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  6. Case type 2 dishonesty
Guidance introduction

Case type 2: dishonesty

  1. Honesty is a basic quality that is expected of all, based on shared moral values. It involves being truthful about important matters and respecting the property rights of others. Dishonesty is a disregard for this shared moral value and can be used to describe a lack of probity, cheating, lying or deliberately withholding information.

  2. Whether behaviour is dishonest is judged by considering what is known about a doctor’s knowledge or belief of what they were doing and assessing if that is dishonest by the standards of ordinary decent people. There is no additional requirement for a finding of dishonesty that the doctor must appreciate that what they have done is, by those standards, dishonest.

  3. Dishonest behaviour can include a wide range of actions or omissions which may arise inside or outside a doctor’s working life. When dishonesty arises in a doctor’s working life, their behaviour may be directed towards patients, former patients, relatives of patients, colleagues,21 the organisation the doctor is working for, or seeking to work for, or their professional regulator(s). Outside a doctor’s working life, dishonesty may be directed at any person or organisation.

The professional standards doctors are expected to meet

  1. Honesty is at the heart of medical professionalism and is essential for the public to have trust in doctors and the systems they work in. Doctors must make sure their conduct justifies their patients’ trust in them and the public’s trust in the profession.22 They must follow the law23 and always be honest about their experience, qualifications and current role.24

  2. Good doctors are open and honest with patients if things have gone wrong. Doctors must respond promptly, fully and honestly to complaints and apologise when appropriate.25

  3. Documents made by doctors to formally record their work (including patients’ medical records) must be clear, accurate, contemporaneous and legible.26 When writing references and when appraising or assessing the performance of colleagues, doctors must be accurate, fair and objective.27

  4. Doctors must be honest and trustworthy when writing reports, completing or signing forms, reports and other documents, and when giving evidence to courts and tribunals. They must make sure that any information they communicate is not false or misleading. Doctors must take reasonable steps to check the information is correct, must not deliberately leave out relevant information or present opinion as established fact.28

  5. When communicating publicly as a doctor, they must be honest and trustworthy, not exploit people’s lack of medical knowledge and declare any conflicts of interest.29

  6. Conflicts of interest may arise in a range of situations. They are not confined to financial interests and may also include other personal or professional interests. Doctors must not allow any interests they have to affect, or be seen to affect, the way they propose, provide or prescribe treatments, refer patients or commission services.30 Nor must they ask for, accept or offer an incentive which may affect, or be seen to affect, these things.31

  7. When designing, organising, or carrying out research, doctors must put the interests of participants first, act with honesty, follow national research governance guidelines and GMC guidance.32

Seriousness

  1. Whilst a range of behaviour can be seen, the nature of the departure from the standards expected may mean that a concern or allegation relating to dishonesty falls at the high end of the spectrum of seriousness. Even a single incident of dishonesty can have a significant harmful impact and pose a risk to public protection.

Impact on public protection

In cases of dishonesty, the different parts of public protection might be engaged as follows:

Protecting, promoting and maintaining the health, safety and wellbeing of the public (patient safety)

Dishonest behaviour may impact the physical, emotional and/or psychological wellbeing of a patient or member of the public, including colleagues, or cause financial harm. These impacts can be long lasting and may affect how a person accesses health services in the future.

Where dishonest behaviour has impacted, or could impact on patient care, there is a clear risk to patient or public safety. Examples include:

  • falsifying records
  • failing to act honestly and with integrity during drug trials
  • providing false or misleading references or information on a CV resulting in the doctor being appointed for a role they do not have the skills to perform safely  
    theft of resources, such as drugs from a hospital.

Where a doctor is dishonest in their interactions with colleagues, this can cause breakdowns in communication and/or in the collaborative working needed to deliver safe patient care.

Promoting and maintaining public confidence in the profession (public confidence) 

Patients and members of the public must have confidence in doctors to behave professionally and act with honesty and integrity. Dishonesty arising inside, or related to, a doctor’s professional practice may result in a breakdown of trust and undermine public confidence.

Exploiting patients financially and/or not maintaining boundaries through proper financial processes undermines the trust of patients and may risk public confidence in the profession.

Dishonesty related to matters outside the doctor’s clinical responsibility, such as providing false statements or fraudulent claims for monies, can undermine public confidence. The public should be able to trust the integrity of medical professionals, and where a doctor undermines that trust it may risk public confidence in the profession.

Where dishonest behaviour arises in a research context, such as by presenting misleading information in publications or clinical drugs trials, this can have far reaching consequences and undermine the trust that both the public and the profession have in medicine as a science, regardless of whether it leads to direct harm to patients.

Dishonesty arising outside a doctor’s professional practice can also undermine public confidence. This is particularly the case where the dishonest behaviour resulted in a criminal conviction.

The public having confidence in the profession is more important than the interests of an individual doctor.

Promoting and maintaining proper professional standards and conduct (upholding professional standards)

Good medical practice requires that doctors are honest, trustworthy, act with integrity and uphold the law.

Identifying and managing conflicts of interest provides guidance on how to recognise when conflicts of interest arise, how to avoid them wherever possible, and requirements for declaring and managing them.

As doctors are expected to be honest and act with integrity, dishonest behaviour will usually amount to a significant breach of the professional standards.

Decision on interim order

  1. Where the concern or allegation relates to dishonesty in the workplace or otherwise arising from the doctor’s professional practice, or the doctor is under police investigation for a dishonesty offence, the interim orders tribunal (IOT) should carefully consider the public interest, and the impact on public confidence if the doctor were to continue working unrestricted pending resolution of the fitness to practise process.

  2. More detail about when an interim order is likely to be appropriate in a dishonesty case can be found in the specific case types section in Section 2: IOT hearings.

Decision on impairment

  1. Many allegations relating to dishonesty fall at the higher end of the spectrum of seriousness. Where they do, the starting point for assessing current and ongoing risk to public protection will be high.

  2. In these cases, evidence of relevant context known about the doctor and/or their working environment and evidence of insight and remediation that decrease risk may have less impact because dishonesty allegations falling at the higher end of the spectrum of seriousness can be more difficult to remediate.

  3. In such cases the medical practitioners tribunals (MPT’s) decision on risk should reflect this and a conclusion the doctor poses a current and ongoing risk to public protection may be needed even in cases where the doctor has shown insight and taken steps to try and remediate. Where the MPT concludes that the doctor poses a current and ongoing risk, this will result in them finding that the doctor’s fitness to practise is impaired.

  4. The level of risk associated with a dishonesty allegation will often be medium or high. However, where there is a single incident of dishonest behaviour which falls at the lower end of the spectrum of seriousness, the level of risk may be lower.

  5. Where a dishonesty allegation leads to a finding of impairment, it may engage one or more of the three parts of public protection. Whilst the MPT must consider the individual circumstances of the case, it will be unusual for a proven allegation of dishonesty not to undermine public confidence in the profession.

Decision on whether a warning is required

  1. Where a dishonesty allegation falls at the higher end of the spectrum of seriousness, a conclusion that the doctor poses a current and ongoing risk to public protection will often have been made. However, where the specific type of behaviour amounting to dishonesty is found to have just fallen short of a finding that the doctor’s fitness to practise is impaired, and there are no other proven allegations that require restrictive action to be taken, a warning will usually be appropriate to maintain public confidence in the profession and uphold professional standards.

Decision on sanction

  1. The proportionate sanction in response to an allegation of dishonesty will depend on the extent of the doctor’s behaviour and the impact it’s assessed to have on each of the three parts of public protection. 

  2. Where the level of current and ongoing risk to public protection is medium or high, this will require consideration of suspension or erasure. 

  3. When deciding on sanction, the medical practitioners tribunal (MPT) should consider the sanctions banding for dishonesty cases in Part C of Section 3: MPT hearings.

Lower level of risk to public protection Medium level of risk to public protection Higher level of risk to public protection
Suspension up to 3 months Suspension 3 to 9 months Suspension 9 months to Erasure

  1. In dishonesty cases, evidence about the impact of a specific type of restrictive action and references and testimonials will have limited, if any, relevance to the medical practitioners tribunals (MPT’s) decision about what sanction is appropriate. 

  2. For dishonesty cases involving a criminal conviction or caution, the MPT should also refer to the specific case type section Criminal convictions, cautions, court sanctions and determinations. Where there is more than one type of proven allegation, the MPT should impose the sanction that addresses the risk posed by the most serious findings.

21 Colleagues include anyone a medical professional works with, whether or not they are medical professionals.

22 Good medical practice, paragraph 81.

23 Good medical practice, paragraph 4.

24 Good medical practice, paragraph 82.

25 Good medical practice, paragraphs 45 and 46.

26 Good medical practice, paragraph 69.

27 Good medical practice, paragraph 62.

28 Good medical practice, paragraph 89.

29 Good medical practice, paragraph 90.

30 Good medical practice, paragraph 94.

31 Good medical practice, paragraph 96.

32 Good medical practice, paragraph 85.