Exploring public views on medical professionals' behaviour outside of the workplace
Credit: Melissa Laun (Unsplash)
What should happen to a doctor who uses a disabled person’s railcard fraudulently? Or a physician associate who expresses views on social media that cause serious offence? These are questions explored in a recent research project conducted for the General Medical Council (GMC).
The GMC works with doctors, physician associates (PAs), anaesthesia associates (AAs), patients, and other stakeholders to support good, safe patient care across the UK. It sets the standards doctors, PAs, AAs and their educators need to meet, and helps them achieve them. If there are concerns these standards may not be met or that public confidence in doctors, PAs, or AAs may be at risk, the GMC can investigate, and take action if needed.
With regulatory reform providing an opportunity to review their fitness to practise thresholds, the GMC commissioned Community Research to test and explore the public’s view on cases where there is no direct risk to patient care and the basis for considering regulatory action is to maintain public confidence in the professions regulated e.g., cases involving dishonesty, violence, use of social media/freedom of expression and criminal behaviour. These types of public confidence concerns are less well understood than those where there are patient safety issues.
The complex nature of public confidence demanded a comprehensive research approach. This began with a rapid evidence review and was followed by an online forum, extended discussion groups and a quantitative survey of over 2,000 respondents.
For the public to be able to form a view on the complex, sometimes abstract issues that arise in public confidence cases, we needed to bring the research questions to life. A series of eight scenarios were developed based on the types of concern that the GMC commonly receives and selected to reflect cases where there are shades of grey. Getting the scenarios right was crucial to the overall success of the project, requiring an iterative approach across the research phases and close collaboration between the GMC and Community Research teams.
The combination of an online forum followed by reconvening participants to live discussion groups was also effective. The forum was a convenient way of both introducing the scenarios and collecting individual views (mitigating against group think at the group discussions and facilitating analysis of views of different demographics). Participants had the opportunity to review the scenarios over a period of days and give us their initial feedback. They were also encouraged to think about the scenarios (and potentially discuss with family/friends) in the period between the online forum and groups so that they brought a more considered viewpoint to discussions.
A further consideration for the design was that the topics for debate included discrimination, violence and domestic abuse. We needed to ensure that participants weren’t triggered in any way by the content and felt that the research setting was a safe space for discussion. This was achieved through conducting fairly homogeneous group discussions, putting participants in control and using an enhanced consent procedure.
Across both the qualitative and quantitative phases, participant engagement was consistently high. Those at the group discussions were extremely engaged with the subject matter, often discussing with friends and family between qualitative stages and willing to continue the live discussions beyond the allotted time. Survey respondents also provided thoughtful, well-reasoned answers, and the overall quality of feedback reflected careful consideration. The online survey, nominally timed at 15 minutes, took an average of over 21 minutes to complete, and open-ended responses were notably longer and more detailed than is typical for online surveys.
The full report has recently been published and the findings can be found here: