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I’ll be giving a talk on Thursday 25th September 2014 on my personal experiences of alcoholism and interacting with the GMC, at a meeting called “Regulation, Respect and Health Practitioners” in London.
This is a draft of the text of my talk.
** Please check against delivery. **
Thank you for inviting me to speak for about 15 minutes on my viewpoint of the creation of a healthier regulatory process to benefit doctors and patients.
My speaking here comes at a time when there is a genuine drive for care and compassion in national policy in healthcare.
I believe that there should be a mutual respect between junior and senior clinicians, and the clinical regulator. In fact, I think this respect should be cherished and nurtured.
Last month, I had a hearing arranged by the Medical Professionals Tribunal Service (“MPTS”) to hear my application for restoration to the GMC register. This was just weeks after my 40th birthday.
I was asked by one of the panelists there what I had learnt most from my time off the register.
It is, of course, a necessary requirement that all Doctors on the GMC register have kept their skills up to date. This is so that Doctors can fulfill their obligations of performance, skills and knowledge. One of the benefits of having had at least five years out is that I’ve read the doctors’ code of conduct, “Good medical practice”, very many times. But I gave an answer which I don’t regret now for a moment.
I said, “Most of all, I finally know what is like to be a patient.”
I was erased in July 2006. At the time, it was uncertain what my ultimate diagnosis was, but a number of psychiatrists were in no doubt that I was suffering from an alcohol dependence syndrome. After I erased, I then spent heavily drinking alcohol a year in a pub. I used to go to local pubs at opening time, and leave at closing time. They say that unemployment is a big risk factor for mental illness.
Not being regulated at all by the medical profession was a big part of losing what I had perceived to be my identity. There was absolutely no structure or goal to my life. My life hit rock bottom. But, as an alcoholic, you soon realise that, however low you have gone, you can always go even further.
I had been first referred to the GMC a few years earlier. At the beginning of the process, no-one ever told me how long the regulatory process would last. This uncertainty about the future was a huge part, I feel, in my subsequent precipitous decline in mental health. I was erased ultimately for deficiencies in conduct and performance, and poor health, in 2006.
Whilst I was not punished for being ill, it was clear that the professional regulator could in no way condone my undisputed shortfalls in conduct and performance. The question about whether the clinical regulator views health to be intimately linked to professional conduct and performance is an important one. I do. This matter is also relevant to ‘revalidation’. I feel a junior must not ignore his own personal ill health first selfishly, above the needs of patients. He needs to get help as soon as possible. With the benefit of hindsight, I so wish I had sought help sooner.
When I was erased, I felt I became “public enemy number one”. However, they say that self-pity is a huge risk factor for drinking relapse. It was at one level a private shame . My father, who later passed away in 2010, was deeply humiliated by the whole experience, even though he had caused none of it. My father had been a GP for about 25 years. Therefore he adored the GMC. He felt GMC was “God”. But God moves in mysterious ways? As a loving father, he stuck by me throughout. As did my mother, with whom I still live.
The whole thing was, however, also a very public shame. You can still find reams and reams of it adorning Google. The avalanche of news reports about this, while creating a moral panic, virtually invariably never mentioned my severe alcohol illness. But that, as such, doesn’t matter to me any more even though I am keen on one aspect. I am still keen to remind myself of the distress I caused while I was powerless over alcohol. That’s why I have never asked for any of it to be deleted off Google in this jurisdiction.
I’ve never had a salaried job for the last eight years following erasure. In the only two job interviews I had for legal posts I was asked about my Google footprint of the GMC case.
On a day at the beginning of June 2007, I was ‘blue lighted’ into the Royal Free. I had had an epileptic seizure, but the crash team lost my airway. They tried to intubate me, but I then had a cardiac arrest, from which I was successfully resuscitated. I literally owe my life to the NHS. I was kept alive for six weeks, while completely unconscious in a coma. When I woke up, I could not walk or talk. I became newly physically disabled. But the neurorehabilitation team at the National Hospital for Neurology and Neurosurgery, where I was in fact a junior doctor, then taught me how to walk and talk again. I remember how the occupational therapist taught me how to shop in a supermarket. I learnt, from scratch, how to perform basic tasks, such as making a cup of tea.
I always had loved medicine. I got the second highest First in neuroscience in my undergraduate course in Cambridge. I got my PhD in 2001 in identifying an innovative way of diagnosing behavioural variant frontotemporal dementia. I later passed my diploma of the membership of the Royal College of Physicians. I have published three books for junior physicians negotiating each of the three components of this demanding examination for core medical training.
My late father, however, emphasised to me that that coma, in many respects, saved my life. I agree with him now. It heralded the start of my period of abstinence from alcohol. I have now been in recovery from alcohol continuously for seven years. I take one day at a time. I am content now.
Since my coma, I have obtained my Bachelor of Law, Master of Law and my Master of Business Administration, and completed my pre-solicitor training. I adore the law as well, and I am fully signed up to the legal doctrine of proportionality, where the law must balance competing interests where they exist. I became regulated in 2011 by the Solicitors Regulation Authority after an extensive due diligence process.
Last month, my application for restoration onto the GMC Medical Register was approved.
This is not, however, by any means the ‘endpoint’ to my new life. I am not only keen to learn lessons for myself from the experience, but I am now also keen to help others. This is why I regularly attend, voluntarily, the ‘suspended Doctors group’ for “The Practitioner Health Programme”. I am under a psychiatrist, whom, without being hyperbolic, I feel saved my life.
I look back on the psychiatry reports of me when I was ill during 2004-2006 with utter disbelief. I was hugely in denial – had no insight into all how I at all junctures minimised the catastrophic effects of my active drinking. The “paradox” for dealing with a drink problem is that you cannot ‘do it’ on your own, and yet you must get help for the problem and realise your powerlessness over it. For me, it’s very simple – I can’t ever have a casual drink ever again. One alcoholic drink is one too many, and yet one drink is never enough. It ruined my life.
For me, the critical key to success is having a close circle of people in a social network, including an after care group in my local hospital, would be able to spot and intervene early in problem behaviour. For the first time in 2007, after my coma, I fully engaged with my General Practitioner. I had numerous ‘false starts’ in dealing with my alcoholism between 2004 and 2007.
I personally found the pressure of being investigated and dealing with my illness, during this period, unbearable. A part of me wishes, in retrospect, that I had been “better managed” in terms of performance at the time. Witness statements report me as looking ‘alcoholic’ and ‘dishevelled’ while on the wards, when my performance was clearly poor. A part of me wishes I had been “made to go to occupational health”, when these problems first surfaced.
But a part of me strongly resists my transference of blame onto other parties. As I admitted to my restoration panel, I made plenty of mistakes of my own: for example, I never engaged properly with my own G.P. until my coma.
I was most obviously, prior to my coma, a clear threat to patient safety. And it states clearly in s.1 (1A) Medical Act 1983, the GMC must promote patient safety. So I strongly believe the original sanction was the correct one.
But now, next month, as a different person, I’ll be presenting my research, based on an online survey, on the funding of dementia care. This will be at the prestigious Alzheimer’s Europe conference in Glasgow. This January, I published a popular book entitled, “Living well with dementia”. I feel that, with my truncated medical training thus far, and my postgraduate degrees in law, medical research and business management, I can be an asset to the public health and health policy arm of the medical profession.
For me, my return to the GMC register, after completion of the identity check, will be a huge privilege.
Sadly, it can be rather too easy for colleagues to gang up on individuals and ringfence problems, rather than solving the problems at root to make the health and care services better. I am sure that many juniors feel: “there for the grace of God go I”.
One cannot away from the enormity of the problem of unwell Doctors in the NHS, however. I felt totally abandoned during the regulatory process and could have done with more support at a time when I especially needed it? In conclusion, the public including staff would like to have pride in the medical profession and its regulator. I too would like to see this goal come to fruition one day.
Yesterday, I went for lunch with my friend and colleague, Prof Facundo Manes. Facundo kindly wrote a Foreword to my book ‘Living well with dementia”, an essay on the importance of personhood and interaction with the environment for persons living with dementia. We were just a stone’s throw from all those bars and pubs in Covent Garden I knew well in a former life.
I spent nine years at medical school, and very few as a junior doctor.
I’ve now been in recovery for just over seven years.
But in that time I do remember doing shifts starting at Friday morning and ending on Monday night. I remember the cardiac arrest bleep in Hammersmith at 4 am, and doing emergency catheters at 3 am in Norfolk.
I had an unusual background. I loved medical research at Cambridge. In fact, my discovery how to diagnose the behavioural variant of frontotemporal dementia is cited by the major international labs. It is in the current Oxford Textbook of Medicine.
Being ensnared by the General Medical Council in their investigation process devastated my father. He later died in 2010. I remember kissing him goodbye in the Intensive Care Ward of the Royal Free, the same ward which had kept me alive for six weeks in 2007.
I of course am completely overwhelmed by those events widely reported, especially in the one in 2004. The newspapers never report I was blind drunk. The media when they do not mention my alcohol dependence syndrome are missing out a key component of the jigsaw.
Until I die, I will never be safe with one alcoholic drink. I will go on a spiral of drinking, and that one event I am certain would either see me in a police cell or in A&E.
One event did change my life. I was blue lighted in, after a year of heavy drinking after I was erased by the GMC in 2006, having had a life-threatening epileptic fit. The crash team attempted emergency intubation, but I ended up having a cardiac arrest which was successfully resuscitated.
I do not wish to enter any blame games about what happened a decade ago. It turns out that the Trust which reported me as dishevelled and alcoholic, and having poor performance simultaneously, is in the Daily Mail this morning for a running a ‘chaotic’ A&E department.
It also turns out that another Trust in London which reported me as dishevelled and alcoholic, and having poor performance simultaneously, had its A&E department shut down this week.
I have written previously here about my experience as a sick doctor.
I was in denial and had no insight. Hindsight is a wonderful thing, but I needed sick leave and a period of absence and support. But I do not wish to blame anyway for those events I wish had never happened some time ago.
But the GMC referrals were absolutely correct. I had a proper medical plan put in place for me when I awoke from my coma. I followed religiously my own GP’s advice too.
I am now physically disabled, and have had no regular salaried job since 2005. But I am content. I live in a small flat with my mother in Primrose Hill. I regularly go out to cultural events. I maintain my interest in dementia, going to a fourth conference this year for Alzheimer’s Europe in October, where I have been chosen to give one of the research talks. It’s actually on an idea which David Nicholson inspired me over.
I’ve done four books on medicine, including one on living well with dementia. The Fitness to Practice panel in their judgment note my contribution there, which I am pleased about.
The Panel also crucially made the link in their judgment that my poor performance in conduct and competence coincided with my period of illness, the alcohol dependence syndrome, for which I am now under a psychiatrist.
I go to AA sometimes, and the weekly recovery support group at my local hospital. Being in contact with other people who are starting the same process of getting their life back continues to inspire me. I also attend the suspended doctors group for the Practitioner Health Programme, which helps me understand myself too.
I believe that there is no higher law than somebody’s health. I understand the pressures of why trainees preventing them from seeking help in the regulatory process.
But I do have an unusual perspective. First and foremost, I am a patient myself, and proud of it.
Secondly, I am regulated by the Solicitors Regulation Authority. I can become a trainee solicitor, if I want to be. I had a careful due diligence process in 2010, and I thank the legal profession for rehabilitating me.
Thirdly, I will now be regulated once again by the General Medical Council pending a successful identity check on October 7 2014. Having my application to be restored to the UK medical register is a massive honour for me. I caused a lot of hurt to others during my time with the medical profession last time, and this time I would like things to be different, and be of worth.
This, I hope, will mean a lot to my late father.
I am grateful to all the people at the Medical Practitioners Tribunal Service, and to the GMC prosecutor for presenting a fair case on behalf of the GMC who need to promote patient safety.
I am encouraged that the GMC’s new Chair, Prof Terence Stephenson, “gets” change for the better for the profession, and has an excellent track record as a clinical leader.
I genuinely feel it’s only a matter of time before the giant supertanker which is the medical profession changes its bearings to acknowledge that sick people in their profession exist. Dr Phil Hammond has done a superb article on this.
I love my law school, BPP Law School. They got me through this. I have become a non executive director of their Students Association now. There’s a lot of work to be done there, but I am lucky that there are two colleagues there of mine who are simply the best: Shahban Aziz and Shaun Dias.
I am now about to be regulated by two professions. I could not be happier.
Thanks for your support. I couldn’t have done it without you.