The GMC recently suggested to an MPTS fitness-to-practise tribunal that a doctor’s apology to a patient was an admission of guilt.
Earlier this month, Dr Nithya Santhanalakshmi Shunmugavel Pandian was suspended for two months after a tribunal found that her actions were ‘dishonest’ and amounted to ‘serious misconduct’ when she was found to have recorded information about a patient without having completed the necessary examinations.
Working as a Trust locum doctor in the acute day unit, Dr Pandian recorded an entry in Patient A’s notes for cardiovascular, respiratory and abdomen indicators, but the patient said that Dr Pandian did not listen to her heart or her breathing, and did not examine her abdomen.
In 2019, in response to an internal Trust investigation, Dr Pandian said she believes she performed the examinations, adding: ‘If Patient A feels that I documented this without examination then I sincerely apologise for all the distress that Patient A went through because of this.’
In its allegation of dishonesty, the GMC suggested this was an admission of guilt as ‘the apology would only make sense if Dr Pandian had not examined’ the patient.
However, this is seemingly contrary to its ethical guidance, which states says that ‘apologising to a patient does not mean that you are admitting legal liability for what has happened’ when a patient has suffered ‘harm or distress’. Meanwhile, NHS Resolution ‘advises that saying sorry is the right thing to do’.
Despite ultimately ruling against Dr Pandian, the tribunal dismissed the GMC’s suggestion, saying ‘the apology was not an admission’ and it ‘accepted’ Dr Pandian’s explanation that she had only apologised on advice from a senior colleague because the patient had suffered distress.
In her witness statement in November, Dr Pandian said: ‘I wish to make it clear that when I apologised to Patient A in my response to the initial complaint that was made to the Trust, my intention was to apologise for the distress caused to Patient A.
‘I was not accepting any wrongdoing. I would not add a note to the patient record unless I had completed the examination. However, if the patient believed that I had done so this may have caused some distress for which I apologised.’
The tribunal outcome garnered interest on Twitter, with some doctors expressing concerns around the risk of apologising to patients.
Dr James Booth, a GP in Essex and GPC member, wrote: ‘Indemnity organisations always advise apologies for distress, even if nothing was at fault, or that’s the belief of their member.’
Similarly, consultant in elderly care Dr Philip Lee said the fact an apology is not an admission of liability is ‘one of the central tenets of managing complaints and reconciliation’.
He wrote: ‘Perhaps in light of the MPTS and GMC findings we should stop apologising until investigations are complete.’
Dr Selvaseelan Selvarajah, a GP partner in East London and representative on the BMA Council, said ‘apologising when things don’t go quite right can be quite restorative for patients and doctors’.
The MDDUS, the defence union representing Dr Pandian, said the MPTS’ decision was ‘very disappointing’ on Twitter, however refused to comment further as this is still an active case.
When asked about the rationale for suggesting that Dr Pandian’s apology was an admission of guilt, the GMC declined to answer.
However, a spokesperson for the regulator said: ‘We are carrying out work across the GMC to promote fairness in our processes, and across the UK health system.’