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Trainee's portfolio 'used as evidence against them' in legal case

A trainee’s ‘written reflections’ on an incident in their training development portfolio was used against them in a legal case, which GP leaders have said illustrates the medico-legal ‘minefield’ that GPs are having to operate in.

Health Education England bosses in London and the South East have warned that a recent legal challenge saw a trainee release their reflections - a vital part of a trainee’s portfolio - which ‘was subsequently used against the trainee in court’.

But in a letter to postgraduate deans and training supervisors, HEE said trainees should continue to make particular note of cases where ‘things do not go well’.

It highlights that for trainees the reflection process is exactly the same as for GP appraisal, and that these should avoid patient-identifiable information and focus on the positive lessons learned.

GP leaders warned that GPs need to take all precautions to not incriminate themselves

The letter from HEE, which was shared by doctor and medical educator Dan Furmedge on Twitter, said: ‘Recently, a trainee released a written reflection to a legal agency, when requested, which was subsequently used as evidence against the trainee in court. This has resulted in questions about whether trainees should still provide reflection about incidents in their portfolios.

‘Health Education England in London and the South East is clear that all doctors have to provide written reflections for their ARCP and appraisal, and so doctors in training must continue to write reflections, especially when there are things that do not go well.’

GP trainers have said they are concerned this could have a knock-on impact on their relationship with trainees.

Dr Peter Holden, a former GPC negotiator and a GP in Derbyshire, said: ‘I do think some of our colleagues are a little naïve and should be taking legal advice before they do things. And the problem is there’s a whole generation of doctors whose training is incomplete, they’ve not been given enough medio-legal training to at least recognise a medico-legal minefield when they see it. 

‘When you get into legal territory, all is fair in love and war and your registration comes before the patient.’

Dr Kamal Sidhu, a GP and trainer in East Durham, told Pulse the move was ‘unprecedented though not surprising’ because appraisal evidence is already used by regulators when investigating GPs.

He added: ‘It is bound to create discomfort for trainees and will potentially limit uninhibited and free reflection, which is vital for learning at this stage. On the other hand, evidence of learning from significant events can also demonstrate that the lessons have been learned.

‘It then befalls on a robust trainee-trainer relationship to have free discussions on significant events without being worried about legal implications.

‘We all make mistakes and an opportunity to be able to reflect and learn will only make us better doctors. I think the regulatory bodies too, have a duty to look at such reflections in the context.’

GPC executive member Dr Dean Marshall said: ‘This is very concerning and I would encourage all doctors to consider exactly what they commit to paper and who might subsequently have access to what is written.

’It’s sad that this is likely to result in less reflection by doctors but if we can’t expect confidentiality then we need to act accordingly.’

A Health Education England spokeperson said: ‘The purpose of the letter is to provide guidance and clarity on what trainees need to be aware of when preparing their reflective notes.’

Readers' comments (56)

  • Who in there right minds would go into General Practice let alone medicine. What other profession gets this level of scrutiny.

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  • It's been a while ago I was a trainee but I still do my appraisals. Surely in the appraisal, notes and reflection should be annonymised (i.e. measured put in place and identifiers taken out sufficiently in order NOT to be able to identify the patient) e.g. I wouldn't put in name, date/time of consultation, age and even change some facts in order to make pt unable to identify.

    If the trainee failed to do this, they have failed on 2 accounts - one is to protect themselves but also to keep patient information confidential. My understanding is, patient unidentifiable data can be stored and used without the patient's consent for medical purpose (which should includes appraisals).

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  • This was only ever going to be a stick with which to beat us. Cardigans like that sort of thing though.

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  • This country hates its doctors.The benefit seeking nation hates its hard working medical professionals.The politicians, NHS,press and those on dole need them but want them to be shivering in fear all the time.It has become the worst country for doctors.They could not Shipman and now treat every doctor as a potential criminal.Shame on this country

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  • 12.40 several points - anonymised data is often not so anonymous if you know the location of the GP and a few minor details of the patient eg the scandal with recent attempts to mine data. The reality is, information can always be exploited beyond its original intent and e-portfolio data would have a market value to unscrupulous researchers and the press. Secondly, patients have a right to expect confidentiality and not have their information shared beyond what is clinically necessary beyond their care without giving consent whatever their reasons. I always used to ask where practicable, if I could share a case at a grand round. Thirdly, this stuff seems to last forever and no doubt will one day turn up unencrypted on computers resold on eBay... Fourthly, you cannot change the details about cases very much as it would be a probity matter if you were just making up your portfolio as you went along.

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  • @1259 - the UK resents all successful people. The media is full of people being built up and then chopped off at the knees. The public love to see the mighty fall.

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  • Only tell what they need to know is what I have learned.

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  • 1259 is right. Having done a 80 hour weekend with 3 hours sleep at 30 pence an hour, I read in a famous paper editorial how self seeking, how overpaid and lazy we doctors are.
    All my colleagues have done long hours. Take home pay today per consult is 3 pounds.
    The message is simple now. Do not be a GP. Do not be a doctor in the UK.
    There is GMC waiting to wreck your career and sometimes take your life.
    There is CQC, NICE, Litigation, Defence fees, patient complaints, e portfolios, endless hours of work, 50 consults a day, the list is just too long to write.
    What really grieves me is that so many young people with such brains are all clamouring to get in when they could do cosmology and look at gravitational waves instead.
    Simple, medicine in the UK is a horror made so by papers, politicians and do goody peers.

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  • This article really tells us nothing about the facts. Who requested the information? Who released it? Was it with the trainee's consent?

    The only line that I can see which explains it is:

    "Recently, a trainee released a written reflection to a legal agency, when requested, "

    in which case, it is highly naive to be even considering this without speaking to your MDO; trainees receive free indemnity cover as part of their training.

    We don't know enough of the facts but everyone is very keen to speculate.

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  • why not just issue us with a gun and bullets so we can shoot ourselves when things go wrong?

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