I promised to update you if and when I heard anything concrete from the General Medical Council regarding its policy on evidence-based Practice. Miraculously, after I drew the GMC’s attention to my last post (which reported their deathly silence), the following hit my inbox:
Thank you for your inquiries about evidence based practice. Please accept my apologies for the delay in responding to you. As my colleagues have indicated, the GMC has not issued any advice about complementary and alternative medicine. However, all doctors have a duty to be familiar with and follow our core guidance, Good Medical Practice (2006), which describes what is expected of all doctors registered with the GMC. Good Medical Practice is guidance, not a statutory code; so doctors must use their judgement to apply the principles to the various situations doctors will face, bearing in mind that they must be prepared to explain and justify their decisions and actions. Specifically, we say that ‘in providing good care [doctors] must provide effective treatments based on the best available evidence’ (paragraph 3c of Good Medical Practice). Doctors must also be satisfied that any drugs or treatment provided serve the patient’s needs. In many cases this is straightforward as the evidence base for particular treatments is clear. Where there is little or no evidence to support a particular treatment, or where there is genuine uncertainty about the evidence base for a particular treatment, doctors need to use their clinical and professional judgement, and, working in partnership with their patient, make a decision about treatment options that will serve the patient’s needs. As a result, doctors will not always only be providing evidence based treatments. We would not wish to stifle all innovation or unconventional approaches or prevent doctors from taking a patient’s wishes into account. However, a doctor who believed that treatment, which would generally be regarded as outside the boundaries of conventional practice, would be of benefit to a patient should always:
- seek advice from at least one experienced colleague or ask a colleague to provide a second opinion.
- keep a detailed record of the decision making process.
- monitor the patient’s condition and progress very carefully, and again keep a detailed record of the patient’s response to the treatment, reverting to conventional therapies if the patient has an adverse reaction.
In addition, our guidance, Consent: patients and doctors making decisions together (2008) requires doctors to give patients the information they want or need to make an informed decision about whether to agree to a particular treatment. This includes information about the ‘purpose of any proposed investigation or treatment and what it will involve’ and ‘the potential benefits, risks and burdens, and the likelihood of success’ of any treatment options offered. Regardless of whether a doctor is providing conventional or alternative treatments, they are expected to follow our guidance and serious or persistent failure to follow the guidance will put a doctor’s registration at risk. We have imposed sanctions on several doctors in relation to their use of complementary and alternative treatments. We are currently undertaking a review of Good Medical Practice (2006) and we can further consider the advice we give on this issue as part of this review. In considering these issues, we are mindful of the recommendations of the Science and Technology Committee Report, ‘Evidence Check 2: Homeopathy’, and the Government’s response to the Inquiry Report. In its response the Government noted that the commissioning of health services by Primary Care Trusts involved a range of considerations including, but not limited to, efficacy and outlined their continued position that local NHS services should continue to have responsibility for deciding what treatments to provide, including treatments such as homeopathy. I hope that you will take the opportunity to be involved in the review of Good Medical Practice by responding to the formal consultation when it is launched in October 2011 (you can keep up to date with developments by visiting www.gmc-uk.org/gmp2012). I apologise again for the delay in responding to you and hope this written response is helpful in explaining our guidance.
It seems to me that all this took a lot of working out. The policy seems to have morphed from the previous “doctors must follow evidence-based practice at all times” to the present “if doctors don’t follow evidence-based practice, they must tell their patients they are prescribing quackery and they must seek advice from a colleague” (I paraphrase). Would any of us be surprised if that colleague turned out to be another quack?
Coincidentally, I have been having a heated discussion with some homeopaths on Edzard Ernst’s Pulse Today blog. One of those is a GP. Presumably the GMC’s policy has no problem with accommodating the regular prescribing of medicine with no medicine in it, as Dr Andrew Sikorski proudly admits to doing?
One more point. Do take up the invitation to get stuck into the GMC’s consultation. If you belong to a relevant professional body or other group (eg a patient support group), agitate for them to stand up for science in health care.