In 17 of our 100 reviews, there was a particular focus on the issue of probity.
It is rare for a hospital to request an invited review regarding the subject of probity. However, when examining clinical decision-making, team interactions, communication with patients and clinical record-keeping, the topic of probity emerges as an issue.
Where concerns are identified these can relate to:
- A lack of openness when discussing complications with colleagues. Surgeons should proactively alert their colleagues to complications or problems that have arisen in the delivery of surgical care, for instance, at morbidity and mortality meetings.
- Inaccuracy or incompleteness of clinical records documentation – comprehensively describing interactions with patients prior to surgery and documenting the nature of operations performed and any resultant complications is essential.
- Inappropriately counselling patients on their options and the relative risks and benefits associated with each, including failing to ensure that the advice of the MDT is accurately conveyed or that estimations of risks are appropriately evidenced.
- Conflicts of interest regarding private practice or other financial incentives – giving advice to patients that is not free from consideration of what may benefit the surgeon personally or failing to ensure time allocated to NHS commitments is used appropriately.
- Inaccurately representing research findings, not documenting failures and successes equally or accurately presenting findings to peers.
- Misrepresenting training, qualifications and memberships – either deliberately or inadvertently making a false representation of the surgeon’s skills and experience in their CV or other documentation
Where a surgeon’s probity is called into question, it is often the case that their credibility among colleagues is affected. Colleagues may lose respect for the individual and devalue their judgements and advice. In the most serious circumstances, it could lead to resentment and hostility that may undermine the work of the department.