an enormous relief initially," he says. "I must admit that I only read the first few lines of the letter at the time. I told my wife immediately and we wept with the sheer relief of it.
"However, there seems to be an assumption that if you go through a legal process and they don't find against you, then everything should be okay. It's all done and dusted and you carry on as normal. But the experience does leave deep scars and there is the physiological effect of having been under severe stress for a long period of time. I still get pangs. In fact, I am having them now as I resurrect those thoughts."
"It's good to talk."
Looking back on his difficult period under investigation, Richard is tremendously grateful for the network of support that sustained him. His message for other doctors who find themselves in his situation is that it's good to talk.
"Be completely open with your family about what is happening and engage with them," he advises. "If you try to keep things back or feed them bits of information, they don't have the complete picture. And of course, they worry too.
"It was very hard for me at first because I wasn't used to asking for help and I was nervous about how my family would see me. But they were fully supportive and absolutely fantastic. If you haven't got any immediate family then talk to your good mates as I'm sure they would understand.
"My MDU adviser was someone else I could cling to and she proved to be an absolute rock. She reassured me that if I had a problem, they would deal with it and that I should try to focus on looking after myself. The nature of the case meant I had more contact with my solicitor, who was very helpful but belonged to the alien world of law. Being a doctor herself, my MDU adviser could see things from my perspective and was able to offer a kind of peer support.
"I also consulted a psychologist recommended by my GP. While my family and friends were very much on my side, I found it helpful to talk to a professional who could be more objective. That was a really good move because he taught me things and helped me through the process. I'd never had to call for that kind of professional help before but that was another thing for me to get used to."
And although he would infinitely prefer not to have come under the GMC's spotlight, Richard believes he has learnt some valuable things from the experience which may help others. "First, it is something we hospital consultants are not used to doing - but don't be afraid to ask for help. Having representation from a good lawyer was really important because it is a very iterative process, which is nothing like medicine. And work with them, rather than rail against them, because they are on your side.
"When it came to composing a response to the GMC, I was glad that I could speak to my former colleagues and refer to my written reflections at the time of the incident. I'd forgotten a lot of the detail of the case but reading this document helped to bring it all back, as well as helping me demonstrate insight to the GMC. I've worked in medical education myself, so I know how important it is to make an honest reappraisal straight after something has gone wrong so you can understand and improve. It shouldn't be a box-ticking exercise; it has to be meaningful reflection."
Being a doctor herself, my MDU adviser could see things from my perspective and was able to offer a kind of peer support.
"Last but not least, this experience helped me understand what it is to be 'the accused'. When you read about cases in the media, you often think 'Well, they deserve to be there,' but it is rarely that simple. You really have to be there to understand the situation."
MDU peer support network
Richard's empathy with other doctors struggling under the weight of a medico-legal investigation has led him to sign up to the MDU's new peer support network, which officially starts this year after a successful pilot (see below).
Under the programme, MDU members who need support through a GMC case, claim or some other investigation process will be given the opportunity to talk to fellow members who have been in their shoes. The idea is that hearing directly from voices of experience like Richard will help members put things into perspective and give them hope for the future.
"My first reaction when I heard about this project was that I've been helped by the MDU and now I would like to give something back," says Richard, who will begin his training later this year.
"When I was facing the stress of a fitness to practise investigation, this service would have been enormously helpful. Although my MDU adviser was fabulous and my lawyer was a good lawyer and decent human being, it would have been wonderful to speak to somebody who had been in the same boat and who understood what I was feeling and why. Of course, each case is different but there are always some common themes.
"Ultimately I'll be guided by the member. Whether they need a one-off session or ongoing support, someone to talk to, or just someone to listen, I'm going to be here for them."
Interview by Susan Field.
*Names and identities have been changed.
Head of advisory services Dr Caroline Fryar explains how the MDU's peer support network can offer members a lifeline.
Richard's experience will, sadly, resonate with many of our members. We are only too aware of how incredibly stressful it is being subject to a GMC investigation or involved in another process such as a claim or coroner's inquest.
That's what prompted us to set up our peer support network. It puts members who are struggling in the face of their involvement in a complex medico-legal matter in touch with another member who has been through a similar process, supported by the MDU, and therefore has first-hand experience on which they could draw to provide personal support, guidance, reassurance and hope.
When we have a member who is finding the process they are facing very stressful, we ask the member if they would like to speak to another doctor over the telephone who has been through a similar process and 'survived it'. The purpose of the contact is not to discuss the specifics of the case, but to offer the member an opportunity to ask questions and obtain the advice of someone who has 'been in their shoes' and can share tips on how to best cope with the process ahead of them.
So far both the peers and the members who have been involved have found the experience positive. We are delighted that Richard will soon be joining our team of peers.
If we're helping you with a medico-legal matter and you feel you'd benefit from accessing the peer support network, please speak to your medico-legal adviser.