Missold---Exposing the 'Overarching Objective' of Medical Practice

30 July 2019

This month in the British High Court of Justice, the General Medical Council successfully defended a Judicial Review Claim that sought to challenge their decision to not investigate the fitness-to-practice of a Doctor who allegedly called Social Services on a woman for refusing to follow her medical advice after she (the doctor) had pronounced a disease diagnosis in the absence of symptoms.

The allegations were that the Paediatric Doctor:

[1] Failed to discharge the patient (a minor) – the patient had engaged with all indicated treatments and was due for discharge

[2] Conducted diagnostic tests where there was no clinical need.

The Claimant in the Judicial Review proceedings had submitted to the court evidence that such tests result in false positives at least 80% of the time [going by the Conditional Probability calculations as described in the Paulos (1990) excerpt].

You may ask: What use can be got from a test that generates false positives 80% of the time? Well the test is definitely in use (widely used by the NHS in England), so that means it is very useful; it is useful when all you need is an excuse.

The Doctor was fishing for an excuse to justify keeping the patient coming.

[3] Failed to inform the patient’s parent of what a positive test result would mean.

[4] Pronounced a disease diagnosis in the absence of symptoms.

[5] Failed to follow treatment protocol for the disease that she was supposed to be treating.

When the patient’s parent subsequently disengaged the child from accessing the NHS treatments, she

[6] Referred the parent to Social Services to be investigated on allegations of Child Abuse.

What that referral actually meant though, was that Social Services would be holding the parent hostage using her children; which they did.

Defending their decision to not call the Doctor’s fitness-to-practice into question, the GMC argued that “for misconduct to warrant a sanction, it must be serious”. They also claimed to have given due regard to “the overarching objective” when they came to their decision.

The court refused to accept that there were any human rights issues indicated by the evidence presented, and ultimately ruled in the GMC’s favour seeing as no procedural impropriety could be evidenced.

Let’s do a quick exercise:

Premise 1: Doctor fails to discharge the patient who is due for discharge

Premise 2: Doctor conducts diagnostic tests where there is no clinical need

Premise 3: Doctor fails to inform the patient’s parent of what a positive test result would mean (it means that the chances of you actually having the disease for which you have been tested is in the region of 80%)

Premise 4: Doctor pronounces a disease diagnosis in the absence of symptoms.

Premise 5: Doctor fails to follow treatment protocol for the disease that she was supposed to be treating.

Conclusion: Therefore the ___________  should be investigated on allegations of Child Abuse.

Please fill in the blank in the Conclusion statement above.

Looking at those five premises the GMC concludes: Doctor is fit to practice medicine and her conduct is beyond question.

I hope that you are puzzled by the logic and rationale that has the above sequence of allegations resulting in the conclusion: Therefore the parent should be investigated for Child Abuse.

You may also be wondering what the GMC statement “for misconduct to warrant a sanction, it must be serious” means; and for that, l will need to take you on a trip down memory lane. But before that, consider this: England has built an entire Population Screening programme (Newborn Blood Spot) that routinely uses diagnostic tests to prescribe healthy newborns with hormonal treatments that they could have done without based on the results of screening tests. I refer specifically to the “preventive medicine” moves where Thyroid Function Tests are used in screening for Congenital Hypothyroidism. Simply put, hormones are what make teenagers teenagers, but here we have healthy newborns having hormones administered to them based on the results of a screening test that, all things considered, is approximately 20% accurate at best. What do you expect to result from such action?

It’s not as if the population screening tests are mandatory, you say? If a parent gets referred to Social Services for refusing to engage with NHS recommendations (and knowing Social Services as you do), is there much of an option there? Yes the public is told that Population Screening tests may generate false positives. We however are told about this possibility through the use of simplistic explanations such as the ones found here https://www.gov.uk/guidance/nhs-population-screening-explained

They go so far as to provide videos to illustrate and make it easy for us to understand the concept of false positives. The English are said to be masters at understatement but I think that they have taken their mastery a bit too far: The chance of you actually having the disease if you test positive on such a screening test is in the region of 20% and they call the test reliable?!

(Maybe I should be asking “Reliable for what purpose?”)

What is Population Screening but Societal Cleansing by another name?

I mentioned a trip down memory lane: Once upon a time, a certain Doctor (Dr Andrew Wakefield) dared to try and warn the British Public that vaccines were actually more dangerous than they had been led to believe. We have a Vaccine Damage Payments Act (1979), so it is generally known that vaccines are dangerous. What we don’t know is just how dangerous vaccines are. The GMC not only investigated Dr Wakefield, they struck him off the register of practitioners licensed to practice. This they did while allowing the Newborn Blood Spot screening programme to continue under their watch. Perverse much? Given what we now know about these screening tests, and the GMC’s High Court victory that I mentioned at the beginning of this article; what are the chances that Dr Wakefield was right?

The Claimant in the Judicial Review failed to convince the High Court that there are Human Rights abuses here, and the GMC won the case by employing what I will call the Procedural Propriety defence. Procedural Propriety is a new word to me but I will explain it as I have come to understand it. The defence focuses on adherence to documented procedures. If you can demonstrate that you have conformed to documented procedures, you get away scot free.

Certain things go without saying, so when procedures are documented, the things that go without saying don’t get documented. For example, the rules say that a motorist driving on the road must have his seatbelt fastened. There likely is no mention, however, of which side of the seatbelt the motorist’s body must be. Because it goes without saying!

These fancy cars of today are programmed to beep if the vehicle starts moving and the seatbelt on a seat that the automated system senses contains a weight is not fastened. (No, I haven’t forgotten that I am supposed to be explaining the Procedural Propriety defence). The car cannot differentiate between the weight of your bag of groceries and, say, the weight of a child. All it senses is a weight, and it will beep until the bag of groceries is removed.

“Wait a minute, I have an idea, I’ll fasten the seatbelt!”

Oh, so you put your library books on the front passenger seat then fastened the seatbelt over them to satisfy the requirements of the system and save yourself having to put up with that irritating beeping sound all the way home? Smart. But has your fastening the seatbelt over the library books served the purpose for which the beeping mechanism was designed?

“No, but I got to get away with putting my library books on the front seat” 😉

I hope that the example above has helped to illustrate how that procedural propriety can be demonstrated even as you (technically in this case) break the rules. It also serves to illustrate how the procedures (beeping mechanism) may end up misserving the car owner!

That wasn’t the best example of course, how about this: If a Traffic Policeman were to catch you driving while seated on top of your fastened seatbelt (done “to get around that irritating beeping sound”), would you even try to voice the Procedural Propriety defence to him? I think we can all agree that to plead Procedural Propriety to the safety-conscious Traffic Policeman would be a stupid move.

But the GMC did try; and they won the case. They submitted to the Court (the British High Court – where “the outcome was a breach of Human Rights” is sufficient grounds for a decision to be Judicially Reviewed), that in refusing to open a fitness-to-practice investigation over the Doctor’s alleged actions they had given due regard to “the overarching objective”. The Judge, ruling in their favour, said that the Claimant’s case did not have a realistic prospect of success. 

It goes without saying that an effective investigation is not the one that answers a standard list of questions, but one that asks pertinent questions. Why? Because every case turns on its own factors.

It also goes without saying that what makes a person qualified is their focus on, and contribution to, the organisation’s bottom line/overarching objective. Every now and again, someone demonstrating competence gets hired even if they lack the paper qualifications and/or the work experience because at the end of the day it is the competence that services the bottom line. It goes without saying that having the paper qualifications is only part of what makes a professional a good fit for their job position; competence is key. Do professionals with the paper qualifications and the work experience not get fired for incompetence?

System processes and procedures are all set up to service the bottom line. When we focus on adherence to procedures when clearly the bottom line is not being served, we are missing the point.

Now for the cherry on the top: If Procedural Propriety had been the criteria used to judge the accused during the Nuremberg Trials, no convictions would have been made. Just saying.

Despite the lack of correlation between the conclusion endorsed by the GMC (therefore the parent must be investigated on allegations of Child Abuse) and the five premises that purportedly support that conclusion, the GMC had the gall to submit a Statement of Costs to the court: £2000 costs they sought from the parent for disturbing their busy schedule. The Court Order awarded them £1500. Think about this: If the GMC can visit such upon a poor parent, think what they do to the Doctors who try to speak out about misrepresentations they see being made to the trusting public… Oh, we know that already; remember Dr Wakefield? And yet we trust this institution with our lives; literally.

If my narrative sounds unbelievable to you, that is because you have the wrong bottom line. The GMC and the High Court acted the way they did “having regard to the overall objective”. The overall objective is not what you think it is; Medical Practice is being missold.

If you want to know what exactly “the overarching objective” of Medical Practice is, I recommend that you read the book

NOT IN SERVICE: A Perspective View on Religion, Philosophy, and Governance

by  Pepukai N. Mungaparara

The book is available for free download from

www.sufficientproductions.com

Chances are that you will find some of the truths shared in the book hard to swallow, but read it you must.

Thank you for reading this article.

Please consider showing your appreciation for my efforts so far by way of your kind donation at

www.sufficientproductions.com\donate

Read the book first though. I wouldn’t recommend just dipping into it, (you won’t get the whole picture), read it from the beginning to the end… then re-read it. Matters of such importance need the framing, and they cannot be condensed.

 

01 August 2019

Note 1: As I have been searching some more online, I came across a 50-page document entitled ‘A Laboratory Guide to Newborn Screening in the UK for CONGENITAL HYPOTHYROIDISM‘. My reading of the document did not pick up details of the actual accuracy of the TSH test used. And conditional probability calculations are nowhere mentioned.

 

Note 2: One of the remedies requested by the Claimant in the Judicial Review application had requested that the GMC fund the preparation of UK-specific Conditional Probability Calculations along the same lines as the Paulos quote for the Thyroid Function Test to help educate Doctors and Patients with Informed Consent in mind. It was unclear whether the GMC considered the calculations to be unimportant, or just that it was not their duty to fund them. What was clear though, was that they were not amenable to the funding idea.

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