Defence

Today has been quite stressful as I was seeing patients without knowing whether I was covered by “medical indemnity” for most of the day. We live in a litigious and complaining age and doctors are constantly at risk of being sued (in the courts) or complained about (to the GMC or the local health authorities). A number of “defence societies” exist to help doctors in these circumstances. They provide advice, legal help if required, and if the worst comes to the worst will pay the damages awarded against a doctor. This is extremely reassuring. The public seems to have a “Madonna-whore” attitude to doctors, seeing them as either selfless heroes or incompetent bunglers. Someone who puts doctors in the latter group may think it wrong that defence societies protect doctors from the revenge rightfully wreaked on them for their bungling. But conversely, if doctors knew that a single error could result in them and their families being reduced to penury they would not stay in the job for long. The infallible doctor has not yet been born and few doctors are so selfless that they will put their families at risk.

I understand that in the USA things are far worse and some doctors resort to “going bare”, which means not paying the colossal medical indemnity premiums but transferring all their assets to family members so that they are not worth suing. This is not a tactic widely used in England.

For over a quarter of a century I have been indemnified by defence society A. More by luck than judgement I have never needed anything more than a little advice over that time. This is par for the course, I believe. Recently a friend who has professional dealings with doctors who have needed more than a little advice, told me that defence society B tends to be better when things get sticky. My membership of society A was due for renewal on 1st July so at the beginning of June I made some enquiries of society B about joining them. I was advised that because most of my partners are also with society B we could benefit from a group subscription. They offered to send me an information pack with an extra form to return with my application. I then let my attention wander a bit, until two weeks ago I realised that the information pack was not going to arrive. So I sent off my application form without it.

I knew that the approval process takes a little time because society B has to write to society A to check my “claims history”. But I had little doubt that my history would be satisfactory, and when I rang society B last Wednesday I was told that they had received the necessary letter from society A. Everything seemed fine, which was just as well as by this stage I had told society A that I would not be renewing my membership on 1st July. On Friday morning (29th June) I rang society B again and was told that the managers were in a meeting at which my application would be approved; the lady said she would ring me back in the evening to let me know the result but did not do so.

On Saturday and Sunday I do no work at all, so 'twas on the Monday morning that I decided to call society B again. I was told that my application was still on the manager's desk and when did I want to start work? I said that today would be convenient. She offered to ring me back later.

I was now in a difficult position and yes it was entirely of my own making, which didn't make it any easier to bear. I did not know for certain that my application for membership would be approved and by this stage I was getting worried. Why hadn't it been approved at the meeting on Friday? Was there something in the claims history that I had forgotten which had alarmed them? Were they going to ask for further and better particulars from society A? How long would that take? And what would happen if they refused to approve my membership? Would society A take me back? More to the point, if my membership were eventually approved, would I be covered for the work I did today? And finally I was in a delightful Catch-22: I couldn't ask my defence society for advice because I didn't have one!

The sensible thing would have been to see no patients until society B confirmed that they would cover me. But I had two surgeries booked, prescriptions to write and visits to do. I have responsibilities to my partners and I could hardly say “sorry, I'm not going to do any work today”. So I carried on, possibly “going bare”, and it was very unpleasant. I don't think I did anything differently but I was aware in every consultation of the uncertainties with which I was dealing. I don't think I did anything negligent, but if anyone were to sue me I might have to prove it myself. The final “extra” patient in the morning was someone about whom I may write later, a man with extreme somatisation and anxiety who has already seen all the other partners since he joined the practice last week. Not the sort of person you want to see without medical defence cover, but I swallowed and got on with it. I think I consulted brilliantly, drawing his attention from his symptoms to his anxiety and being supportive while declining to be manipulated, but “tell that one to the judge”.

An older partner I shared my worries with was not at all sympathetic, which is not something I shall forget in a hurry. But at the start of evening surgery I spoke to the young and energetic Neil who was much more supportive, said he was sure my application would be approved and backdated, and that the delay was simply bureaucratic. I rang society B again and finally spoke to someone helpful who said that my application was simply awaiting routine approval and that the manager responsible was about to deal with it. She said she would ring me back by 5 o'clock, and she did. My membership had been approved with effect from 1st July. I could have kissed her, although this is difficult over a telephone.

But I realised when I got home that I had been tense all day and that I still felt shaken and upset. My wife and daughter were smiling, happy and relaxed but I couldn't join them. I ate my tea quietly and came upstairs and wrote this blog and now I feel a little better.

I'm not after sympathy, it's just that I promised to say how things are for me.