Medicine and the media: GMC under the cosh
Authors: Richard Smith
Journal: BMJ (1998)

Self regulation of the medical profession is coming under increasing media scrutiny, writes Richard Smith. Last week, Channel 4’s Dispatches continued the attack on the GMC.

These are difficult times for the General Medical Council. The media seem to be circling, perhaps sensing a kill. The media are, of course, not one thing but a collection of newspapers, magazines, and radio and television programmes, most of them in furious competition. They do not ever sit down together and decide that something is a story, although they do feed off each other. Thus, when you see a pattern of stories about one organisation—like the GMC—it may mean that the media are reflecting some deeper social mood. 

Sir Donald Irvine, the current president of the GMC, constantly reminds doctors that self regulation is not a right of professionals but rather a privilege that has to be earned every day. The media seem to be arguing that the medical profession is not keeping its side of the bargain—to guarantee that registered doctors are competent and trustworthy. And what the media say today, politicians may be forced to act on tomorrow, whether they want to or not. Few politicians want to pick a fight with the medical profession. Nor do they want to pick up the costs and headaches of regulating doctors, but there may come a point when they are forced to by public—media—pressure. 

One reason for the recent spate of anti-GMC stories is the Bristol case currently running at the GMC. Two cardiothoracic surgeons and a manager are accused of continuing to operate on children long after it was clear that operative mortality was unacceptably high. The case began before Christmas and is not expected to end until at least April. It’s the longest case in the GMC’s history and is likely to have profound consequences. 

There was extensive media coverage when the case began. The reports were generally unsympathetic to the accused, and many of those following the reports must have been left wondering why the case was going to take so long to hear. A highly emotive feature article in the Guardian on 18 February set the case in the broader context of self regulation. The article described “the 50 mock coffins” that greeted the accused outside the GMC and highlighted the statement of the parents that “We believe that more children died from cardiac surgery at the BRI [Bristol Royal Infirmary] ... than died at Dunblane.” 

The article creates the impression that, whatever happens to the accused, the GMC will lose. “The only proper forum,” says one of the parents quoted in the article, “is a public inquiry. The GMC is nothing more than an internal disciplinary inquiry. Their hands are tied. They are a tiger without teeth.” Another said, “They are making a mockery of our complaints. It is a sickening sham, a complete cover up. They are putting a lid on it and preventing the full story coming out.” 

“Society today demands answers,” writes Sarah Boseley, the author of the feature. “Public inquiries are held into the actions of social workers after the death of a child ... why ... should doctors be a special case?” The GMC, she argues, is causing parents to wait in “agonised uncertainty” and is “just prolonging their suffering.” 

The Daily Mail on 29 November told the story of a doctor who had sexually abused patients and observed that it had uncovered “an appalling lack of checks by the medical establishment.” The Sunday Mirror on 1 February reported on a “bungling GP,” noted he had “escaped with a mild ticking off from the General Medical Council,” and concluded that “The medical profession knows how to look after its own.” The News of the World reported on another case of a doctor sexually abusing patients on 28 December and quoted the abused patient as being “disgusted” that the doctor was only suspended for three months. 

Last week Dispatches (Channel 4, 12 March) used a series of highly charged cases plus a smattering of statistics to condemn the GMC and question self regulation. The programme did not attempt to amount an intellectual case against the GMC. Rather it used the power of the medium to devastating effect. Most of the programme consisted of abused patients, all women, describing in detail the horror of being abused. All of the patients were shocked that the guilty doctors, all male, were not more heavily punished. The cases were intercut with a defensive Sir Donald Irvine seeming to be trying to defend the indefensible. Sam Everington, a BMA Council member, and Jean Robinson, a former lay member of the GMC, were used to support the case against the GMC, but, cleverly, the programme makers used the abused patients to make the case. 

“A profession is something that you look up to. You trust these people implicitly. You trust them with your life.... The doctors sit in judgement on their colleagues.... They’re protecting the doctor. Definitely.... Everything is done behind closed doors. They’re all doctors and they all stick together.” 

“Would you,” the presenter asked Sir Donald, “like your wife or daughter looked after by a doctor found guilty of a sex offence?” How do you answer a question like that when you know that doctors found guilty of sex offences are practising? “I am by nature—as you would expect in a doctor—a forgiving person,” answered Sir Donald. But very few members of the audience of the programme would by this time want a “forgiving person” sitting in judgment on erring doctors. “The GMC,” said Dr Everington, “has failed to protect public confidence in doctors.” The programme ended by pointing out that “your doctor” may have been found guilty of an offence. You would not be told. 

This programme followed a formula that has been used before, but it used it powerfully. A few more programmes like this, combined with reports on cases like the Bristol case, and self regulation may be finished. “Zero tolerance,” doctors may have noticed, is the rage among those protecting the public.