Fitness to practise and the spectre of erasure: Some reflections from a psychiatrist assessor

Abstract

Referral of doctors to the General Medical Council concerning their fitness to practise is an important subject, not only because of potential risk to patients, but because of its impact on the mental wellbeing of the doctors concerned. This paper is based on the case histories of 124 doctors (1990–2015) reported to the GMC and for whom I was requested to undertake a psychiatric assessment. My findings are summarised under three headings: psychiatric problems, substance misuse and inappropriate sexual behaviour. Nerve-wracking though GMC referral is for any individual doctor, most investigations do not proceed beyond the triage stage, after which the case is closed. I also reflect on the changing pattern of doctors’ professional identity and how this might help them seek help for mental disorders at an earlier stage than in the past, thus preventing referral to the GMC.