By Daniel Sokol and Tarek Seda<\/p>\n
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.<\/p>\n
A few months later, Dr Seda e-mailed his locum company asking for a certificate to prove that he had worked for them.\u00a0 The company\u2019s 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.\u00a0 Dr Seda created a certificate with the company\u2019s letterhead and transposed the e-mail into the forged certificate.\u00a0 He then sent it to a third party as proof of past employment.<\/p>\n
The NHS Trust raised concerns to the General Medical Council and in December 2019 the Medical Practitioners Tribunal Service (\u201cMPTS\u201d) suspended Dr Seda for 12 months.\u00a0 Another hearing was scheduled for December 2020.<\/p>\n
In October 2020, Dr Seda underwent a half-day, one-to-one remedial ethics course with Dr Sokol, a medical ethicist.<\/p>\n
This piece contains reflections by Dr Seda and Dr Sokol on the process of remediation.<\/p>\n
<\/p>\n
Dr Seda\u2019s perspective<\/strong><\/p>\n I was fortunate enough to have legal help during the disciplinary proceedings.\u00a0 My lawyers explained that dishonesty was difficult to remediate but suggested I attend a medical ethics course.<\/p>\n After looking at various options, I chose a course with Dr Sokol.\u00a0 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.\u00a0 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.<\/p>\n 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.\u00a0 In each case, he showed how the topic applied to my particular circumstances.\u00a0 For example, we discussed the injunction found at the very heart of the Hippocratic Oath: \u201cin a pure and holy way, I will guard my life and my craft<\/em>.\u201d\u00a0 We talked about probity, its meaning, importance and relevance to my case.\u00a0 We identified the temptations that a doctor must guard against.\u00a0 I realised the extent to which I fell short of the Hippocratic ideal back in 2017 and 2018.<\/p>\n To my surprise, I enjoyed the sessions and by the end of the course my ability to reflect on what had happened deepened.\u00a0 I learned more about medical ethics in 4 hours than I did in my 24 years of studying and practising medicine.<\/p>\n 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\u2019s barrister and the Tribunal members.<\/p>\n Since completing the course, I have read books on medical ethics and I am considering further studies in the subject.<\/p>\n <\/p>\n Dr Sokol\u2019s perspective<\/strong><\/p>\n When teaching doctors in Dr Seda\u2019s situation, the stakes are high.\u00a0 Their career, their livelihood, their mental health and the wellbeing of their family are often on the line.<\/p>\n The main challenge was to ensure that, in the space of a few hours, Dr Seda truly understood the ethical aspects of his situation.\u00a0 I am aware that some doctors only attend ethics courses to tick the \u2018ethics\u2019 box for their portfolio.\u00a0 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.\u00a0 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.\u00a0 It should not be dry or academic but a veritable \u201caha\u201d moment for the doctor.\u00a0 Any lack of insight can be the kiss of death for doctors in a disciplinary hearing.\u00a0 I sometimes call teaching remedial ethics \u2018ECT for doctors\u2019: Ethico-Convulsive Therapy.<\/p>\n 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\u2019s case. \u00a0\u00a0He had to understand, and accept, the fundamentally moral dimension of being a doctor, with all the attendant duties, responsibilities and expectations.<\/p>\n Another unusual aspect of teaching doctors in Dr Seda\u2019s situation is the central importance of trust.\u00a0 However dreadful the misconduct – and Dr Seda\u2019s case was by no means at the most severe end of the spectrum – the doctor must have complete trust in the ethicist.\u00a0 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).<\/p>\n Dr Seda, like most of the doctors who complete the course, was a \u2018wounded\u2019 doctor.\u00a0 He was anxious, embarrassed, and exhausted by a disciplinary process that had dragged on for years.\u00a0 This required a different approach to, say, teaching medical students.\u00a0 As well as the urgency and intensity of the encounter, there was a greater need for sensitivity.\u00a0 Through my words and conduct, I tried to convey the idea that \u201cI am on your side.\u00a0 I will help you.\u00a0 Let me show you the way<\/em>.\u201d<\/p>\n During the course, Dr Seda was engaged and reflective.\u00a0 I was delighted to learn that he wants to pursue his interest in medical ethics.<\/p>\n <\/p>\n Outcome<\/strong><\/p>\n In December 2020, the MPTS reconvened to consider Dr Seda\u2019s fitness to practise.\u00a0 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:<\/p>\n \u201c[Dr Seda] has engaged properly in reflecting upon the fundamental tenet of probity required for a member of the medical profession.\u00a0 He has reflected on the adverse impact of a failure to adhere to these standards.\u00a0 He has adequately remediated the adverse impact on public confidence.\u00a0 The Tribunal therefore determined he was no longer impaired by reason of dishonesty.<\/em>\u201d\u00a0 <\/em><\/p>\n Dr Seda\u2019s 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.<\/p>\n <\/p>\n Authors: Daniel Sokol and Tarek Seda<\/p>\n Affiliations: DS: Barrister, 12 King\u2019s Bench Walk Chambers, London, UK. TS: Medical doctor and MSc Student,\u00a0Department of Health, Psychology & Social Care,\u00a0Manchester Metropolitan University<\/p>\n Competing interests: DS is the founder of the Centre for Remedial Ethics, which provides one-to-one ethics training for doctors.<\/p>\n Social media: DanielSokol9<\/a> @TarekSeda<\/a><\/p>\n","protected":false},"excerpt":{"rendered":" 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 […]<\/p>\n