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Dilemma: Uncomfortable request for reference

A colleague approaches you for a reference but she is regularly late, keeps poor notes and has been the subject of several informal complaints. How could you decline her request?

Find a tactful way to say no

Dr Fiona Cornish

Tempting as it is to write a dazzling reference for a colleague you would love to see the back of, restrain your impulsive desire to write a misleading reference.

Your first option is actually to find a tactful way of saying no to the request. For example, you could suggest someone else, saying that you think they know the doctor better, personally or professionally. If you are the obvious choice because you have worked closely with this doctor, then it can look rather odd to decline to give a reference.

People tend to assume that their referee will be purely complimentary and sometimes they even have the cheek to ask to see the reference. I would strongly advise against this, and you can give the reason that it should be confidential.

If you have no option but to say yes, then there are some ways of communicating with the potential new employer that will convey your thoughts and reservations. Most GPs are familiar with ‘reading between the lines’. After all, we spend all day with patients, working out what they actually mean, even if they don’t say it. You should definitely contact them by telephone as it is much easier to be frank and you can then have a two-way conversation.

The GMC now emphasises our duty of candour, honesty and transparency and it is irresponsible to give a false picture to a colleague who might have to work with this doctor for many years.

Dr Fiona Cornish is a GP in Cambridge and president of the Medical Women’s Federation.

Tell her you don’t have enough experience of her work to do it justice

Dr Sarah Coope - online

Any doctor with concerns about a colleague’s suitability for a post should follow the GMC’s 2012 guidance on this subject and decline to write a reference.

If you have not actually had much direct experience of working with this doctor, you could legitimately tell them that you do not feel you are the best person to comment on their suitability for the role.

A tactful way of dealing with the situation might be to explain that you are regularly asked to write references and it’s now your practice only to provide one when you have had extensive experience of working with them in a clinical setting.

Suggest that the doctor asks someone they have previously worked with instead, as others may have a different perspective. 

Most people would accept this but if the doctor presses you, you could decide to tell them that you have heard some negative comments about them from patients and describe your own concerns (you could also take the opportunity to give them any positive feedback, assuming you are in a position to do this). In writing a reference your professional duty is to include all relevant information and you are concerned this could damage their chances.

It’s worth bearing in mind that if you had any reservations about the doctor’s behaviour, it might have been fairer to have fed this back to them earlier so they had an opportunity to reflect on your comments and address any issues.

Dr Sarah Coope is a GP in East Yorkshire.

You should provide the reference if you are best placed to do so

Dr Mary Peddie - online

While your initial instinct may be to decline your colleague’s request, the GMC guidance in Writing References states: ‘You should usually provide a reference if you are the person best placed to do so.’

If you are, or have been in the past, in a senior role, for example as a supervisor or trainer of the candidate, you may be uniquely placed to comment on their suitability for the post.

The GMC guidance in Good Medical Practice is clear that: ‘References must include all information relevant to your colleague’s competence, performance and conduct. You must not deliberately leave out relevant information.’

If you agree to provide a reference, you must be objective and only provide comments that you can substantiate. You must therefore be honest in your appraisal of your colleague and ensure the reference you provide is not false or misleading nor unfairly influenced by your personal view of issues that have no bearing on the candidate’s suitability. 

When writing the reference, you need to consider the concerns you have regarding your colleague in an honest manner and ensure that you can justify any potentially adverse comment.

Potential employers need to be able to rely on the information you provide to make the right appointment for a position. Writing References states: ‘A reference that presents an inaccurate picture of a prospective employee could lead either to an unsuitable candidate being appointed or the most suitable person not being appointed. In some cases this will put patients at risk of serious harm.’

Although you are not obliged to provide the candidate with a copy of the reference, it would be unusual to include information that was unknown to them or which you would not be prepared to discuss.

However, ultimately, your relationship with your colleague is secondary to your responsibility for patient care and safety. If you are unsure whether information should be included, you could discuss your concerns in confidence with your medical defence organisation or a senior colleague.

Mary Peddie is medical adviser at UK-wide medical defence organisation MDDUS.

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