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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 is monitoring these lawyers who make there careers from manipulating and misconstruing the truth particularly where it comes to doctors. We all know in truth who those are causing all the damage in the NHS and who are the individuals draining all the finances -unscrupulous lawyers!

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  • This is sad because we're meant to be going away from a blame culture. Probably best to write up events which had a neutral outcome, where no action needed.

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  • Love the 1.37pm significant events list!!!

    People should write some more in and there should be a competition for the best entry!

    We really care about these important issues as they mean so much to us.

    Ok lets go....
    Patient upset by drug causing side effect of diarrhoea.
    Patient upset by cold waiting room.
    Patient upset by rude receptionist.
    Patient upset by getting sent the same form twice.
    Patient sent a form for a smear 4 years after she has had a hysterectomy and was upset.....etc...
    Or
    Patient upset when collegue refused to drop some pain killers off at her house when she was busy watching re-runs of Downton Abbey and had a headache and could not go out as she had just had a glass of wine with her curry....

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  • Patient upset because they waited an hour for their appointment. They attended 1 hour early but that doesn't matter.

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  • keep it simple - choose non-controversial subjects eg

    patient upset re: wrong address on records
    full apology given by GP with written apology if requested.

    explain how you felt, what went wrong and how you fixed this problem so it won't happen again.

    GP felt awful, and ashamed of his profession, tearful apology given, offered to top himself but patient declined. Patient escorted to reception area and change of address form wrapped in velvet given to patient, GP offered back for patient to use as writing surface, all of staff stood up and apologized, patient less angry and would hold back from writing to daily mail about how awful the NHS is as he moved yesterday and the NHS should know his new address today, full staff meeting called to discuss issue, GP refers self to GMC and practice voluntarily closes.

    it's not difficult guys !

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  • Patient upset that GP missed their hidden agenda. They came to talk about left foot bunion, but they really wanted to discuss the one on right side. GP missed several opportunities to turn the consultation right.
    Indescribable suffering by patient.
    GP reflects and appologises. Offers his first-born child for ritual sacrifice that is required to appease the almighty public. Offer accepted. GP gets revalidated. Not so hard, is it?

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  • pt upset because GP told the patient PLEASE try to keep your next MRI appointment [ missed 3 MRI appointments for the same condition ]

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  • 3:45 OMG, I've just seen that patient! Upset because free transport turned up to take her to an appointment that she couldnt be bothered to go to

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  • no these are all too serious

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  • The sad thing is that sometimes what's written down, far from causing trouble, gets you off the hook. I was sued by a patient who claimed that as a result of a missed diagnosis of her shoulder problem she suffered severe pain, could not drive a manual car, couldn't lift anything, needed surgery she couldn't afford and needed a water bed to sleep on. Her story began to unravel when the GP notes indicated she had was going scuba diving in Fiji (try lifting an aqualung with a painful shoulder) and had had liposuction privately.

    The bottom line is that appraisal material should all be confidential or anonymised or both. One should also remember that there is a difference between truth and justice.

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