Dr Ciara Kelly: 'The power - and the pain - of an unopened letter'
I received a letter last week from the Irish Medical Council (IMC). It sat on my hall table for five days. The Private and Confidential stamp looked at me every time I passed. I knew I needed to open the letter, as the IMC is an important regulatory body.
It grants or sometimes withdraws the right to practise medicine as a doctor in this country. But still I ignored the letter every day. I knew it contained details of whether or not I was being struck off as a doctor. And none of those days were days where I felt able to hear that news if I was. I had too many other things on. I simply wasn't ready.
I started studying medicine in 1991, qualified as a doctor in 1997 and as a GP in 2001. I worked in clinical practice for 20 years. It wasn't just a job, it was part of my identity.
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I remember wondering when I left my position as a GP in 2017, who I would be now if I wasn't a doctor any more. I didn't really know what bits of Ciara would be left when that part was taken away.
I often say I got as much if not more from my patients as they ever got from me. And I like to think I did my best for them. I never had an IMC complaint from a patient, for which I'm extremely thankful. Because medical council complaints are incredibly stressful for a doctor.
It's a bit like being taken to court in terms of formality. You need to put a defence together. Doctors are all indemnified to practise medicine, so your indemnity provider puts together solicitors and barristers for you. Legal responses are written and submitted. There are committees who review what you say.
Depending on what they think, there is evidence given at hearings, and at the end of the full process - if you're found guilty of professional misconduct, you're struck off. You're stripped of your professional standing, your livelihood. And as one doctor put it, your sense of self is shattered.
The former chair of the Royal College of GPs said the biggest risk to the mental health of doctors isn't burnout; it's the complaints process and there's little support available for doctors going through this process. Many hide it from colleagues and even family. Female GPs already have four times the risk of suicide compared to the rest of the population, and there's a known spike in suicides among doctors being investigated.
Richard Harding, a UK consultant anaesthetist, took his own life in 2017 after a medical council complaint against him.
He subsequently was cleared of professional misconduct. The verdict took five months and was by that point too late.
Here in Ireland it can take three to six months for a decision on whether a full inquiry will be held into a complaint received by the IMC. Council CEO Bill Prasifka has said they "would like the ability to be able to resolve complaints as quickly as possible in a manner that is satisfactory for the complainant and also protecting the public interest".
But we must think too about the doctor and their mental well-being.
It strikes me as odd in a process that so closely mirrors the justice system that an innocent until proven guilty duty of care to the accused appears not even to be considered.
As mentioned, I'm lucky enough never to have had an IMC complaint from a patient. That, however, doesn't mean I've never had one at all. I've had four. All in the past few years.
All from people I've never treated or even met. All related to me publicly advocating for the HPV vaccine for Irish teens.
Complaint after complaint has been made that initiated the IMC's process against me. After I defended each complaint, causing considerable personal stress, and it was struck out, another one would come in.
I've been tied up in knots for years by this. And on this complaint, number four, I informed the IMC I believed these complaints were vexatious and that the medical council's own complaints system was being weaponised against doctors to prevent them from speaking out for public health benefits of vaccines.
So I said I would no longer defend myself against these complaints and it could strike me off if it so wished.
I should point out I'm far from the only doctor to have had vexatious complaints made against them. I know one female GP who had a complaint made against her for being seen out holding her wife's hand.
It was dismissed but she was still put through the humiliation of having to "defend herself" over this and the months of waiting to hear if she was cleared of any "wrongdoing". What other job would demand this?
Which brings me back to that sick feeling in the pit of my stomach every time I decided not to open my letter. I had to open that letter in the end, of course. And it informed me that despite not defending myself, the complaint had been dismissed.
I was briefly elated and then inexplicably upset. It felt as if I'd been holding my breath for a long time and now could finally exhale.
But to be honest, it simply isn't enough. I've had two years of dealing with recurrent complaints, simply for trying to do the right thing as a doctor.
The IMC system is deeply flawed. It could summarily dismiss spurious or vexatious complaints without putting doctors through this heartache. It is unfairly adversarial and makes no consideration of the impact it has on doctors or their mental health. It was me this time; it will be someone else the next.
It's possible to be fair to genuine complainants without treating doctors this badly. Other jurisdictions do it differently and better. I'm calling on Health Minister Simon Harris and the IMC to review its practice and remember doctors are people too, who often do a challenging job under difficult conditions.
The Irish Medical Council should not be making that job harder than it needs to be.