Reprimanded by the GMC for sharing faith with a patient – reflections on the Richard Scott case

On 14 June the General Medical Council’s Investigation Committee reprimanded a Christian doctor who shared his faith with a patient at the end of a private consultation. They ruled that his actions ‘did not meet the standards required of a doctor’.

Dr Richard Scott (pictured) has now been issued with a warning which will remain on his record for five years. Further serious or persistent failure to follow GMC guidance will put (his) registration at risk.

Dr Scott, who has been a doctor for over 28 years, was initially investigated by the GMC after it received a complaint from a patient that he had discussed the benefits of Christianity with him.

The full judgement is available on the GMC website and the Huffington Post gives more detail of what Dr Scott said in his defence.

The case arose from a complaint made to the GMC on 14 August 2010 by a patient’s mother about the doctor’s conduct when her son consulted him ten days earlier. It was alleged that Dr Scott ‘abused his position as a medical practitioner to push (his) religion upon a vulnerable patient’.

The patient on 20 October 2010 provided a written statement on which the GMC’s allegations were based. After seeking Dr Scott’s views on the allegations, which he did not accept, they sought to issue him with a warning, which he refused thus exercising his right to an oral hearing before the investigation committee.

When the patient refused to give evidence to the committee last autumn the case was adjourned until June 2012. On this occasion the patient again refused to appear but eventually agreed to give oral evidence over the phone.

During the hearing the committee noted that there was ‘clearly a conflict of recollection of what occurred in the consultation between the participants’ but considered that ‘both witnesses were honest and not trying to deceive’.

Dr Scott insisted that he had acted with the GMC guidance but also accepted that if he ‘had acted in the way in which the alleged this would be a significant departure from (it)’.

There was, in other words, a significant disagreement between Dr Scott and the patient about what was actually said during the consultation.

The committee, however, considered that the patient ‘gave credible evidence, direct answers and made all due allowances’ in Dr Scott’s favour. But they considered that ‘a number’ of Dr Scott’s responses ‘were in conflict with the evidence’ and that at times he ‘appeared to be evasive when answering questions’.

In other words the committee appeared to prefer the patient’s evidence over that of Dr Scott where their recollections were in conflict.

However, whilst a number of the allegations made were found ‘proved’, three significantly were not, raising questions about the accuracy of some of the patient’s evidence.

In summary, the committee concluded that Dr Scott ‘caused the patient distress which (he) should have foreseen’ by the way he expressed his beliefs. He also ‘sought to suggest (his) own faith had more to offer than that of the patient’ and in so doing ‘sought to impose his own beliefs’.

The GMC claimed that Dr Scott’s actions were in direct conflict with paragraph 19 of its supplementary guidance: Personal Beliefs and Medical Practice’:

‘You must not impose your beliefs on patients, or cause distress by the inappropriate or insensitive expression of religious, political or other beliefs or views’.

and also with Paragraph 33 of ‘Good Medical Practice’:

‘You must not express to your patients your personal beliefs including political, religious or moral beliefs, in ways that exploit their vulnerability or that are likely to cause them distress.’

The GMC defended its issuing of a warning by saying it was obliged ‘to lay down a marker as to expected standards and to maintain public confidence in the profession’. It also said that ‘the discussion of religion within consultations is not prohibited’ and that this case ‘relates to the manner in which religion was approached during the consultation’.

The case raises a number of important questions for Christian doctors:

1.Is the GMC guidance overly restrictive?

The GMC Guidance, ‘Personal Beliefs and Medical Practice’ is currently under review but the 2008 version, under which Dr Scott has been assessed ‘attempts to balance doctors' and patients' rights - including the right to freedom of thought, conscience and religion, and the entitlement to care and treatment to meet clinical needs - and advises on what to do when those rights conflict.’

It does not intend to ‘impose unnecessary restrictions on doctors’ but does point out that doctors have an obligation not to impose their beliefs on patients. So there is no blanket prohibition on expressing personal beliefs, as long as it is done in a way that is sensitive and appropriate.

The guidance also underlines the principle that doctors must ‘make the care of (their) patient (their) first concern’ and must treat them ‘with respect, whatever their life choices and beliefs’.

These are all good principles that I personally have no problem with. No doctor, Christian or otherwise, should impose his views on his patient or seek to exploit his or her position.

However, the guidance goes on to stress that all patients and doctors have personal beliefs implying that these principles apply not just to those who subscribe to a particular faith, but to everyone.

‘Personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients.’ ‘All doctors have personal beliefs which affect their day-to-day practice.’

It also emphasises that taking account of patients’ beliefs is part of good medical care.

‘Patients' personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness or treatment.’ ‘For some patients, acknowledging their beliefs or religious practices may be an important aspect of a holistic approach to their care. Discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.’

Provided these guidelines are retained within the new guidance, they are parameters that Christian doctors should be able to work with.

2.Was this investigation fair?

The faith conversation which seems to have got Richard Scott into trouble came at the end of a 20 minute consultation, when he asked the patient whether he could talk about his Christian faith and the patient replied ‘Go for it’. So there was mutual consent and when the conversation became tense they stopped it.

The key problem faced by the GMC was that they were making an assessment based on two varying accounts of what actually happened, one from the patient and one from Dr Scott. However, in so doing they seem to have preferred the patient’s testimony over that of Dr Scott where the two accounts conflicted. Also the initial complaint was made by the patient’s mother who was not a witness to the consultation and transcripts of Dr Scott’s radio interviews were actually gathered by the National Secular Society, who undoubtedly had an ideological vested interest in the case.

Furthermore there were elements of the patient’s written testimony which were not upheld on cross-examination and he repeatedly refused to turn up to give evidence face to face. The Christian Legal Centre, who represented Dr Scott, have understandably raised questions about the legality and transparency of this process and had undertook unsuccessfully to have the case ‘struck out’. They are still considering whether to ask for a judicial review of the way the GMC conducted the enquiry.

Given, as acknowledged by the GMC, that Dr Scott had a previously unblemished record and was able to produce many patients’ testimonials, might they not have given him the benefit of the doubt in these particular circumstances? Wasn’t this a case that would have been better resolved locally with a mutual apology and a handshake? Has the GMC overreacted?

Furthermore, might the judgement encourage other individuals or organisations to bring forward vexatious written complaints against other Christian doctors knowing that it will essentially be the patient’s word against the doctor’s?

And why should suggestions that faith might help a patient be treated any differently from suggestions about other lifestyle choices or beliefs? As one doctor has argued in Pulse this week:

‘Patients already could say that you are ‘exploiting their vulnerability’ and ‘causing them distress’ when you speak to them about lifestyle choices which have led to obesity or addiction, but that is OK, because the evidence shows that dealing with these things would be good for them. Dr Scott has presented similarly robust evidence that shows that ‘doing God is good for your health’. So why would the GMC want to encourage one and discourage the other?'

There are certainly questions here that are worth asking and I am aware that a number of Christian doctors have already written to the GMC about them. Others who wish to express concern about the case, or to ask questions, can do so via the GMC website. The most appropriate addressee would be Niall Dickson, the Chief Executive.

3.What sort of faith discussions are still allowed within a consultation?

Last year I was involved in a Radio four PM debate with Niall Dickson, the Chief Executive of the GMC in which he confirmed the appropriateness of sensitive faith discussions with patients. His exact words were as follows:

‘The first point is that the start of a consultation is not the point at which you start introducing your faith and you should be where the patient is at. But there may be circumstances where a patient is at a point where they do want to discuss faith and it may be appropriate for the doctor to reflect on their own faith during that discussion.’

When asked how the GMC determined whether or not a doctor had expressed ‘religious, political or other beliefs or views’ in an ‘inappropriate or insensitive’ way Dickson explained that the GMC guidance was there to enable doctors to make good judgements themselves:

‘I am not there to judge, the doctor is there to judge and this essence of medicine is making judgements in the face of uncertainty and the importance of the doctor understanding where the patient is at. Taking a vulnerable patient and imposing your religious views on them and exploiting their vulnerability would be on the wrong side of the line as far as we are concerned.’

Jane O'Brien, GMC Assistant Director for Standards and Fitness to Practise, in a letter to the Daily Telegraph in 2009 even suggested that a ‘tactful' offer to pray could be appropriate. O’Brien’s letter in full read as follows:

‘Nothing in the GMC's guidance Personal Beliefs and Medical Practice (2008) precludes doctors from praying with their patients. It says that the focus must be on a patient's needs and wishes. Any offer to pray should follow on from a discussion which establishes that the patient might be receptive. It must be tactful, so that the patient can decline without embarrassment – because, while some may welcome the suggestion, others may regard it as inappropriate.’

The same sentiments were expressed in a letter from David Horkin, GMC Investigation Officer, to a CMF member this last week.

‘The GMC has no objections whatsoever to the clinician bringing up faith in the consultation if it is done in an appropriate and sensitive manner. The patient must of course consent and be happy for such discussions to take place. Also, the clinician should take note of the patient's own beliefs and not attempt to belittle / disrespect their own faith or lack thereof. You should not attempt to impose your views on any patient who does not want to discuss such matters.’

These three statements strongly endorse the appropriateness of sensitive faith discussions.

4.Are doctors still free to practise ‘spiritual care’

Taking all this into account, it is clear by the GMC’s own admission that doctors are fully entitled to take part in ‘faith discussions’ within a medical consultation provided that they are carried out in an atmosphere of sensitivity, permission and respect.

In fact, good doctors, we might argue, have a professional duty to practise ‘whole person’ medicine that is not concerned solely with physical needs, but also addresses social, psychological, behavioural and spiritual factors that may be contributing to a person’s illness.

It would be a tragedy if, as a result of this case, Christian doctors shrunk back from providing appropriate spiritual care or from sharing their own Christian beliefs in a sensitive way, when it was appropriate, and when the patient had welcomed it.

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The GMC is recognizing the importance of spiritual care but is still struggling to define what it actually is

The General Medical Council is about to review ‘Good Medical Practice’, its general guidance to doctors, and new draft guidance is due to be issued later this month.

Early indications are that the revised guidance will give more latitude to doctors attempting to provide whole-person healthcare (including spiritual care) but will take a harder line than at present on doctors who attempt to share their own faith with patients in the context of a consultation.

But given that there is a substantial body of evidence which suggests that religious faith benefits health, does withholding ‘spiritual care’ constitute a breach of GMC guidelines?

One doctor decided to pose exactly this question to the GMC and has given me permission to post his letter along with the reply he received.

Letter to GMC from Dr David Chaput de Saintonge

Dear Sir,

Thank you for your detailed reply to my letter of 27.5.2011.

In fact, my query was not ‘… whether doctors are permitted to offer or provide spiritual care of their patients’ though I'm pleased to note the GMC’s acceptance of this, always providing it is done sensitively.

The question I asked was when it would be allowable to contravene GMC guidelines by withholding spiritual care which is shown to be beneficial?

Of course I recognise that, as you state, the committee cannot, require doctors to offer faith-based management options. I don’t think that is the point. Your guidance on consent: patients and doctors making decisions together (Part 1; para 5) clearly states:

‘The doctor and the patient make an assessment of the patient's condition, taking into account the patient's medical history, views, experience and knowledge. The doctor uses specialist knowledge and experience in clinical judgement, and the patient's views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit from the patient. The patient weighs up the potential benefits, risks and burdens of the various options as well as any nonclinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one.’

However the patient will be unable to weigh up the risks of an intervention which has not been discussed with them. They will therefore be denied the freedom of choice which your guidelines indicate they should be given and spiritual care might be wrongfully withheld.

I recognise, of course, that the doctor might consider that spiritual interventions ‘would not be of overall benefit to them’ and would advise against any such intervention.

However, according to your guidelines, this does not absolve the doctor of the responsibility taking the patient's views into account when entering into this discussion.

Clearly the doctor cannot fulfil this requirement with respect to spiritual care without ascertaining the patient's views. It would therefore seem an essential part of the assessment not just to enquire about physical, social and psychological aspects of the patient's condition, but the importance to the patient of spiritual aspect also.

Failure to do so restricts the patient's choice and is would appear to be a denial of their autonomy.

It may be I have misunderstood the GMC’s position on this. If so I'd be very grateful for your clarification.

Yours sincerely

Reply from Jane O’Brien, Assistant Director, Standards and Fitness to Practise Directorate

Dear Dr Chaput de Saintonge,

Thank you for your letter of 30 August 2011.

I think your analysis of our guidance is absolutely right, and where there is medical treatment that is clinically appropriate for the patient and likely to provide overall benefit, doctors should raise this with the patient as part of the consent process.

The more difficult issue is where the boundaries lie between medical treatment and management, which are within the expertise of doctors and properly provided by the NHS or other health funding bodies; and the provision of spiritual support and care, which is generally provided by religious or faith leaders or others with expertise in this area. The GMC does not place a duty on doctors to provide 'spiritual care' - but rather to recognise patients' need for such care and to facilitate patients’ access to it, where the patient would welcome this and is not in a position to do so him or herself.

There are some therapies that might be regarded as 'faith based', including meditation and yoga, but in general it is difficult to identify treatment options which would be available only as part of faith-based management of conditions. Where such treatment options exist, they should be discussed with patients.

I would not claim to be an expert on the research on the impact of faith or spirituality on health, but much of the most accessible evidence relates to the health benefits of practising religion or having a 'spiritual' life more generally. We encourage doctors to help patients to take an interest in their health (see paragraph 6 of Good Medical Practice), for example by talking about the benefits of lifestyle choices, such as taking exercise or losing weight. Of course, doctors can also tell patients about the evidence of the impact on health of being an active member of a faith community or otherwise engaging in a spiritual life.

Finally, the GMC fully supports a holistic view of patient care. You will see in our guidance on consent and treatment and care towards the end of life, in particular, that we encourage doctors to think about the patient’s overall needs, and to take into account their values and beliefs. You may be interested to note that as part of the review of Good Medical Practice we will be consulting shortly on changes to our guidance on good clinical care. This will include the following (additional text in bold type):

If you assess, diagnose or treat patients you must provide a good standard of clinical care: Good care will involve:

a. Adequately assessing the patient’s conditions, taking account of their history (including the symptoms, and psychological, spiritual, religious, social and cultural factors), the patient’s views, and, where necessary, examining the patient.

If you would like to be sent an alert when the consultation is launched later this month, please let me know.

Yours sincerely

Observations

The GMC letter makes a number of statements that Christian doctors will welcome, namely:

1.Where faith-based treatment options exist, they should be discussed with patients (but what does the GMC actually understand by the term 'faith-based'?)
2.The GMC fully supports a holistic view of patient care (but what does it understand by the term 'holistic'?)
3.Good care, which doctors must provide, involves taking a spiritual, cultural and religious history.

But there is still lack of clarity over whether providing information about spiritual care and access to it is a duty or an option.

On the one hand the GMC says that doctors must recognise patients’ need for spiritual care and facilitate their access to it, when they would welcome this and are not in a position to access it themselves.

On the other hand the GMC seems to give doctors an option about whether or not to tell patients about the evidence of the impact on health of being an active member of a faith community or otherwise engaging in a spiritual life.

But if patients are not aware of the benefits of faith to health then how can they be in a position to welcome spiritual care?

The GMC is moving in the right direction but needs to be clearer on its requirements so that doctors understand their duties and patients understand their rights.

Perhaps the key problem here is that while the GMC is recognizing the importance of spiritual care for health, it has not yet managed to define what spiritual care actually is. They will need help from doctors practising spiritual care on the front line to do this effectively.

I would urge Christian doctors to respond to this consultation in order to ensure that a whole person approach - including spiritual care - is universally implemented; that doctors are given freedom to practise it and that patients are given full opportunity to make use of it. A majority of patients actually want their doctors to practise whole person medicine which involves the spiritual dimension. Shouldn't that be the bottom line?

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The big interview from Evangelical Times

I gave an interview last month for the October Evangelical Times ‘big interview’ column. It is posted on their website but I have also pasted it below.

The big interview – October 2011

Peter Saunders is Chief Executive of the Christian Medical Fellowship, a UK-based organisation with 4,500 UK doctors and 1,000 medical students as members. His role includes leadership training, teaching evangelism and ethics, medical mission, writing, editing and media work. Peter took some time out to answer questions from Sheila Marshall.

SM Which TV drama series — Holby City, Casualty or ER?

PS Definitely ER. As a general surgeon I loved the challenge of assessing and treating critically ill patients. Holby City and Casualty are just too ‘soapy’ and too slow-moving for me.

SM What drives your work with CMF?

PS Luke the physician tells us that Jesus sent his followers out ‘to preach the kingdom of God and to heal the sick’ (Luke 9:2). This means, to attend to the spiritual and physical needs of a suffering world. Christian doctors motivated by Jesus’ teaching and example have been profoundly influential in shaping healthcare’s history. A significant number of medicine’s pioneers were people of faith — Paré, Pasteur, Lister, Paget, Barnado, Jenner, Simpson, Sydenham, Osler, Skudder, Livingstone and many more. The CMF exists to help doctors continue in the steps of Jesus, the Great Physician. What drives me is a desire to help doctors fully integrate their faith and practice, to be witnesses to the gospel, and instruments of God’s grace and compassion.

SM Why does CMF need to promote Christian values in the church?

PS CMF’s fourth aim (after evangelism, discipleship and healthcare mission) is ‘to promote Christian values, especially in bioethics and healthcare, among doctors and medical students, in the church and in society’. As Christian doctors, rooted in Scripture and dealing daily with a host of physical, psychological and spiritual needs, we are uniquely placed to bring medicine and the Christian faith together. Members are often asked by Christian friends for guidance on end-of-life care, abortion, infertility, contraception and a host of other lifestyle and healthcare issues. Many pastors feel they lack the expertise to apply the Bible to contemporary issues of healthcare and medical ethics. Christian doctors can help fill that gap. We want to help Christians make wise decisions about their own healthcare and want to equip Christians to engage in the wider national debate on issues that have a significant effect on the most vulnerable people in our society.

SM Can Christian values be promoted in a secular society?

PS As Christians we are called to proclaim the gospel and live to honour Christ in every way. This involves bringing a Christian mind to the many issues that plague our society, and being salt and light. As citizens of a democracy, we have a responsibility both to choose our political leaders and to do what we can to ensure that the laws in our statute books are just and fair. We have a special responsibility to stand up for those who have no voice, like those who are poor, marginalised, elderly, unborn, sick and disabled. There is a growing hostility amongst some quarters of our country towards Christian faith and values. This needs to be challenged.

SM Are Christian values too expensive for our welfare system?

PS The current crisis in healthcare has complex causes. Much of the rising burden of disease is a consequence of poor lifestyle choices, such as people literally eating, smoking, drinking and drugging themselves to death. There is little money free to invest in care, because we are spending our financial resources on the wrong things or living way beyond our means. This is compounded by the breakdown of the family. I believe that the root cause is that as a society we are increasingly turning our back on God, so the supports of family, church and community are no longer there. Christian faith has huge benefits for health, because it has a huge impact on lifestyle choices; people are more likely to avoid or delay many of the diseases that are costly to our health service. If more people in Britain lived according to Christian values, there would be less medical need and much more money available to care for the sick and dependent.

SM What issue did you take with Terry Prachett’s recent BBC documentary on assisted suicide?

PS The BBC has become something of a cheer-leader for assisted suicide. This was the fifth BBC documentary in three years that portrayed assisted suicide or euthanasia in a positive light. We are disturbed by the bias of our national broadcaster, which has an obligation to remain impartial. The programme also breached both national and international guidelines on suicide portrayal and posed a great risk to vulnerable people by fuelling the well-documented phenomena of suicide contagion and copycat suicide.

SM How should the media approach this subject?

PS The BBC’s own editorial guidelines on portrayal of suicide are very clear. They call for, ‘great sensitivity’; ‘factual reporting and fictional portrayal of suicide, attempted suicide and self-harm have the potential to make such actions appear possible, and even appropriate, to the vulnerable’. The World Health Organisation’s guidance is equally unambiguous: ‘Don’t publish photographs or suicide notes. Don’t report specific details of the method used. Don’t give simplistic reasons. Don’t glorify or sensationalise suicide’.

SM Can you give examples?

PS Media stories about how people coped positively with suicidal feelings lead to a decrease in levels of suicide in the general population. Researchers have named this protective effect the ‘Papageno effect’, in honour of the character in Mozart’s opera The magic flute. When Papageno fears that he has lost his love, Papagena, he prepares to kill himself. But three boys save him at the last minute by helping him to find purpose in his suffering.

SM Are euthanasia, abortion and bioethics matters of conscience?

PS The Bible teaches us that human beings are made in the image of God and infinitely precious — meaning worthy of respect, protection, empathy and compassion. The sixth commandment ‘You shall not kill’ is based on this idea and forbids taking the lives of innocent human beings, even if they request us. For centuries the laws of our country have been based on these biblical concepts. Moral issues are not simply matters of individual conscience. It takes a huge amount of grace, courage and character to obey God in tough, costly decisions, but that doesn’t mean that it should not be clearly and unambiguously taught. That is why there is so much moral teaching throughout Scripture.

SM How can everyday believers make a difference?

PS God uses weak and ordinary people to do great things. The smallest step of faithful obedience by God’s grace can turn the course of history. God can use day-to-day decisions to advance his kingdom in and through us. Nothing done in his service is ever in vain and our job is to be faithful to him where he has placed us and trust the results to him.

SM What verses inspire you?

PS Too many to mention really, but here are just a few: Luke 4:18-19 — the Nazareth manifesto; 1 Corinthians 15:58 — never give up; 2 Corinthians 8:9 — Jesus our model; 2 Corinthians 12:9 — strength in weakness; Proverbs 31:8 -9 — speaking up for the weak.

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General Medical Council considers changes to its guidance that could further restrict faith discussions

Pulse magazine reported last week that the General Medical Council is planning to ‘harden’ its guidance on religion in practice.

The document Good Medical Practice (2006) is the core guidance to doctors and describes what is expected of all doctors registered with the GMC. Although the guidance is addressed to doctors, it is also intended to let the public know what they can expect from their doctors.

The GMC says that it is reviewing Good Medical Practice ‘to make sure it is up to date and fit for its many purposes’.

A formal consultation will be launched later this month and will lead to publication of a new edition of the guidance in 2012.

The new draft guidance has added a duty for GPs to consider ‘patients' religious, spiritual and cultural history' when assessing patients.

The regulator also plans to tighten up anti-discrimination guidance on doctors expressing personal views, including religious beliefs, in consultations.

Its previous guidance had stated: ‘You must not unfairly discriminate by allowing your personal views to affect adversely your professional relationship with patients.' Its new version removes the word ‘adversely', requiring GPs to challenge their colleagues' behaviour if there is any effect to the professional relationship.

Once ‘Good Medical Practice’ has been modified it is expected that the GMC will then move to modify its supplementary guidance ‘Personal Belief and Medical Practice’ which goes into these matters in far greater detail.

The revision of ‘Good Medical Practice’ comes during the course of an ongoing investigation into the case of Dr Richard Scott, a GP in Margate, Kent, who was the subject of a complaint for suggesting to a patient that he might find an examination of the Christian faith helpful.

The GMC had proposed giving Dr Scott a warning for discussing his Christian faith during a consultation, but he refused to accept it and opted instead for an oral hearing before its investigations committee.

Dr Scott told the BMJ in May that he had raised the possibility that Christianity might help his patient only in the last five minutes of a 20 minute consultation, after first asking his permission and being told to ‘go for it.’

His mother then brought a complaint to the GMC, saying that Dr Scott had ‘pushed religion’ on her son.

On 23 September, the second day of the two day hearing in Manchester, the committee adjourned ‘to make a further attempt to secure the attendance of Patient A,’ who has so far refused to appear before the committee. His absence prevented Dr Scott’s lawyer cross examining him to challenge his account of what happened at the consultation in August 2010.

The committee heard that Dr Scott had seen the 24 year old man at his surgery in Margate, Kent, after his mother had said that he was ‘suicidal’.

Paul Ozin, for the GMC, said, ‘A line was crossed because Dr Scott expressed his personal religious belief to a person he knew was a vulnerable patient in a way that was plainly liable to cause the patient distress.' However this is disputed by Dr Scott's lawyer, Paul Diamond of the Christian Legal Centre.

Ozin claimed that Dr Scott 'suggested that Jesus or Christianity - his own religion - offered something exclusive and superior to that offered by the patient’s own religion. It is a matter of record that Patient A subsequently complained about Dr Scott and said he was very upset about the consultation and he was offended by what he saw as the belittling of his own religion.’

The revision of the GMC’s guidance appears to have been influenced by this case. The suggested amendments indicate that the regulator is considering more formally acknowledging that doctors have a duty to consider a patient’s spiritual history whilst at the same time taking a sterner view of any attempt to share their own faith.

Interestingly the GMC guidance ‘Personal Beliefs and Medical Practice’ actually acknowledges that 'all doctors have personal beliefs which affect their day-to-day practice' and that these principles apply to all doctors whatever their political, religious or moral beliefs.

It also emphasises that 'personal beliefs and values, and cultural and religious practices are central to the lives of doctors and patients' (p4); that 'patients' personal beliefs may be fundamental to their sense of well-being and could help them to cope with pain or other negative aspects of illness or treatment.' (p5) and that 'discussing personal beliefs may, when approached sensitively, help you to work in partnership with patients to address their particular treatment needs.' (p9)

The GMC’s suggested new approach will not just make things more challenging for Christian doctors but will have implications for any doctor of any faith (or none) who expresses a personal belief that he or she feels might help (about anything) to a patient. This has the potential to lead to many more complaints against doctors and many more cases for the GMC to examine. The regulator could be walking a very delicate path indeed.

I suspect it will not just be Christian doctors who will be awaiting the draft guidance with much interest and examining its wording very carefully.

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