Dr Rita Pal talks to Meddebate about her experiences as an NHS whistleblower, the trials of stigmatisation and the arduous battle of taking on the General Medical Council.
Dr Rita Pal is an independent medical journalist and well established, evidence-based NHS whistleblower, based in the UK. She qualified in medicine from University College London in 1998 and, between 1999-2007, she worked as a psychiatrist in the National Health Service and was the first whistleblower to raise concerns in the Midlands hospitals run by the same local health authority. Her concerns were ignored, with the net result that many patients died needlessly. Her name was placed on the Royal Society of Medicine Wall of Honour following support from a number of doctors. She has also summarised her experiences in a short narrative available on Amazon – The North Staffordshire Whistleblower – and was second author in the leading research paper Whistleblowing and Patient Safety, published by the JRSM. The Mid Staffordshire Inquiry, concluded in February of 2010, demonstrated many of the problems that Dr Pal raised with the Department of Health in 1999/2000.
1.Could you tell us a bit about your background and how you decided to become a doctor?
I was born in the UK but my father went to work with the Overseas Development Service in Africa. He was a surgeon there. I spent my early years in Zambia leading a relatively tough life attending remote schools. School consisted of learning in a different way. On a Friday afternoon, at the age of 6, I found myself in a sun drenched African field digging the ground with the prisoners. Our school in Mansa, Zambia decided that we had to all learn resilience. We dug the dry ground with all our might, planted the maize, ate with the prisoners, laughed with them then returned home in the evening singing African songs.
I returned to England at aged 11 and decided then that I wanted to be a doctor. School was difficult in England as my education in Africa had not prepared me for the challenges here. Nevertheless, I went to a comprehensive school where we had people from all backgrounds. In those days, making it to medical school was extremely difficult nevertheless I believed then as I do now – nothing is impossible. I cleared the interview for University College London Medical School wearing a bright green suit while everyone else wore black or navy blue. At the time, the interviewers told me, “you are a bit different from everyone else aren’t you”. As history tells us, they were right. My main aim in life was to help those less fortunate than us. This is the reason I decided to do medicine. I have never been interested in the trappings of the medical establishment or its need to suppress originality in medicine. One lesson everyone should learn in life is this – if you are given a job, you do your best and that is all anyone can expect of you. I saw “whistleblowing” as part of my job. It isn’t anything special. In summary, I became a doctor to do my best for my patients and the public. That is what I did or at least tried to do. This is what I have always focused on no matter how difficult the journey has been.
2. Speaking out against the GMC must have been a very difficult thing to do. What sort of opposition did you receive from colleagues, friends or family?
Firstly, I am not the first person to speak out against the General Medical Council. When asked “have we lost faith?” George Bernard Shaw said, “Certainly not; but we have transferred it from God to the General Medical Council.” (Shaw GB. Doctors’ delusions, crude criminology and sham education. London: Constable, 1932). I may have been one of the first junior doctor to challenge or speak out against the GMC in the way that I did, but it is important to understand that we owe our younger colleagues a good regulatory body. In any event, I wasn’t left with a choice given the shambolic manner in which I, and more importantly, the patients I whistleblew about were treated.
Moreover, patients deserve a regulatory body that can function well and one that maintains patient safety. It is important to understand that patient safety should be in the forefront of every doctor’s mind. We then return to the concept of doing your duty as a doctor and taking your vocation seriously. It has never been difficult for me to speak out against the GMC. The Shipman Inquiry severely criticised it as have many senior doctors. Given my experiences as a very junior doctor, I felt it was paramount to raise concerns about the manner in which it malfunctioned. Quite simply, I did not want patients to suffer, and neither did I want medical students or doctors to meet the same fate as I did.
The problem with my knowledge of the GMC is that it is quite extensive. Not only do I know its case law but I know the way it has functioned for many years. This places me in a good position to criticise it in an evidence based manner. Unfortunately, many doctors or members of the public have not had the opportunity to study the GMC in detail. No one can therefore blame their attitude towards me. To them, the GMC is flawless.
Anyone who criticises the medical establishment is always met with opposition. There is a stigma attached to being outspoken and a whistleblower. It is known as the pariah effect. I have had very limited support for my concerns and many are quick to make rapid and cruel judgments. This issue was difficult initially, as professional isolation always is. Nevertheless, through all journeys, we meet people who are willing to accept us for who we are and it is those people that really matter. Living up to peer pressure is probably an obstacle to originality. It is, though, natural for everyone to have a sense of belonging and colleagues you can rely upon. If you take your vocation seriously, all doctors are brave people with many ideals at the start of medical school. It is the medical establishment that removes that originality. The trick is to preserve your idea of medicine and live the life you want to lead no matter what obstacles are placed in your way. Preserving individualism results in a variation of ideas and this is one of the fundamental ingredients to health care innovation and patient safety. Doctors should be brave independent problem solvers who are able to do anything it takes to maintain patient safety.
3. What advice would you give to people who find themselves in a situation where they are being victimised at work.
My solutions are relatively simple. The prognosis of a work environment where victimisation is ongoing is poor. It is important to assess this first. It is very tempting to fight against “victimisation” but every person has to analyse the cost of long legal battles and complaints. Having been through the system with many doctors who have had these problems, it is important to understand that if your health and family are at stake, you should walk away and restart a new life. This is effectively like shutting down a computer and rebooting with a different operating system. On occasion drawing the line under a traumatic situation is the right way forward. Assessing the potential risks and benefits of continuing to fight a system is something that few people do. Every decision is a personal one but this should be a considered decision. These are some steps people should use as a guide;
1. If you are being victimised, the first thing to do is take some time off. During your time off, it’s important to read around the subject of victimisation and bullying. In medicine, the phenomena of medical mobbing is interesting.
2. During your time off, you need to assess the pros and cons of your situation.
3.Try and speak to colleagues, family and relatives. This will help gather your thoughts and shape your ideas.
4. If you have a trade or students union, approach them early and explain the situation you are in.
5 There are voluntary organisations that support people who have been victimised and bullied. It is worth looking these up online or in the phone book and having an informal discussion.
6. If you don’t have a trade union, take legal advice early. Assess whether it is may be a good decision to place a grievance through the complaints procedure. Doing this can have negative effects if management is part of the victimisation. On the other hand, it can resolve the problem. All this depends on the culture of your environment and whether they take accountability seriously.
7. If you feel your health is suffering, it is important to start seeking some counselling and/or visiting your doctor.
8. After addressing all pros and cons, if you believe resignation is the best option, then go through it. On occasion starting afresh has its advantages.
4. The GMC had breached principle 5 of the Data Protection Act when they retained information about you for longer than was justified under the Act. Also, your right to privacy under article 8 was also infringed. Why did your case not receive more publicity?
At the time, I was told by various newspaper reporters that the mainstream media were simply refusing to carry the story. One journalist who worked for the Sunday Mercury [ a local paper] wrote a good article on it. Many many years later, it was referred to briefly by the Guardian newspapers. My view of the situation is this. The GMC questioned my mental health on the strength of a “typo” I had made while writing a letter to them after a heavy oncall shift. Now, as everyone knows, the stigma of mental health sticks. I have had to live with that stigma for more than a decade now. I have never had a mental illness, by the way, but the net effect is for journalists to avoid or question the veracity of claims no matter what the court judgment says. Whistleblowers, like mentally ill people, are often shunned by society. There is an element of that in this case.
Publicity has never bothered me really. Fame is a short-lived commodity – a flash in the pan effect. What is important is to try and work hard to change the system for the better. This is why I worked towards writing a paper called Whistleblowing and Patient Safety and developed a petition based on our findings.
Very early on, I preferred the internet. I did my own publicity via a website and I knew that those who needed it would find the material on the internet. This is actually a more effective medium of circulating material.
The final point concerns the complexity of the case. At the time I had a victory in court, the reports vindicating my whistleblowing had been concealed by the GMC and related authorities. As everyone knows, juniors have no credibility with the media or the medical establishment, no matter how good the evidence. It was because of this that my story did not convince people. History was to tell a different story as I was vindicated by numerous reports that came to light almost a decade later, but it took hard work to unearth the evidence. In effect, after you have unearthed the evidence, it’s too late and few people are interested in a historic case.
The case was also legally quite complicated to grasp, and few journalists were prepared to understand the implications of such a case. The UK medical media has never featured the case in any way or form, preferring instead to make their own judgments on my character, but a few allowed it to be mentioned in comments to articles as if they are doing me some kind of favour.
In summary, the case was an uncomfortable one for the UK medical media, who prefer that up and coming doctors believe that medicine is a flawless profession. The truth becomes controversial in a land where a certain etiquette must be preserved. They would like the rumours that I was mad, bad or sad or just a “one off faulty apple out of the cart” to propagate around the profession. This ensures the reality of the profession is essentially concealed from young doctors so there is no accountability.
The net effect is that the information is not available to doctors until its too late and disaster has occurred, because it is during this time when doctors frantically search for solutions to their problems. Solutions for real problems in medicine do not lie within the establishment at all. They lie outside of it, because it is the rebels in the profession who actually come up with solutions on how to survive the darker side of medicine. Unfortunately, rebels are not always popular with the establishment-led medical media so you often find them at the periphery of medicine.
5. What is the one piece of advice you would give to new medical graduates making the transition into the work place.
Read all employee reviews/feedback about your new employers. Visit the place, talk to the most junior staff and assess whether the place suits you. Never go by its reputation on paper.
6. At one point, the GMC became concerned that you were suffering from a mental illness. What were some of the ways that you dealt with the character assassination that came after your complaints?
Character assassination is quite a difficult thing to cope with, especially if you are trying to work as a doctor. Each part of your character is scrutinised in detail. Even normal activities can seem abnormal to those placing you under a microscope. These rumours were primarily circulated by doctors on an internet website, and this is how the issue spread like wildfire. It worsened to such an extent that it began to infiltrate my work and professional life. Hate mail is probably the worst to deal with.
Firstly, I used the internet to present my side of the story. Secondly, I was forced to carry a doctor’s note to say I had never suffered from a mental illness. This resolved any concerns following rumours seeping into my workplaces. Thirdly, I was forced to work much like a fugitive [locum doctor] because it was impossible to sustain a permanent job with the underlying problems and character assassinations caused by the GMC. Locum contracts were short, didn’t have the extra hassle and I could leave when the rumour mill commenced. As soon as rumours flew into a hospital, I left the job. That is the way I survived in the National Health Service for almost ten years. In the end, as matters were worsening so I litigated successfully. Litigation though did not resolve the character assassination and the on-going malicious rumour mill. Indeed, I am sent hate mail to this day, sadly, but am a lot better at handling these now. It is interesting that despite successfully litigating, the medical profession branded me a serial litigant. This even cropped up in a reference on one occasion.
Character assassination affects your entire life and vocation. It is professionally and socially damaging. This damage cannot be repaired completely. The only way to deal with it is to move on and reinvent yourself. The next way is just to stop caring what anyone else says.
7. You have been an inspiration to many people for standing up for what is right. In your opinion, how can we train more doctors to have this same perseverance? Do you think it starts in medical school or with parental upbringing perhaps?
Firstly, I had no idea I was an inspiration. If I am then I am humbled by that idea.
I think the medical school system of selection has to improve. There are many good people who are not allowed entry into medical school due to the manner in which entry exams often concentrate on academic excellence. Moreover, psychometric testing does not test the important abilities of doctors – kindness, consideration, fairness, good communication skills, respect for ones colleagues, the importance of taking the job of serving patients and the public seriously.
Personal qualities are not necessarily due to parental upbringing – it is multifactorial. What shapes your personality is largely dependent on what you are exposed to and what your ambitions are as a person. In an ideal system, doctors shouldn’t have to “stand up” or “speak out” alone. Everyone should be speaking out. This should be part of normal practise. If we can train each medical student to maintain patient safety, healthcare would improve phenomenally. In summary, the selection criteria for medical school has to change so good people with a sense of morality and an ambition for improving the system are given medical places. That is of course a long term concept. In the immediate culture, if you find yourself in the position of being a whistleblower or having to stand for what is right – first think very carefully. Prepare yourself mentally, physically and emotionally. Ensure you have good support networks in and out of medicine. Lastly, never give up no matter how hard it is. If the going gets tough, take a rest, watch a good movie, have a great meal, have great sex [safe], grab some chocolate and start again because every day is always a new day.
8. Most readers of this blog are medical students. Many of them find it difficult to manage stress from medical school and relationships. How do you manage stress on a day-to-day basis?
There is a good leaflet on managing stress. This leaflet should be downloaded by all students and read properly. The key to reducing stress levels is to understand time management and also learn the ability to multitask well. When I was a junior doctor, we didn’t have smartphones. We did, though, have diaries, pens and paper. Sometimes it’s useful to sit down and outline lists of what you have to do. This ensures you use your time efficiently. Also, prioritise what you need to do first and concentrate on what is important before progressing forward.
It is important to eat properly and get enough sleep and exercise no matter how stressed you are. This is difficult as a doctor but not impossible. In medicine, peer pressure is quite difficult to deal with, as is the competition. The important thing to remember is this – you have to do well enough to get through your exams. When you are a doctor and a patient drops down with a cardiac arrest, no one is going to compete in that situation. It’s important to get some perspective. Studying medicine is hard. Medical students often believe that buying the biggest books and ploughing through them is the solution. It isn’t. You need to buy the smallest book in the subject, learn it well and then use different media to re-emphasise the facts. This reduces stress and makes revision more interesting. A note on relationships – friendships and the one you love are important. Make time for them, don’t neglect them. Medicine isn’t everything and there is a whole wide world outside it. Don’t miss out.
Further details about the case of Dr Rita Pal V The General Medical Council can be seen in this article.
Dr Pal recently shared her views with expolink about incentivisation, the Public Interest Disclosure Act, public and media attitudes to whistleblowers and preventing whistleblower retaliation. The article can be found here.