He's Done a Course

Back in my days editing the JME blog, we used to get the occasional unsolicited post sent to us.  Almost always, they went unpublished; this was overwhelmingly because they weren't very good.  The one person who did sometimes get his unsolicited work published was the ethicist-turned-barrister Daniel Sokol.  There was a number of reasons why we were a little more forgiving of him: he was someone we knew, and a reasonably well-known person in the field - he had a fairly regular column in the BMJ; his submissions, while sometimes a bit self-congratulatory, were often fairly inconsequential - but they were by the same token pretty harmless, so could tide us over during those periods when we had little to say of our own; and, finally, if we did reject his submissions, we could more or less guaratee that they'd appear on the BMJ's own blog anyway, so there wasn't much point our trying to act as gatekeeper.

A post by him appeared on the JME blog a few days ago, detailing the help he had been able to give a doctor, one Tarek Seda, who had found himself in professional trouble and facing a hearing from the Medical Practitioners' Tribunal Service in 2019.  This post purported to be a brief account by Dr Seda of how Sokol was tremendously helpful, andit was supplemented by an account by Sokol himself of how Sokol was... er... tremendously helpful.

Now, I do not know whose idea the post was - in the comments, Sokol writes that

[a]fter the outcome of the MPTS hearing, Dr Seda selflessly asked how he could help other doctors in a similar situation.   One suggestion was to write an article, giving a dual perspective on the process of ethics remediation: the doctor’s and the ethicist’s.   This blog is the product of that idea.

This tells us little about whose idea the post was, although I do have my suspicions - and I'll come back to that in a moment.  But it will not have escaped anyone's attention that the post as a whole does come across rather as an advertorial.  Evidence for this can be produced from the final sentence of the post proper, and the supplementary text that follows it:

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.

Targeted medical ethics teaching of the sort provided by one D Sokol.  Credit where it's due: the body of the post doesn't function as an advert explicitly, but granted the content of the post, and that there's a declaration of interests underneath the main text that says that Sokol is "the founder of the Centre for Remedial Ethics, which provides one-to-one ethics training for doctors", it's not wild to suppose that people might put two and two together.  That is to say: I suspect that the declaration of interests serves not as a disclaimer here, but as an invitation.

Now: granted that, how selfless was Dr Seda's involvement?  It may have been entirely so; but it's worth looking at the rulings from the two disciplinary panels that he faced.  In 2019, he was found guilty of misconduct on a number of counts by the MPTS, and was suspended from practice for 12 months, the maximum possible penalty.  The ruling is available here.  In December 2020, it was decided that he was able to return to work, albeit under supervision.  That ruling is available here.

Important in that 2020 decision is this passage, from p 15:

The Tribunal determined to direct a review of Dr Seda’s case. A review hearing will convene before the end of the period of conditional registration. The Tribunal reminds Dr Seda that at the review hearing, the onus will be on him to demonstrate the extent to which he has remediated and that he is safe to return to unrestricted practice. The Tribunal considered that it may assist the reviewing tribunal if Dr Seda provided:

i. Reflections on his progress;
ii. Reports from his clinical and educational supervisors;
iii. Report from his workplace reporter;
iv. Evidence that he has kept clinical skills up to date.

This is not intended to be an exhaustive list and Dr Seda may provide any other information he considers will assist at a future review hearing. [emphasis mine]

Given that, one may wonder about the precise mixture of selflessness and performative "See! I've done a COURSE!"-ism.

Of course, one cannot begrudge Dr Seda for wanting to do everything he can to get back to working normally; and I don't think that people should be banished from the profession unless it's for extremely good reasons - and Dr Seda has not met that threshhold by a long way.  But whether the blog of an academic journal is the right place to be talking glowingly about a professional service in which both parties have a fairly clear interest is not obvious to me.  It's one thing for such blogs to be opinionated - lord knows, I was opinionated enough when I was posting there - but this seems to me to go quite a way beyond that.

My other concern has to do with the nature of the ethics training.  There is a certain kind of soi-disant ethicist - it's clinical ethicists that fall into this category more than any others, I think - who treats the subject as simply a matter of not falling foul of the regulators.  It matters little on this rather legalistic account whether the GMC's Duties of a Doctor was drafted by two drunk regulators and a ouija board: what matters is that there is a professional code of ethics, and ethics therefore means the code.  And the relevance of "targeted ethics teaching" to a case like Dr Seda's is hard to fathom unless "ethics" is understood in this legalistic way.  I fear that it provides little more than a way for doctors who've stuffed up professionally to snuffle up to the regulatory bodies.

Indeed, if one looks at the charges that Dr Seda faced in 2019, it's slightly strange that "ethical teaching" in anything other than the legalistic sense - and by now it should be clear that I mean by that "not really ethics at all" - would be the appropriate remedy.  It's blindingly obvious that dishonesty isn't the kind of thing that ethics classes address.  Ethics is not about instilling behaviour in people, and certainly not about instilling behaviour that should have been instilled in primary school.  Neither are things like falling asleep on duty ethical problems, beyond the confines of "regualtor's ethics".

 

And what, when it comes to the crunch, is being remediated?

 

So what, then, is being offered on these (doubtless expensive) courses?  What's their point?  It's not the kind of ethics training that's going to leave anyone questioning the content of the rules or the authority of the GMC.  It's not going to generate puzzlement or counterintuitive outcomes.  If it generates reflection, it's going to be reflection on sins committed, rather than on the nature of sin.

 

Dr Seda is said to want to study ethics further.  Great!  The more the merrier.  But he's going to have a surprise when he encounters the topic proper.

 

Sure, this is a very brief post.  There's a lot more to be said - about the nature of ethics, about Dr Seda's professionally vulnerable position, about lots of other things.  But there's something about that post that's really got under my skin.

 

It'd've never been published were I still editor.