Reprimanded by the GMC for sharing faith with a patient – reflections on the Richard Scott case

On 14 June the General Medical Council’s Investigation Committee reprimanded a Christian doctor who shared his faith with a patient at the end of a private consultation. They ruled that his actions ‘did not meet the standards required of a doctor’.

Dr Richard Scott (pictured) has now been issued with a warning which will remain on his record for five years. Further serious or persistent failure to follow GMC guidance will put (his) registration at risk.

Dr Scott, who has been a doctor for over 28 years, was initially investigated by the GMC after it received a complaint from a patient that he had discussed the benefits of Christianity with him.

The full judgement is available on the GMC website and the Huffington Post gives more detail of what Dr Scott said in his defence.

The case arose from a complaint made to the GMC on 14 August 2010 by a patient’s mother about the doctor’s conduct when her son consulted him ten days earlier. It was alleged that Dr Scott ‘abused his position as a medical practitioner to push (his) religion upon a vulnerable patient’.

The patient on 20 October 2010 provided a written statement on which the GMC’s allegations were based. After seeking Dr Scott’s views on the allegations, which he did not accept, they sought to issue him with a warning, which he refused thus exercising his right to an oral hearing before the investigation committee.

When the patient refused to give evidence to the committee last autumn the case was adjourned until June 2012. On this occasion the patient again refused to appear but eventually agreed to give oral evidence over the phone.

During the hearing the committee noted that there was ‘clearly a conflict of recollection of what occurred in the consultation between the participants’ but considered that ‘both witnesses were honest and not trying to deceive’.

Dr Scott insisted that he had acted with the GMC guidance but also accepted that if he ‘had acted in the way in which the alleged this would be a significant departure from (it)’.

There was, in other words, a significant disagreement between Dr Scott and the patient about what was actually said during the consultation.

The committee, however, considered that the patient ‘gave credible evidence, direct answers and made all due allowances’ in Dr Scott’s favour. But they considered that ‘a number’ of Dr Scott’s responses ‘were in conflict with the evidence’ and that at times he ‘appeared to be evasive when answering questions’.

In other words the committee appeared to prefer the patient’s evidence over that of Dr Scott where their recollections were in conflict.

However, whilst a number of the allegations made were found ‘proved’, three significantly were not, raising questions about the accuracy of some of the patient’s evidence.

In summary, the committee concluded that Dr Scott ‘caused the patient distress which (he) should have foreseen’ by the way he expressed his beliefs. He also ‘sought to suggest (his) own faith had more to offer than that of the patient’ and in so doing ‘sought to impose his own beliefs’.

The GMC claimed that Dr Scott’s actions were in direct conflict with paragraph 19 of its supplementary guidance: Personal Beliefs and Medical Practice’:

‘You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views’.

and also with Paragraph 33 of ‘Good Medical Practice’:

‘You must not express to your patients your personal beliefs including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.’

The GMC defended its issuing of a warning by saying it was obliged ‘to lay down a marker as to expected standards and to maintain public confidence in the profession’. It also said that ‘the discussion of religion within consultations is not prohibited’ and that this case ‘relates to the manner in which religion was approached during the consultation’.

The case raises a number of important questions for Christian doctors:

1.Is the GMC guidance overly restrictive?

The GMC Guidance, ‘Personal Beliefs and Medical Practice’ is currently under review but the 2008 version, under which Dr Scott has been assessed ‘attempts to balance doctors' and patients' rights - including the right to freedom of thought, conscience and religion, and the entitlement to care and treatment to meet clinical needs - and advises on what to do when those rights conflict.’

It does not intend to ‘impose unnecessary restrictions on doctors’ but does point out that doctors have an obligation not to impose their beliefs on patients. So there is no blanket prohibition on expressing personal beliefs, as long as it is done in a way that is sensitive and appropriate.

The guidance also underlines the principle that doctors must ‘make the care of (their) patient (their) first concern’ and must treat them ‘with respect, whatever their life choices and beliefs’.

These are all good principles that I personally have no problem with. No doctor, Christian or otherwise, should impose his views on his patient or seek to exploit his or her position.

However, the guidance goes on to stress that all patients and doctors have personal beliefs implying that these principles apply not just to those who subscribe to a particular faith, but to everyone.

‘Personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients.’ ‘All doctors have personal beliefs which affect their day-to-day practice.’

It also emphasises that taking account of patients’ beliefs is part of good medical care.

‘Patients' personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness or treatment.’ ‘For some patients, acknowledging their beliefs or religious practices may be an important aspect of a holistic approach to their care. Discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.’

Provided these guidelines are retained within the new guidance, they are parameters that Christian doctors should be able to work with.

2.Was this investigation fair?

The faith conversation which seems to have got Richard Scott into trouble came at the end of a 20 minute consultation, when he asked the patient whether he could talk about his Christian faith and the patient replied ‘Go for it’. So there was mutual consent and when the conversation became tense they stopped it.

The key problem faced by the GMC was that they were making an assessment based on two varying accounts of what actually happened, one from the patient and one from Dr Scott. However, in so doing they seem to have preferred the patient’s testimony over that of Dr Scott where the two accounts conflicted. Also the initial complaint was made by the patient’s mother who was not a witness to the consultation and transcripts of Dr Scott’s radio interviews were actually gathered by the National Secular Society, who undoubtedly had an ideological vested interest in the case.

Furthermore there were elements of the patient’s written testimony which were not upheld on cross-examination and he repeatedly refused to turn up to give evidence face to face. The Christian Legal Centre, who represented Dr Scott, have understandably raised questions about the legality and transparency of this process and had undertook unsuccessfully to have the case ‘struck out’. They are still considering whether to ask for a judicial review of the way the GMC conducted the enquiry.

Given, as acknowledged by the GMC, that Dr Scott had a previously unblemished record and was able to produce many patients’ testimonials, might they not have given him the benefit of the doubt in these particular circumstances? Wasn’t this a case that would have been better resolved locally with a mutual apology and a handshake? Has the GMC overreacted?

Furthermore, might the judgement encourage other individuals or organisations to bring forward vexatious written complaints against other Christian doctors knowing that it will essentially be the patient’s word against the doctor’s?

And why should suggestions that faith might help a patient be treated any differently from suggestions about other lifestyle choices or beliefs? As one doctor has argued in Pulse this week:

‘Patients already could say that you are ‘exploiting their vulnerability’ and ‘causing them distress’ when you speak to them about lifestyle choices which have led to obesity or addiction, but that is OK, because the evidence shows that dealing with these things would be good for them. Dr Scott has presented similarly robust evidence that shows that ‘doing God is good for your health’. So why would the GMC want to encourage one and discourage the other?'

There are certainly questions here that are worth asking and I am aware that a number of Christian doctors have already written to the GMC about them. Others who wish to express concern about the case, or to ask questions, can do so via the GMC website. The most appropriate addressee would be Niall Dickson, the Chief Executive.

3.What sort of faith discussions are still allowed within a consultation?

Last year I was involved in a Radio four PM debate with Niall Dickson, the Chief Executive of the GMC in which he confirmed the appropriateness of sensitive faith discussions with patients. His exact words were as follows:

‘The first point is that the start of a consultation is not the point at which you start introducing your faith and you should be where the patient is at. But there may be circumstances where a patient is at a point where they do want to discuss faith and it may be appropriate for the doctor to reflect on their own faith during that discussion.’

When asked how the GMC determined whether or not a doctor had expressed ‘religious, political or other beliefs or views’ in an ‘inappropriate or insensitive’ way Dickson explained that the GMC guidance was there to enable doctors to make good judgements themselves:

‘I am not there to judge, the doctor is there to judge and this essence of medicine is making judgements in the face of uncertainty and the importance of the doctor understanding where the patient is at. Taking a vulnerable patient and imposing your religious views on them and exploiting their vulnerability would be on the wrong side of the line as far as we are concerned.’

Jane O'Brien, GMC Assistant Director for Standards and Fitness to Practise, in a letter to the Daily Telegraph in 2009 even suggested that a ‘tactful' offer to pray could be appropriate. O’Brien’s letter in full read as follows:

‘Nothing in the GMC's guidance Personal Beliefs and Medical Practice (2008) precludes doctors from praying with their patients. It says that the focus must be on a patient's needs and wishes. Any offer to pray should follow on from a discussion which establishes that the patient might be receptive. It must be tactful, so that the patient can decline without embarrassment – because, while some may welcome the suggestion, others may regard it as inappropriate.’

The same sentiments were expressed in a letter from David Horkin, GMC Investigation Officer, to a CMF member this last week.

‘The GMC has no objections whatsoever to the clinician bringing up faith in the consultation if it is done in an appropriate and sensitive manner. The patient must of course consent and be happy for such discussions to take place. Also, the clinician should take note of the patient's own beliefs and not attempt to belittle / disrespect their own faith or lack thereof. You should not attempt to impose your views on any patient who does not want to discuss such matters.’

These three statements strongly endorse the appropriateness of sensitive faith discussions.

4.Are doctors still free to practise ‘spiritual care’

Taking all this into account, it is clear by the GMC’s own admission that doctors are fully entitled to take part in ‘faith discussions’ within a medical consultation provided that they are carried out in an atmosphere of sensitivity, permission and respect.

In fact, good doctors, we might argue, have a professional duty to practise ‘whole person’ medicine that is not concerned solely with physical needs, but also addresses social, psychological, behavioural and spiritual factors that may be contributing to a person’s illness.

It would be a tragedy if, as a result of this case, Christian doctors shrunk back from providing appropriate spiritual care or from sharing their own Christian beliefs in a sensitive way, when it was appropriate, and when the patient had welcomed it.