Remediating dishonesty: perspectives of a doctor and ethicist

By Daniel Sokol and Tarek Seda

In June 2017, Dr Tarek Seda was a locum A & E doctor who worked consecutive night shifts in an emergency department. During this time, Dr Seda fell asleep, failed to adhere to his allocated break times, and made a number of errors when assessing and treating patients.

A few months later, Dr Seda e-mailed his locum company asking for a certificate to prove that he had worked for them.  The company’s representative said they did not provide such certificates but confirmed in an e-mail that Dr Seda had been employed by them in the past.  Dr Seda created a certificate with the company’s letterhead and transposed the e-mail into the forged certificate.  He then sent it to a third party as proof of past employment.

The NHS Trust raised concerns to the General Medical Council and in December 2019 the Medical Practitioners Tribunal Service (“MPTS”) suspended Dr Seda for 12 months.  Another hearing was scheduled for December 2020.

In October 2020, Dr Seda underwent a half-day, one-to-one remedial ethics course with Dr Sokol, a medical ethicist.

This piece contains reflections by Dr Seda and Dr Sokol on the process of remediation.

 

Dr Seda’s perspective

I was fortunate enough to have legal help during the disciplinary proceedings.  My lawyers explained that dishonesty was difficult to remediate but suggested I attend a medical ethics course.

After looking at various options, I chose a course with Dr Sokol.  As it was bespoke, I believed it would be more useful than a generic medical ethics course, where much of the content would be irrelevant to my circumstances.  I also valued the privacy of a one-to-one delivery where I could speak freely and in confidence about what happened, why it happened and my reflections on the whole process.

Dr Sokol read the documents in the case and produced a programme covering topics such as the Hippocratic Oath, the relevant provisions of the GMC and other professional bodies, the four principles of medical ethics, and truth-telling and record-keeping.  In each case, he showed how the topic applied to my particular circumstances.  For example, we discussed the injunction found at the very heart of the Hippocratic Oath: “in a pure and holy way, I will guard my life and my craft.”  We talked about probity, its meaning, importance and relevance to my case.  We identified the temptations that a doctor must guard against.  I realised the extent to which I fell short of the Hippocratic ideal back in 2017 and 2018.

To my surprise, I enjoyed the sessions and by the end of the course my ability to reflect on what had happened deepened.  I learned more about medical ethics in 4 hours than I did in my 24 years of studying and practising medicine.

The course had a big impact on the quality of the reflective statement submitted to the MPTS and on my confidence when answering questions by the GMC’s barrister and the Tribunal members.

Since completing the course, I have read books on medical ethics and I am considering further studies in the subject.

 

Dr Sokol’s perspective

When teaching doctors in Dr Seda’s situation, the stakes are high.  Their career, their livelihood, their mental health and the wellbeing of their family are often on the line.

The main challenge was to ensure that, in the space of a few hours, Dr Seda truly understood the ethical aspects of his situation.  I am aware that some doctors only attend ethics courses to tick the ‘ethics’ box for their portfolio.  However, my role is to impart knowledge and skills that will stand the doctor in good stead beyond the reflective statement and the disciplinary hearing.  The course should be a potent injection of ethics straight into their veins, not only changing the way they see their case but also how they think about medicine and how they behave in practice.  It should not be dry or academic but a veritable “aha” moment for the doctor.  Any lack of insight can be the kiss of death for doctors in a disciplinary hearing.  I sometimes call teaching remedial ethics ‘ECT for doctors’: Ethico-Convulsive Therapy.

That is why I started the course by looking at key passages from the Hippocratic Oath and the Declaration of Geneva, and applied them to Dr Seda’s case.   He had to understand, and accept, the fundamentally moral dimension of being a doctor, with all the attendant duties, responsibilities and expectations.

Another unusual aspect of teaching doctors in Dr Seda’s situation is the central importance of trust.  However dreadful the misconduct – and Dr Seda’s case was by no means at the most severe end of the spectrum – the doctor must have complete trust in the ethicist.  Trust in their knowledge and insight, trust that they will not judge or look down on them, and trust that they will not share their secrets with others (without their permission).

Dr Seda, like most of the doctors who complete the course, was a ‘wounded’ doctor.  He was anxious, embarrassed, and exhausted by a disciplinary process that had dragged on for years.  This required a different approach to, say, teaching medical students.  As well as the urgency and intensity of the encounter, there was a greater need for sensitivity.  Through my words and conduct, I tried to convey the idea that “I am on your side.  I will help you.  Let me show you the way.”

During the course, Dr Seda was engaged and reflective.  I was delighted to learn that he wants to pursue his interest in medical ethics.

 

Outcome

In December 2020, the MPTS reconvened to consider Dr Seda’s fitness to practise.  In their outcome letter, the Tribunal noted that Dr Seda had attended a one-to-one medical ethics course with a specialist in ethics and probity, and concluded:

“[Dr Seda] has engaged properly in reflecting upon the fundamental tenet of probity required for a member of the medical profession.  He has reflected on the adverse impact of a failure to adhere to these standards.  He has adequately remediated the adverse impact on public confidence.  The Tribunal therefore determined he was no longer impaired by reason of dishonesty. 

Dr Seda’s case shows that dishonesty can be remediated in some circumstances and that targeted medical ethics teaching can lead to great benefits for doctors undergoing disciplinary procedures.

 

Authors: Daniel Sokol and Tarek Seda

Affiliations: DS: Barrister, 12 King’s Bench Walk Chambers, London, UK. TS: Medical doctor and MSc Student, Department of Health, Psychology & Social Care, Manchester Metropolitan University

Competing interests: DS is the founder of the Centre for Remedial Ethics, which provides one-to-one ethics training for doctors.

Social media: DanielSokol9 @TarekSeda

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