Shahrar Ali’s Second Rebuttal in Response to Negative Campaign: Maintaining Professional Boundaries in Patient Settings

Also available as pdf here.
Recently a Party member wrote to the GMC in an attempt to undermine the position I took in a statement of 19 July 2021, about maintaining professional boundaries in patient care settings, where I was also responding to a Young Greens motion criticising my appointment as a national spokesperson. Specifically, I distinguished between the expression of general solidarity with the LGBTIQ+ community through wearing of a rainbow lanyard, say (which is something that I also do and have done) and the sharing of personal data about one’s own sexuality in a patient-care setting (also to express solidarity). It is these last two circumstances (personal data + patient setting) around which greater sensitivity may be required that can make a difference to the appropriateness of the gesture.

Mindfulness of this boundary is always an important professional consideration for a clinician, notwithstanding their right to be able to bring their whole self to work and to be supported in that by their employer. People can reasonably differ on where a threshold of sharing personal data in such a context lies but I do not think it can be denied that such a threshold exists and that this is supported by guidance from key regulators in the medical profession. With respect to the article that was published by a Party member, quoting from GMC correspondence, in order to discredit me:

a)      The GMC in response to the member took pains to emphasise that they were not commenting on any specific statements made by me but only to a more general enquiry. Therefore, publication of that GMC correspondence to undermine any position I took was contrary to the use to which it was explicitly intended (and they have expressed apology that this has happened). The GMC was correct in its approach as they were obviously not going to adjudicate on just one person’s interpretation of what I had said (which could have been a misrepresentation, and I believe it was). This, in turn, does raise questions about the ethics of publishing an article attacking a leadership candidate using such material. I park this aspect for now, but just to say that although the temptation may be great, I do not expect any member to want to resort to such tactics.

b)      The GMC (Head of Standards and Ethics) has helpfully provided me with a fuller response which does now address the actual content of what I said, and I am making some of that available below. The reader may well find that this confirms the position that I have been taking and not the contrary (hurtful, offensive) allegations that my statements betray homophobic prejudice. The final paragraph is particularly relevant to what I said.

GMC Re guidance for doctors on wearing badges that express their sexual orientation at work (20 Sept 2021)

“We were very clear that we were not seeking to express a view on any specific comments or tweets, or on any internal Green Party matter. We were asked a question about the content of our guidance and we responded to that in line with our usual practice and timescales.

We made clear to the enquirer that the focus of a healthcare interaction is the patient, and that doctors should keep the discussion focussed on care and treatment. Our published guidance does not specifically prohibit wearing a badge which identifies a doctor’s sexuality (or displaying any other statement of sexual orientation). We expect doctors to use their judgement to take a view on what may be appropriate in a particular setting, taking account of their responsibilities to provide a good quality of care for patients, consistent with the standards set out in our guidance and any relevant local policies.

I should also say that we do not determine the policies and practices of health service employers when it comes to staff dress codes, or the ways in which they work with their staff to create a welcoming environment for the diverse local populations which they serve. However, we would expect doctors to be aware of local policies and to use their judgement about how best to work with these policies to meet the needs of the patients whom they serve.

Good medical practice itself makes clear that doctors are expected to use their judgement when applying the principles in our guidance to the situations they face, and it is important that they take into account the needs of their individual patients and the context in which they are working (see ‘Professionalism in action’, paras 1-6).

We absolutely accept that there may be disagreement about the extent to which it is helpful for staff within different healthcare settings to publicly share personal information about themselves with the general population of service users or in their interactions with individuals. Individual doctors may weigh different factors in different ways when they make decisions about this, and it is not our view that discussion or exploration of these issues is inappropriate.  It remains the case that there is nothing in our guidance to specifically prevent a doctor from displaying a statement of their sexual orientation, provided that in doing so they can explain and justify their decisions against the principles in our guidance; ultimately the question of whether or not a doctor’s actions might be seen as a breach of our guidance would depend on the individual circumstances.”