This information guide is
intended for a psychiatrist who is facing a review, an
investigation or an inquiry. The information can be used as a guide
only and is not a substitute for professional advice. If you need
further advice and support, please contact the Psychiatrists’
Support Service or one of the organisations listed at the end of
this information guide.
This document focuses primarily on
the consultant psychiatrist. It may be helpful for trainees or
non-training grade psychiatrists if brought into a review,
investigation or inquiry, but for them the first line of support
and advice should be from their consultant.
When a consultant psychiatrist
finds himself/herself facing a review, investigation or inquiry
there are four main steps to think about:
- clarity – be clear which of the
three processes you are facing
- preparation – check that you are
fully prepared for the process
- advice – check that you have taken
the best advice available
- getting support – just because you
are a doctor this does not mean that the process of review,
investigation or inquiry will not take its emotional toll and you
must take care to make certain that you keep yourself healthy.
When an untoward clinical event has
occurred it should not be seen as a sign of weakness or acceptance
of blame for you to say ‘sorry’. Expressions of regret and sorrow
about an adverse event coupled with a willingness to learn lessons
are entirely appropriate and professional reactions. A defensive
approach could well be interpreted negatively.
Employers and professionals use the
words ‘review’ and ‘investigation’ in different ways. It is perhaps
not so much the label assigned to the process that is the most
important, but the nature of the process itself. However, the
definitions below may be of practical help.
An investigation usually refers to
a process undertaken locally by an employer. The investigator is
usually employed by the same organisation as the psychiatrist, team
or service that is being investigated.
Depending on the case, there may be
a single investigator or a panel. The former often happens when the
issue under investigation is a conduct or behavioural problem, or
an issue that may lead to disciplinary processes (i.e. probity). A
panel may be more appropriate when the investigation has been set
out to understand an adverse event or a series of events of
In investigations involving a
panel, the chair is often a non-executive member of the trust board
in the National Health Service (NHS) sector; in the independent
sector there may be a non-clinician chair. There should always be a
psychiatrist member on the panel if there is concern about the
clinical practice of a psychiatrist. In some workplace situations,
this sort of (panel) investigation may be referred to as an
As this is an internal process,
timescales are usually short and an investigation can be completed
in a week or two.
This often refers to a panel
considering an adverse event or series of events; one or more of
the members will be drawn from a professional body external to the
trust. For example, the Royal College of Psychiatrists may be asked
to provide a list of individuals to an employer attempting to set
up a review panel. The psychiatrist member should be a senior
experienced clinician who will preferably have been trained in
investigatory work and with appropriate specialty knowledge and
skills equivalent to the psychiatrists/team/service under review.
For example, an adverse event in a child psychiatry service may
lead to a panel being set up with a child psychiatrist nominated by
the Royal College of Psychiatrists.
Owing to the involvement of
external professionals, and the focus on a service rather than an
individual, this process usually takes longer than an
When a serious event has occurred
(for example, a homicide committed by an individual in contact with
mental health services) or if the adverse event has led to
significant adverse publicity, a formal inquiry may be set up.
These are more legalistic in character and are often (although not
always) chaired by a lawyer or judge. The panel membership is often
wider including a psychiatrist, a nurse, a social worker and a lay
This is a much more formal process
than a review or investigation and interviews of witnesses by the
panel may be tape-recorded and transcribed.
Because of the seriousness of the
event that triggered the inquiry, the process is lengthy and
detailed and many witnesses may be heard. Additionally, there will
usually have been either an investigation or a review conducted by
the employer before an externally triggered inquiry is set up by a
primary care trust (in the NHS). Of all the processes described
here the inquiry can be the most difficult to cope with.
The four principles to consider
If an adverse event has occurred,
anticipate that a process of review/investigation/inquiry may take
If you are contacted by your
employer, you should ask yourself or those contacting you:
- Is this a review, an investigation
or an inquiry?
- What is the panel membership?
- What are the terms of
- Is there a clear timescale?
- Am I likely to have to give oral
or written evidence?
- If I have to give oral evidence,
can I arrange to be accompanied by a colleague or a professional
- Will the process focus on learning
lessons and improving services or will I be criticised?
- How will the final report be
produced? It is good practice for an investigation, review or
inquiry to provide a transcript of what you said and a summary of
what will be used to prepare the report. This is your opportunity
to make corrections. If it is not clear that you can do this, you
should ask. You should ask whether you will have an opportunity to
see either the whole report or part of the report without
conclusions, so that here is an opportunity to correct
You are advised to respond by
letter if you are told that there will be a review, investigation
or inquiry, to your clinical or medical director.
You should seek expert advice (see
below) from the British Medical Association (BMA) if you are a
member, and also your medical defence organisation.
- If an adverse event occurs, you
should consider the likely scenarios which could follow, including
an investigation or review, and in serious cases a formal inquiry.
Obtain advice for yourself.
- Make sure that your staff and
clinical team have support and that you have or are able to set up
your own support network (see below).
- Set up a team-based serious
incident review as soon as possible (according to your local
policies) so that there is an opportunity for the clinical team to
review the events leading up to the adverse event, the event itself
and the response to it. In the process of preparing for a serious
incident review, you are advised to make copies of relevant case
records, reports, the serious incident review document and any
enclosures, as it is likely that the entire clinical record will be
taken by the employer for the use of the investigator or panel.
Preparation for this will make it much easier for you to respond to
- and clarification of events if an
investigation or review occurs.
- You should not appear before an
investigator, review panel or inquiry without preparing for the
questions that you are likely to be asked. You should read all
- If you are asked to give oral
evidence, attend with a professional supporter or professional
adviser if you wish. You may always take a break from the interview
process if you need to.
It is advisable to be fully briefed
and obtain the best advice available. The BMA, medical defence
organisations and the Royal College of Psychiatrists’ Support
Service are some of the options to consider.
While you may receive good advice
from colleagues, those who have been through similar processes
themselves are not always the best source of independent
It can be extremely stressful and
have an effect on your professional and personal life. It is
important not to consider seeking support to be a sign of weakness.
It is good practice to make sure that you have a support network at
work; this may be a colleague(s) that you can trust or you may need
to identify a mentor. Psychiatrists can access and identify a
mentor through local contacts or, depending on where one works,
through the local deanery or the College divisions.
You may need to use the
stress-relieving strategies that you have developed over the
Consider whether your physical or
mental health is being adversely affected. Do not hesitate to see
your general practitioner if in doubt.
At any stage, you can contact the Psychiatrists’ Support Service.
This service can provide practical advice and support. In some
cases this service may assign to you an experienced member of the
College who will be able to provide short-term focused support and
advice to help you to deal in the best way possible with the
difficult situation you are facing.
Sources of further help and support
BMA House, Tavistock Square
London WC1H 9JP
Tel: 020 7387 4499, Fax: 020 7387 4499
Hospital Consultants and
1 Kingsclere Road, Overton, Basingstoke
Hants RG25 3JA
Tel: 01256 771777, Fax: 01256 770999
230 Blackfriars Road, London SE1 89J
Tel: 020 7202 1500
Medical and Dental Defence Union
Mackintosh House, 120 Blythswood Street
Glasgow G2 4EA
Tel: 0141 221 5858
33 Cavendish Square, London W1G 0PS
Tel: 020 7399 1300, Fax: 020 7399 1301
Royal College of Psychiatrists
17 Belgrave Square, London SW1X 8PG
Tel: 020 7245 0412
© Royal College of Psychiatrists 2008
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