Specialist in restorative dentistry, with over 20 years as an Expert Witness with a specific interest in dental negligence litigation claims, Toby Talbot shares his personal experience facing a General Dental Council Professional Conduct Committee.
It isn’t with any pride that I write this article, but with humility. After enjoying 40 years caring for thousands of patients with few complaints, I recently spent eight days listening to appalling negative accounts about myself. I have had to face the very real threat of censure and the possible loss of my license to practice. My future, and my reputation, lay in the hands of just three people sitting in front of me.
Almost every one of us will face our governing body at least once in our professional lives, so whether a lawyer or a dentist, I hope this account will prove useful, or at the very least, of interest.
The first I knew anything was amiss was courtesy of a letter from the General Dental Council (GDC) requesting original clinical records to be sent to their offices due to a complaint having been received.
As you read a letter like this your heart will sink and your stomach will drop with it. My advice? Never read any letter with the stamp of your governing body on the envelope first thing in the morning. I promise you – your day will not go well, despite your own superhuman effort to put on a brave face with your clients (in my case patients).
And do not allow your staff to open such letters either. You don’t want to get the message from a team member. Any letter bearing a governing body stamp should wait until the end of the day when your crew have left. I personally find a G&T before opening very helpful. If you’re lucky, it’s just a renewal notification and, depending on the size of the subscription, you can enjoy your second G&T.
Instinctively, after you’ve read the letter, you will grab the client/patient records and remind yourself of the details. Whatever you do – do not start writing additional notes, consider re-writing those records or conveniently ‘losing them’ or part of them that you may feel will prove incriminating. The authorities WILL find out and you will then find yourself facing the ultimate charge possible – dishonesty.
Once you’ve read your notes, you must contact your indemnity insurers immediately. Transcribe the records exactly if hand-written, and write your own account of events. This will add to the paucity of anyone’s records that are made out in a hurry, contemporaneously and are invariably short on detail.
If your professional body then says they are proceeding, make sure your indemnity provider has also been alerted. This becomes the Sword of Damocles that will hang over your head until conclusion of the case. You will find this spot a lonely place. Support from colleagues and family should be regarded as peripheral.
And while awaiting a PCC hearing, don’t be surprised if the number of charges increases enormously. Ultimately, I found myself facing 85 charges related to two patients, after treating two teeth.
I can thoroughly recommend creating what might be termed a ‘reflective document’. Look carefully at each and every one of the charges and list them. Write against each what you’ve learnt, and what action you’ve taken to address the issues. Treat this document with enormous seriousness and conviction. Don’t hold back with this. Put your heart and soul into it. The indemnity team will not write this for you.
What’s most important is that you do your homework. Read the latest edition of your governing standards cover to cover. It is no doubt the most boring document you’ll ever read in your life, but possibly the most important.
It took me about 4-5 weeks before I really grasped the salient points, viewing the issue from the Committee’s perspective, and acknowledging that it was entirely understandable. Then I turned to the presentation of my own view. I began by assuming the charges might be correct. Why would the PCC think that? Now I was in a better position to respond. Do remember, if the Committee are right, don’t be afraid to admit it. It shows openness, transparency and integrity.
Some time ago I myself spent an evening talking to a senior colleague who had decided he would take his own life and leave his family bereft rather than face the music. As it turned out, he didn’t, and ended up with barely a slap on the wrist for poor record keeping. Another colleague hit the bottle, lost his job when he fell out with his colleagues, and lost his family when he fell out with his wife. He is now living under the care of social services, a totally broken man.
Let me be quite clear here – family, friends and colleagues will all be well meaning, but they are amateurs. You will require professional help to provide you with the emotional tools to get your mind in the best place to manage yourself, whoever you are and however robust you may be.
A PCC hearing begins with the charges read out by opposing Counsel. This is then followed by the clients/patients in the witness box being led by their Counsel and then cross- examined by your own. To this point you have only heard dreadful things about yourself, so during the break, take a brisk walk outside to get some air.
It is then that you have your turn in the Witness box. Your Counsel kick off by confirming your CV. Then specific questions about your professional practices follow. Thereafter their Counsel begins cross-examination.
Throughout the process ensure that your chair and body stay facing directly towards the Chair, to engage eye contact when giving your answers. Ensure you have to turn awkwardly towards Counsel so that you instinctively return to face the Committee. Answer all the questions given and always answer truthfully. Don’t try to weave an answer you think they want to hear. If you remember something, even if it’s not documented in the records, say so. If you don’t, say so.
One of my cases was related to events nine years earlier. Of course I didn’t remember. If I had said I did, I would have had no credibility at all. If you contradict the client with conviction, remember that the patient is only ever recalling events themselves, as they rarely make any notes at the time. They are not police officers with notebooks in their top pockets. It may just come down to who the Committee find the more convincing. And like all committees they can contradict themselves. At my own hearing, they concluded I was a reliable, believable and credible witness and so too, the patient. They still concluded that her account was proven.
So much for the balance of probability. As I’m sure my reader is aware, Civil Law departs from Criminal Law in this respect. Under the former one may find in favour of 51%, under the latter one should be 99% certain of guilt, or ‘beyond reasonable doubt’. As the Committee reported that I was a credible witness and the patient was equally a credible witness that amounts to a 50/50 split in old money. That should have led to an open verdict, surely? However, it is my opinion that PCC committees are institutionally biased, and favour whatever the client has to say in ‘evidence’. Despite the noble principle to the contrary, it seems that a defendant is guilty until they prove their innocence.
If a question is asked of you out of context, answer yes or no, but ask the Chair if you can put the matter in context so that they have a complete picture. My style of engagement with patients is considered highly informal, and I was often criticised by colleagues in my earlier career and by my own legal Counsel in camera. But that’s me. I don’t need to make excuses for that style, but I may have to explain it to a Committee of members that are highly institutionalised and politically over correct. I am quite happy to be regarded as a contrarian in my postgraduate capacity, but that does not make me a rebel. I can take criticism from my peers and I make it clear to the Committee that I can display insight when rebuked and accept that criticism with grace and humility. Humility is important, because arrogant stubbornness wins no friends.
Ensure that your Indemnity Insurers engage your own Expert, as lay members of the Committee do not always appreciate that there are wide variations in opinion within the profession, and relying on a single Expert is inevitably going to present a skewed interpretation of the literature.
In one of my PCC hearings the Expert advising on behalf of the GDC was wholly discredited by our own Expert and was not asked any further questions. In another, a patient was shown to be wholly unreliable in the wake of numerous contradictions. The Chair stepped in, thanking the witness for their contribution and indicating that the questioning had ended.
‘Current fitness to practice not impaired’ were the Committee’s concluding words.
Ultimately, the only upshot – you’ll be as relieved as I to hear, I’m sure – is that I now have less time to actually treat my patients due to additional paperwork. But, in closing, I’d like to conclude with some reflections on what I’ve learnt.
It is a deeply stressful experience and professional support is advised. In my opinion, the language used by my governing body in all their correspondence to me was unnecessarily brutal, and implied my guilt from the outset. This is wholly contrary to the statement of the Chair of the Committee in which the emphasis was placed on fairness. It was exceedingly distressing. My stress levels were enormously increased for the entire 30 months that passed from the arrival of the first letter from the GDC, to the final outcome.
There were times when I found myself in a very dark place.
Finally, as if to rub salt into the wounds, when the Committee concluded that my current fitness to practice was not impaired, they nevertheless keep a record of the entire proceedings on their website for one month after their decision is made. Again, this departs from the stringency of criminal law whereby once a not guilty verdict is reached, the Judge asks for the person in the dock to be released immediately.
When I combine the brutal nature of correspondence received from the GDC offices throughout the process, with the bias I perceived at the hearing, and the continued inclusion of my case on their web site after judgement, it appears that the culture of my governing body is one of complete disdain, especially amongst clerical staff, for members of the profession, and reminds me of the Spanish Inquisition and McCarthyism. I fear this is not exclusive to the GDC. I don’t believe it’s a level playing field – the dice are loaded and the cards are marked, despite any gesture to fairness. Be prepared, and beware, dear reader.
I also wish to add that my Indemnity Insurers advised me not to publish this account, as it could affect a blemish on my reputation. However, I believe it is well measured and demonstrates complete transparency on my part – surely honesty and openness can’t be slurs on one’s character?
All the views and opinions expressed by the author are personal but I would welcome public debate on all the issues included. I share a full account of my experience and some very sage advice on my blog at tobytalbot.com.
Toby Talbot BDS MSD (Washington) FDS RCS