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.’
The GMC: unable to see a foot without shooting themselves in it.
Nonsense to say apology is admission of guilt. Apology diffuses patient’s anger .
You have to wonder If the surname was different, would there have been a totally different outcome…..
I’m just stunned by this statement. I am surprised an organisation with so much responsibility can make statements like this. It’s blatantly obvious what’s going on but sadly there is no Governance of the regulator.
Very disappointing!
I think that the gmc needs an external investigation. What was the name of the person in the organisation that asked the mpts. Have they written to the mpts before. Why necessary for this case exactly. I think that there needs to be an independent investigation into racial bias. Pulse can you look into this further.
Maybe I watch too many american police films, but often the CSIs turn up after a fatal shooting and say to the relative ” I am sorry for your loss.”, which is, then, obviously an admission that the CSI is guilty of shooting the deceased ?
When I was once hauled up before the G.M.C. I indicated that their investigation lacked ”common sense”——-They retorted that my attitude throughout had been ”contemptuous and offensive”———-pretty much sums things up
I think this may be part of a trend.
Exactly same thing happened to me and several other doctors and nurses I know.
Do not apologise anymore.
We have been set up to take the fall.
This whole article is a mess . was suspended for two months after a tribunal found that her actions were ‘dishonest’ and amounted to ‘serious misconduct’ . if the tribunal rejected apology as admission of guilt how can they suspend someone -GMC needs to sort out its racism issues.
Just another demonstration by the GMC, that they are ‘grossly unfit for purpose on so many levels’.
It’s almost starting to look like honest, competent doctors (i.e. the vast majority of us) should start to wear GMC investigations as a badge of honour considering how hopeless they are.
I’ve never been investigated by them but I have had dealings with them. Lets just say that on several levels, they talk the talk but either can’t or don’t walk the walk.
In the end, as the old saying goes, who watches the watchers?
Completely agree
The patient alleges both Dr Pandian and her consultant “Dr C” did not examine her,
There is written documentation in the notes that both Drs examined her….
It’s essentially a case of patient’s word against dr’s….
GMC sided with the patient
https://www.mpts-uk.org/-/media/mpts-rod-files/dr-nithya-santhanalakshmi-shunmugavel-pandian-11-may-23.pdf
“When asked about the rationale for suggesting that Dr Pandian’s apology was an admission of guilt, the GMC declined to answer. “—-This is dishonest. Yes or no? Is it not in their own guidance? The GMC is unfit for purpose siding with the patient without sufficient proof.
Any allegation of dishonesty to GMC will automatically be MPTS. MPTS will have to justify the referral, they list their objective to protect patient, but if there is no patient to protect will destroy the doctor with what seems like a short suspension. MPTS take the role of punitive action, even if there is no risk for patient care or indication that the doctor is delivering substandard medical care: “a deterrent effect and send out a signal to the doctor, the profession and the public”. For this ‘signal’ the suspension will mean exclusion from Indemnity insurance and removal from the performers list for GPs, it will take 6 months to be re-admitted to the performers list and then to work without MPS or MDU cover after, fortunate there is crown indemnity as in the past it meant never to work again. MPTS had clearly found in favour (it is civil standard 51% probability) of the patient, I imagine there was something that was undiagnosed that could have been detected, even if this is the case the verdict relied on ‘dishonesty’; this is justice for making a mistake in record keeping in the eyes of MPTS.
“the purpose of a sanction is not to be punitive, but to protect patients and the wider public interest”
“aggravating factors in this case:
• Dr Pandian’s contention that she could never make a mistake, demonstrating a lack of insight.”
If you contend any allegation, this is always a lack of insight.
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.
Err, no. The doctor was apologising for the distress the patient may have suffered by believing that they had not been examined, whilst maintaining the position that they WERE examined and that this was recorded. That is, the patient was mistaken. The doctor is only guilty of being over generous in her apology.
My goodness, when will the PSA (GMC regulator) ever find the GMC guilty of professional misconduct and negligence?