The General Medical Council wants doctors to be kind, and when the GMC wants doctors to be something, they add it to their set of standards, Good Clinical Practice. On the face of it, this doesn’t sound like it would be too controversial – who wouldn’t want their doctor to be kind? However, this has engendered a slew of discussion, critique, and in some cases, fear.

23. You must treat patients with kindness, courtesy, and respect.

48. You must treat colleagues with kindness, courtesy, and respect.

— Good Clinical Practice 2024, General Medical Council1

The concept of kindness raises some interesting questions, sometimes being a doctor involves raising some harsh truths, or just some things people don’t want to hear2. Is it kind to challenge someones beliefs regarding alternative medicine, to discuss how their lifestyle choices are affecting their health, or to say that medicine has no more to offer their dying relative? I would argue yes it can be, but I can also see why this might not always be welcome.

However, the criticism of kindness is coming from other avenues, and centres largely around distrust. But first, it would help to discuss the nature of the GMC, and the relationship it has to doctors in the UK.

Every doctor pays the GMC hundreds of pounds each year for the privilege of being able to work as a doctor in the United Kingdom. It’s a registered charity, with an operating budget of over £140 million3, but it is not a professional association. Paying fees does not give you any say in how the organisation is run.

Among its roles is to oversee medical education, maintain the medical register, handle revalidation, and to address concerns regarding doctors. Unsurprisingly it’s this last duty that drives animosity, and takes up almost half of its running costs.

When the GMC suggest that doctors should be a certain way, it is not a suggestion. They investigate people suspected of committing infractions against their codes of conduct, and can refer them to the Medical Practitioner Tribunal Service. Although the tribunals are no longer conducted in house due to perceived conflict of interest, the GMC retains the right to appeal decisions by the MPTS.

On my very first day of medical school, after the welcomes and the how-do-you-dos, we were told that our behaviour was now under the purview of Good Clinical Practice, and that we could be subject to fitness to practice proceedings should we go awry. This tends to instill a certain Sword-of-Damocles-esque vibe in the new recruits.

Disclaimer: Not a literal depiction of GMC HQ

Disclaimer: Not a literal depiction of GMC HQ

So, we have the situation where if the GMC believes you haven’t been kind, courteous, and respectful – all quite subjective qualities – you could potentially lose your livelihood, years/decades of your life in training, and thousands of pounds.

However, all of this could be fine – could be, if there was trust in the processes of the GMC. No one denies that medical professionals should be regulated, we operate in privileged roles and with vulnerable people. However, the sentiment exists that we’re facing increasingly invasive oversight, with unjust application of these rules, on a backdrop involving the proliferation of unregulated/less regulated allied health professionals. Suffice it so say, this is breeding discontent.

There are multiple aspects driving wedges between doctors and their regulator. Firstly, a third of doctors under investigation by the GMC have suicidal thoughts4, and they publish monitoring data about the number of suspected suicides that occur under investigation5. Whether it’s the lengthy course of proceedings, loss of finances, or loss of standing and personal relationships, it is by far not a benign process, even if completely exonerated.

Further, the GMC has a racism problem. There have been numerous high profile cases of mistreatment by the GMC on the grounds of race, whether directly or indirectly. Dr Bawa-Garba was thought to have been blamed for systemic failings, with the GMC appealing her initial suspension by the MPTS to get her struck off. Whereas the duty consultant, Dr Stephen O’Riordan, had no formal consequences.

Dr Arora was accused of lying to obtain a laptop based on disagreements on what the word ‘promised’ entailed, before her suspension was dropped on further review6. Mr Karim, was subjected to discrimination in his workplace, which lead to a vexatious GMC referral dragging out over 5 years before being found not at fault. During this process he lost his house, job, private practice, and teaching position7.

Whether it’s internal GMC processes, or that ethnic minority doctors are more likely to be referred due to institutional racism within their employers, the GMC needs to be cognizant in their role in this. The added issue of vague standards such as courtesy, particularly for people for whom English is their second language, seems especially harmful.

We’ve also seen the increasing weaponisation of referral to the GMC. It’s become a favoured strategy of NHS trusts to control troublesome (or principled) doctors. We’re still reeling from the Lucy Letby case, in which paediatric consultants were bullied into apologising to her by senior management threatening GMC referral. Dr Prasad blew the whistle at Epsom and St Helier University NHS Trust, who in turn responded by filing 43 complaints to the GMC, all of which were dismissed8. Mr Duffy raised concerns about the standards at the University Hospitals of Morcambe Bay NHS Foundation Trust, after which he was dismissed and referred to the GMC. He even alleges emails were falsified in order to put him into a negative light 9.

It’s also continually being played out over twitter (formerly known as Prince), where concerns regarding training or working conditions are being dismissed by senior figures who refer to GMC guidance to keep trainees in line.

In short, it is not that people really believe that doctors shouldn’t be kind. However, this is a symptom of the lack of trust in the GMC among doctors, as well as the increasingly more toxic work environments within our hospitals. The GMC has released several reports and initiatives attempting to address these concerns, but unfortunately dissatisfaction within the medical profession doesn’t show significant signs of abating anytime soon.