From: Jane Smith [JSmith@bmj.com]
Sent: 02 December 2010 09:46
To: Charlotte Dewar
Subject: Ref 105661
Dear Ms Dewar
I am responding to your letter of 26 November to Dr Godlee, which arrived in our office on 1 December.
Firstly I must apologise to Dr Pal that she did not get a response from us to her email of 17 November. Dr Pal will know that she has sent us several emails recently and they take some time to deal with. Nevertheless, we should have acknowledged her email of 17 November because we were in fact dealing with it.
Dr Godlee passed Dr Pal’s email to me to deal with; I spent some time reading the article and the reference it cited, and Dr Pal’s email. I then had a short holiday and a short period of illness, and as a consequence got rather behind with my work, including this email from Dr Pal. I was actually just about get round to responding to Dr Pal this week.
The conclusion that I came to on reading the article and the passage that Dr Pal referred to and the reference that it cites was that Dr Pal had a point, but that her claim that the conclusion was utterly wrong seemed too strong. I was also not clear from her email why she was making so strong a statement.
Dr Pal also claims that the editor had prior knowledge of the case and failed to check the judgement. Neither the editor nor any of her staff had any specific knowledge of this case.
I should also point out that we do not routinely check all the references that our authors cite in their articles. Our policy is to be liberal with letters to the editor and corrections when something is wrong or arguably interpreted.
So at the point when your letter arrived I was coming round to the conclusion that the best option would be for Dr Pal to respond in a letter to this article.
In fact her complaint to you clarifies that she is in fact concerned about three factual inaccuracies. None are entirely straightforward, so we would still suggest that Dr Pal sends a letter in response to the article.
They all relate to one passage in the article by Gooderham and Dewar at http://careers.bmj.com/careers/advice/view-article.html?id=20001325
"But this assertion (which is disputed by RemedyUK) cannot be reconciled with another GMC case, upheld by a High Court judge,[6] where it was ruled that a doctor who was no longer engaged in medical practice should nevertheless be investigated for possible misconduct after she had written something on a blog unrelated to medicine"
The first inaccuracy Dr Pal claims is that she was engaged in medical practice (contrary to what the authors say). It does seem from the administrative court judgement [reference 6] that at the time of the complaint she was engaged in medical practice, but the same document also shows that at some stage during the GMC’s consideration of the complaint and before it had been dismissed she became not engaged in medical practice.
The second inaccuracy is that Dr Pal had not “written something on a blog” as the authors say but had linked to another site. I think that might be a rather fine distinction, lost on most of our readers. The administrative court judgement that the authors were citing used the term that she had “referred” in her blog to a record of proceedings held before a committee of the BPS that enabled those to go to the record. Since the authors of the BMJ article probably didn’t have access to the blog itself, I think they have assumed it was “written” – and in a loose sense a link is “written on a blog”: it’s certainly there to be read. I’m also not sure what hangs on the issue of whether it was words that were written or a link inserted.
The third inaccuracy is that the blog was related to medicine. Again that is additional information that Dr Pal has, that was not available to the authors of this article. If their source was the administrative court judgement all they knew was that the subject of the referred-to website was the issue of fitness to practise of a psychologist. It’s not inevitable that the fitness to practice related to medical fitness.
Clearly, however, Dr Pal’s information in her email does to some extent weaken the point the authors were trying to make.
In these circumstances we think the best option is for Dr Pal to write a letter making the point that she was practising as a doctor at the time of the complaint and pointing out information that may not have been entirely clear to the authors. The most important of these is that in her blog she was “referring to” an issue related to medicine because it was about the person’s mental health. If she thinks it important to specify that it was a link and not her own words that was the subject of the complaint then that is fine too. She might also want to point out that although the GMC’s registrar did make a preliminary investigation of some of these complaints and refer them to the cases examiner the complaints were thrown out by the cases examiners.
Alternatively we could publish a correction that said that Dr Pal was working as a doctor at the time of the complaint. The other points seem less amenable to a factual correction and the authors of the article may not agree to them. We’d therefore suggest a letter is preferable.
Your sincerely
Jane Smith
Deputy editor, BMJ
My response
dr.ritapal@gmail.com
18th December 2010
Dear Ms Dewar,
Thank you for your email dated 3rd December 2010, in which you responded to my complaint against the British Medical Journal (BMJ) and enclosed a response from Ms Smith, a Deputy Editor of the BMJ. I have now had an opportunity to review both your suggestions and Ms Smith's response, and have set out my comments below, beginning with those pertaining to Ms Smith's submissions.
1. I am pleased to note that Ms Smith feels able to acknowledge at least one factual inaccuracy in the published article, and has offered to print a correction. Although far from adequate, this is a step in the right direction, and suggests that an amicable resolution may, eventually, be possible. Unfortunately, it is seriously undermined by a number of Ms Smith's other comments, which are, I fear, fairly typical examples of the BMJ's Cavalier attitude towards accuracy and integrity.
(a) I am sure you will have noticed that the article in question was by Gooderham and Marks, not, as Ms Smith asserts in her email to you, Gooderham and Dewar.
(b) With respect to the BMJ's delay in responding to my correspondence, it should be noted that:
i. Dr Godlee and I were in regular communication by email during the relevant period. She responded to other matters, but failed to address the issue under consideration here.
ii. The BMJ employs no less than three Deputy Editors and three Associate Editors. I find it extraordinary that none of these individuals were able to respond to my email. Indeed, it suggests to me that either the complaint handling system in place at the BMJ is unfit for purpose, or my complaint was considered unimportant. In either case, delays like this have considerable impact upon anyone attempting to seek a resolution to defamatory or inaccurate material.
(c) Ms Smith claims that the BMJ does not routinely check all the references that authors cite in their articles. I have not had sight of any of the BMJ's internal policy documents that could support this disturbing claim, and I find it extremely difficult to believe for a number of reasons.
i. The BMJ's own website states, “The BMJ’s vision is to be the world’s most influential and widely read medical journal. Our mission is to lead the debate on health and to engage, inform, and stimulate doctors, researchers, and other health professionals in ways that will improve outcomes for patients. We aim to help doctors to make better decisions”.
ii. How could the BMJ hope to fulfil any of these lofty aspirations if it does not routinely check references in the articles it publishes? A flagship journal must be – and be seen to be – unfailingly accurate, and it is very difficult to see how it could hope to be influential, widely read and help doctors make better decisions when its editorial staff freely admit to publishing unverified material as “fact”.
iii. Such behaviour is both damaging to researchers, who are entitled to rely upon the veracity of material published in an authoritative journal such as the BMJ, and dangerous to members of the public, who are equally entitled to trust material published in the BMJ, but are less likely to be in a position to notice fallacies and inaccuracies.
iv. Moreover, in my experience, such a lackadaisical attitude is unique amongst all the other publications that I have written for. Editors of even the smallest publications insist upon checking articles and references for factual inaccuracies prior to publication, and it seems most unlikely to me that the BMJ could afford to be any different in this regard.
v. On the other hand, if Ms Smith's claim is, indeed, representative of the BMJ's operating procedure, it seems to me that this supposedly-reputable journal is displaying a grossly arrogant, negligent attitude, and placing both the public and the medical profession at risk in the process.
(d) Ms Smith further states, “Dr Pal also claims that the editor had prior knowledge of the case and failed to check the judgement. Neither the editor nor any of her staff had any specific knowledge of this case”. I am horrified that Ms Smith feels able to make such a blatantly incorrect statement. As you will see from the documents set out in enclosures 1,2 and 3, I wrote to Dr Godlee, in her capacity as Editor of the BMJ, regarding R v General Medical Council Ex Parte Pal on 16th March 2009. I enclosed a copy of the pre-action documents, which contained full details of the case in question. She responded on the 16th March 2009 [to the first email of that day], saying, “Dear Rita, thanks for this information. Let me check with colleagues. One of us will get back to you. Please do send a rapid response as well. Best wishes, Fiona”.
(e) Clearly, the editorial staff were fully aware of the case, despite Ms Smith's claims to the contrary. I can only assume that Ms Smith's denial is either a further example of appalling editorial incompetence or an equally incompetent – and, indeed, downright dishonest – attempt to mislead you and discredit the allegation I have made.
(f) With respect to my complaint, Ms Smith says “The conclusion that I came to on reading the article and the passage that Dr Pal referred to and the reference that it cites was that Dr Pal had a point, but that her claim that the conclusion was utterly wrong seemed too strong. I was also not clear from her email why she was making so strong a statement.” It is difficult to know where to begin when faced with such an obtuse interpretation of the article, passage and reference, and, indeed, I cannot help wondering whether, even now, Ms Smith has actually read, much less understood, the material she purports to have read.
i. I am gratified that Ms Smith now acknowledges that, contrary to the wording of the article, I was engaged in medical practice at the material time. This, at least, appears to be beyond her capacity to dispute, although I am disappointed by her attempt to mitigate the earlier error by pointing out that I subsequently ceased to be so engaged before the GMC had dismissed the complaint against me; the whole point of the case set out in the reference that she claims to have read was to determine whether or not the GMC's Registrar was correct in choosing to progress the complaint against me from initial consideration by the Registrar to more detailed consideration by the GMC's Case Examiners. At the time that decision was made, I was engaged in medical practice – whether or not that engagement persisted beyond the Registrar's decision is irrelevant to the point under consideration.
ii. For the avoidance of doubt, I should point out that a doctor need not be engaged in medical practice in order to be subject to the GMC's Fitness to Practise procedures. As long as a doctor's name appears on the Medical Register (a list of doctors entitled to practice, the maintenance of which is the GMC's primary function), their conduct is bound by the terms of Good Medical Practice, the GMC's guidelines on acceptable behaviour for doctors. This is true regardless of whether the doctor in question is working as a doctor, is serving on the checkout in their local Tesco, or, indeed, is not working at all.
iii. When the GMC receives a complaint about an individual whose name appears upon the Medical Register, an essential element of the Registrar's initial consideration of that complaint is to determine whether the behaviour complained of is capable of amounting to misconduct, and, if so, whether that misconduct impinges upon the doctors ability to practice medicine. It is upon this consideration that the Registrar's decision to progress or dismiss a complaint must turn.
iv. Ms Smith's inability to fathom the difference between “writing something on a blog” and publishing a link to another website is somewhat disturbing. She suggests that this is a “fine distinction, lost on most of our readers”, but, in reality, I suspect she is merely defining her own incomprehension, for the two are, in truth, quite different, both practically and legally. Furthermore, I suggest that the distinction would not be lost on any of the many doctors who both operate their own blogs and are likely to read (or have read) the article in question. The BMJ has an obligation to provide accurate information to those who will understand it, and may even rely upon it, even if the subtleties of that information are lost upon the publication's administrative staff.
v. Ms Smith appears to be equally confused about the nature of the blog in question. She writes, “The third inaccuracy is that the blog was related to medicine. Again that is additional information that Dr Pal has, that was not available to the authors of this article. If their source was the administrative court judgement all they knew was that the subject of the referred-to website was the issue of fitness to practise of a psychologist. It’s not inevitable that the fitness to practice related to medical fitness.”
vi. Again, the scope of Ms Smith's confusion is disturbing. The blog that was related to medicine was my blog, not, as Ms Smith appears to think, the website to which I published a link – I am at a total loss as to why Ms Smith should think otherwise, in the context of Gooderham and Marks' article (“it was ruled that a doctor who was no longer engaged in medical practice should nevertheless be investigated for possible misconduct after she had written something on a blog unrelated to medicine”). Nonetheless, this confusion clearly demonstrates the inherent ambiguity of the article, and strongly suggests that further correction is in order.
vii. Furthermore Ms Smith makes a number of assumptions with regard to the authors' knowledge at the time the article was prepared. Again, for the avoidance of doubt, I can confirm that
A. Richard Marks is a long term acquaintance of mine. We have discussed both the Remedy UK case and my case in great depth, and he was given ALL of my legal documents as my case was cited through the permission and final hearing of the Remedy UK case. It is, therefore, unacceptable, unscientific and unprofessional of Ms Smith to make claims on his behalf.
B. Peter Gooderham, a qualified lawyer, has known of my case since 2007, clearly indicating that he has had ample opportunity to seek more information that the administrative court judgement that Ms Smith so eagerly assumes to be the source of his misunderstanding.
viii. Taking these points together, it is difficult to see how Ms Smith could consider the extract in question (“it was ruled that a doctor who was no longer engaged in medical practice should nevertheless be investigated for possible misconduct after she had written something on a blog unrelated to medicine”) to be anything other than utterly wrong: I WAS engaged in medical practice, (and even if I had not been, that would have had no relevance as long as my name was on the Medical Register), I DID NOT write the material complained of, but instead published a link to another, 3rd party website containing the material in question, and the blog on which I published the link WAS related to medicine. A more complete misrepresentation of the true situation would extremely difficult to achieve.
(g) I am sure you will appreciate that, having faced a baseless enquiry into my professional conduct, it is extremely unpleasant, not to say downright distressing, for me to see the circumstances of that investigation blatantly misrepresented in one of the foremost medical journals. Such is the reputation of the BMJ that its portrayal of events will be taken at face value, leaving me with the unenviable task of contradicting a leading journal whenever I need to correct misunderstandings.
(h) Of even more concern to me, however, is the wrong impression this material creates for other doctors – particularly doctors who operate blogs or other forms of publication, especially if they, too, are facing a GMC investigation into their blogging activities. Such doctors are likely to be even more technically inclined than their colleagues, and will almost certainly research their predicament via the internet. Their researches will lead them to the (allegedly) authoritative BMJ, and the flawed article by Gooderham and Marks. Of course, they may notice the errors in the article of their own accord, or they may not rely upon the article at all, but that cannot be guaranteed. The BMJ has an obligation to provide accurate information to those who may seek it, and cannot excuse blatant errors by claiming that the subtleties of the situation will be lost on most readers – or, to put it another way, nobody will notice, so it doesn't matter if the article is factually incorrect and creates entirely the wrong impression.
2. Turning to your comments and suggestions, I note Ms Smith's proposal for publishing a correction regarding my engagement in medical practice at the material time and her proposal that I should write a letter setting out my position with respect to the other points I have raised, and I thank you for your offer to mediate such a letter. Unfortunately, I do not believe that such a solution would be entirely appropriate, as I have set out below:
(a) I welcome Ms Smith's offer to print a correction, but her suggestion that I should write a letter is not workable. Firstly, I have accepted such an offer to correct misunderstandings from the BMJ before, only to find that the letter, or online message (so-called Rapid Responses) is never published. Secondly, such a letter would imply a mere difference in interpretation of accepted facts between me and the authors, a matter of academic debate rather than the establishment of truth over falsity.
(b) This is, of course, not the case. When considered objectively, there can be no question that the material published in the BMJ was blatantly incorrect, and that the BMJ's response to my complaint has been disingenuous at best. During preparation of the article, the BMJ had a number of opportunities to ensure that it was correct:
i. It was open to the editorial team to read the judgement referred to with a view to ensuring the accuracy of the published article. This was, apparently, not done.
ii. It was open to the editorial team and / or the authors to contact me in order to verify the facts of the case. Such basic research is a given in other publications, and would have been easily achievable in this instance as I am known to both the authors and the editorial team, yet it was not done or, indeed, even suggested.
iii. It was open to the editorial team to obtain a legal opinion of the material presented if, as appears from Ms Smith's comments, it was beyond their own comprehension. Again, this was not done.
(c) Having failed to ensure accuracy before publication, the BMJ now appears to be avoiding accountability for its own errors by fobbing me off with an offer to write a letter. Needless to say, this is unacceptable.
(d) Instead, I suggest that the BMJ should publish:
i. an acknowledgement that the material complained of was incorrect; and
ii. an apology for the error; and
iii. a correction to the paragraph in question, along the lines of the facts set out above.
(e) This proposal is not too far removed from the BMJ's initial offer, and I am sure that both the journal and the authors would welcome the opportunity to set the record straight rather than continuing to mislead and misinform their readers. Perhaps, based upon your earlier offer, you would be willing to mediate on the precise wording of this correction?
I look forward to hearing from you.
Kind regards,
Dr Rita Pal.
Dedicated to the petulant Richard Marks . Despite having access to my case papers, he failed to read them or understand the important relevance to ethnic minority doctors. When I asked him to correct his mishap, he felt it was unimportant. Then we could have all taken that stance when he asked for help on his own case against the GMC. 
