A fitness to practise investigation is a traumatic experience, and sadly one that leaves many doctors feeling professionally isolated, either because they don't want to burden their colleagues, or they fear their reaction.

But it doesn't have to be this way. For the doctors in this story, an open and honest approach actually strengthened relationships and ultimately led to a positive outcome.

Getting the call

A consultant in paediatric emergency medicine at Birmingham Children's hospital, Dr Anand Kanani was also interested in medical education and professional development before he received a call from an anxious colleague.

As well as working with trainees as training programme director for the School of Paediatrics in the West Midlands, he had taken on other responsibilities as governance lead and as educational supervisor for a number of international medical graduates (IMGs) in his department.

"These roles match my interests and skillset," he explains. "I have so much time and respect for doctors who choose to leave a familiar culture, health system and training where they might be quite senior to come and work here.

"The interplay between acquiring medical knowledge of the NHS and also settling into life in the UK makes them interesting to supervise. At the same time, communication is something I'm passionate about and this happens to be one of the biggest learning areas for IMGs, as well as being a factor in a lot of governance issues."

An adverse incident

All these things came together when one of the IMGs Dr Kanani was supervising was referred to the GMC following a serious adverse incident a few months before. The complaint centred on the doctor's communication with the patient's family and how they had documented this in their notes.

"There was an ongoing trust investigation into what had happened so the GMC's involvement wasn't a complete surprise, but it was a bit of a shock," he remembers. "As an IMG, the doctor was unsure how to manage the situation and asked if I could help."

• Our dedicated hub offers support and guidance for international medical graduates (IMGs) working in the UK.

Dr Kanani had no hesitation in offering his support. "As much as we want healthcare to be perfect, incidents do happen," he says. "We can never know what's round the corner and I could be in that doctor's shoes tomorrow. Just as I hope people would be there for me, I have to be there for them."

He quickly realised that being referred to the GMC posed particular difficulties for an IMG. "It would have been a big enough challenge for me to cope as a British trained doctor, so imagine what it must have been like for this doctor who had brought their family to the UK and whose visa was dependent on them having a job?

"They were worried about losing their job, losing their visa and what that could mean for their children who were sitting exams. Of course, we had a professional relationship, but it was important for them to share the stresses they were going through. I might not always have an answer, but at least I could understand and point them in the right direction."

"The doctor I supported didn't really have friends and support mechanisms around them and they didn't want to burden their family so it's really important to think about how we support these doctors psychologically through what is an extreme life event.

"Although I was their professional supervisor, I also needed to think about how they were sleeping, how were they eating, whether they were depressed or suicidal. People might feel uncomfortable asking those questions because it feels like invading their personal life, but we need to take on that assessment too. If a doctor is suicidal, they're not safe to be at work looking after patients. And as a supervisor, that's my responsibility."

First responder

While Dr Kanani was the first responder for the doctor throughout their ordeal, he encouraged them to talk to others about what they were going through and seek support from other sources.

"I advised them to see their GP and keep them informed," he explains, "and the GP made a referral to a counselling service. I also referred them to the hospital's occupational health department to get their input on the adjustments we could make to keep them in work.

"I got them a consultant mentor from outside the department in case there was anything they felt unable to talk to me about. And I encouraged them to be open with their family, who would then understand if they were short with people or a bit down at home."

The investigation

The GMC investigation went on for many months, but Dr Kanani urged the doctor to use the time well and give themselves the best chance of a good outcome. "The GMC knows that things can go wrong but what's important is how we respond, because they are here to protect patients," he says.

"What they really want to see is that a doctor recognises and understands concerns, and has taken the time and energy to reflect on how they can change their practice to avoid a similar situation in future. That journey of reflection starts with the first GMC contact and continues throughout the process."

While no previous concerns had been raised about the doctor, the incident did raise concerns about their communication skills, so this became the main focus of their remediation.

With his interest in medical education, Dr Kanani was able to signpost them to elearning for healthcare's online courses and the MDU's communication skills course. But he also identified other resources to help the doctor demonstrate their fitness to practise, including seeking multiple-source feedback from across the MDT, a patient feedback exercise, and working with the doctor's MDO to collect character references from senior colleagues.

"From the doctor's perspective, this stuff could be risky, because if people said they weren't okay it would add fuel to the fire," he reflects. "But it was my responsibility as a supervisor to think about the tools we had and encourage them to be positive.

"Those assessments and exercises were evidence that the doctor was taking proactive steps to listen, and the character references from long-term colleagues were also really powerful. In the end, the doctor recognised the outcome could have been very different without them."

Another factor that made a difference for both doctors was having a supportive and open working environment. "I wanted to do the right thing, but this was an unusual and stressful situation and I didn't have a wealth of experience," Dr Kanani explains.

"However, with the doctor's consent, I was able to share information with senior colleagues and know it wouldn't become hospital gossip. That meant I could ask for support if I needed it, and that we could all work together as a department to support the doctor and keep them safe.

"For example, we'd ask ourselves whether the doctor was okay to be on shift, could they do night shifts unsupervised, and whether we needed to manage the rotas if we felt there were some things they couldn't cope with.

"We had to think how we could keep a close eye on them to ensure they were coping and were okay with patients and other members of the team. And we could be more understanding and supportive if they were upset or found it difficult to work quickly, rather than putting them under pressure."

"Another thing that was very helpful was that the trust CMO made time to meet the doctor and reassure them. One thing they said that really resonated was that doctors come to work to do our best and care for patients, but things can happen. It was the same for this doctor, who had clearly always worked hard and done all the right things. Yes, there had been an adverse incident, but they hadn't intended to cause harm."

The GMC eventually came to the same conclusion, but it took time for this to sink in. "When the doctor received the GMC's letter saying they were taking no further action, they didn't believe it," says Dr Kanani. "It wasn't like 'Oh, I've got the letter and I feel better now' - it took weeks, even months to get over the experience of living in this extreme state of anxiety. It was like a spring that has been wound so tight that it couldn't return to shape straight away.

"It took them a long time to get back to something like their old self and even now they are more defensive, careful and questioning in their clinical practice. They've been through a significant life event that's changed them as a doctor and a person, but it's up to us as a team and department to support them through that."

It was a satisfying outcome and looking back Dr Kanani is extremely impressed with how the doctor handled themselves throughout. "I take it as a win that the doctor didn't call in sick or go off with stress. They were willing to engage with everything we offered and continued to come to work and do the best they could. That can't have been easy. While the department and I can take credit that the doctor felt supported and able to carry on, it's also testament to their character. I'm still not sure how they did it."

For Dr Kanani, the experience of supporting their colleague through such a difficult experience has reinforced his view that doctors need to work together to support colleagues. "Doctors who are having difficulties of any kind need to be open and honest and willing to accept help. However, those of us in a management or leadership role also need to develop a working culture where people feel they can come and talk to us about problems and know that we're here to support them, and not judge.

"We consultants have to be brave when we hear the GMC are investigating someone and support them where we can. I can understand the fear of being contaminated by association with a GMC investigation where the doctor's practice is found to be impaired, but we need to have the courage of our convictions and say if we think the doctor is safe. I think the GMC needs to hear from us if we work with the doctor day in and day out.

"One thing I've taken away from this is how much of a positive impact we can have as consultants and educational supervisors. It's not just about telling someone to complete a task or fill in a form, but how you can mentor and support them through stressful times."

Interview by Susan Field.