What does the Good Medical Practice say about Honesty & Doctors?

Honesty is at the heart of medical professionalism and is essential for the public to have trust in particularly doctors. Dishonesty is particularly problematic for the General Medical Council (GMC) because it points to character flaws that are difficult to remediate and doctors are at high risk of erasure or facing a lengthy suspension.

We look at what the Good medical practice says about honesty and the consequences for doctors whose fitness to practise is found impaired following allegations of dishonesty.

What is dishonesty?

The GMC’s fitness to practise data shows that the highest number of allegations received by it relates to doctors not acting with honesty and integrity.  This has consistently been the highest category of GMC complaints for several years.

Alleged dishonesty can take many forms and could relate to clinical and/or private circumstances.

In common law, dishonesty is defined as:

“… a jury must first of all decide whether according to the ordinary standards of reasonable and honest people what was done was dishonest … If it was dishonest … then the jury must consider whether the defendant himself must have realised that what he was doing was by those standards dishonest.”

The test for dishonesty therefore is subjective and objective:

• Was the act one that an ordinary, decent person would consider to be dishonest (the objective test)? If so:
• Must the accused have realised that what he was doing was, by those standards, dishonest (the subjective test)?

Dishonesty & Good medical practice

According to GMC guidance:

“Dishonest behaviour can include a wide range of actions or omissions which may arise inside or outside a doctor’s working life. When dishonesty arises in a doctor’s working life, their behaviour may be directed towards patients, former patients, relatives of patients, colleagues, the organisation the doctor is working for or their professional regulator(s). Outside a doctor’s working life, dishonesty may be directed at any person or organisation.”

The Good medical practice states:

• Doctors must make sure their conduct justifies their patients’ trust in them and the public’s trust in the profession [i].
• They must follow the law [ii] and always be honest about their experience, qualifications and current role [iii].
• Good doctors are open and honest with patients if things have gone wrong. Doctors must respond promptly, fully and honestly to complaints and apologise when appropriate [iv].
• Documents made by doctors to formally record their work (including patients’ medical records) must be clear, accurate, contemporaneous and legible [v].
• When writing references and when appraising or assessing the performance of colleagues, doctors must be accurate, fair and objective [vi].
• Doctors must be honest and trustworthy when writing reports; completing or signing forms, reports and other documents; and when giving evidence to courts and tribunals. They must make sure that any information they communicate is not false or misleading. Doctors must take reasonable steps to check the information is correct, must not deliberately leave out relevant information or present opinion as established fact [vii].
• When communicating publicly as a doctor, they must be honest and trustworthy, not exploit people’s lack of medical knowledge and declare any conflicts of interest [viii].
• Conflicts of interest may arise in a range of situations. They are not confined to financial interests and may also include other personal or professional interests. Doctors must not allow any interests they have to affect, or be seen to affect, the way they propose, provide or prescribe treatments, refer patients or commission services [ix]. Nor must they ask for, accept or offer an incentive which may affect, or be seen to affect, these things [x].
• When designing, organising or carrying out research, doctors must put the interests of participants first, act with honesty, follow national research governance guidelines and GMC guidance [xi].

Good medical practice

• “Good Medical Practice is the most important”- High Court
• Good Medical Practice – when was the last time you actually read it?

It is worth pointing out that the extent to which a doctor has departed from the Good medical practice is a relevant (aggravating) consideration by the GMC (or a tribunal) when considering the appropriate sanction.

Continued below ↓

Legal Advice & Representation in cases of dishonest doctors

Dishonesty is particularly problematic for the GMC because it points to character flaws that are difficult to remediate and doctors are at high risk of erasure or facing a lengthy suspension.

Engagement with the GMC in cases where dishonesty is alleged is key because it gives the doctor opportunities to respond to allegations and, where appropriate, offer a defence and challenge evidence.  However, key to all the aforementioned is specialist legal advice and representation.

Reflecting on such cases, Catherine, comments:

“In cases of dishonesty before any healthcare regulator, a sanction of erasure is nearly always an option for the GMC or a tribunal. However, any fitness to practise hearing whether it be a substantive hearing, a review or restoration, being able to demonstrate insight and remediation is tantamount and something that is not easy to achieve without specialist advice.”

The importance of engagement was further reinforced in Parkinson v Nursing and Midwifery Council [2010] EWHC 1898 (Admin), where Mitting J said:

“A [registrant] found to have acted dishonestly is always going to be at severe risk of having his or her name erased from the register. A [registrant] who has acted dishonestly, who does not appear before the Panel either personally or by solicitors or counsel to demonstrate remorse, a realisation the conduct criticised was dishonest, and an undertaking that there will be no repetition, effectively forfeits the small chance of persuading the Panel to adopt a lenient or merciful outcome and to suspend for a period rather than to direct erasure.”

Although an NMC case, what Mitting J said applies equally in GMC cases.

Specifically on the topic of insight and remediation, the lack of clear and robust evidence of insight and remorse will be seen as a lack of understanding of the significance of a doctor’s behaviour that will almost certainly lead to the GMC or a tribunal concluding that there is a real risk of repetition.

That said, remediation, and evidence thereof, is not impossible, but it will most likely be a very long process that forms part of a clear defence strategy.  Legal advice and a clear working strategy are both key to good outcomes for doctors facing allegations of dishonesty. 

[i] Good medical practice 2024 paragraph 81

[ii] Good medical practice 2024 paragraph 4

[iii] Good medical practice 2024 paragraph 82

[iv] Good medical practice 2024 paragraph 46

[v] Good medical practice 2024 paragraph 69

[vi] Good medical practice 2024 paragraph 62

[vii] Good medical practice 2024 paragraph 89

[viii] Good medical practice2024 paragraph 90

[ix] Good medical practice 2024 paragraph 94

[x] Good medical practice 2024 paragraph 95

[xi] Good medical practice 2024 paragraph 85