UK & Europe
Regulated professionals will be familiar with the need to show insight and reflection. It is common – if not expected – that registrants submit reflective pieces before appearing before fitness to practise committees.
Indeed, in July 2019 nine of the healthcare regulators issued a joint statement on the importance and benefits of being a reflective practitioner. But does that really matter? Or is a reflective piece just a box to check? The case of Dhoorah v NMC  EWHC 3356 (Admin) reminds us they are far more than perfunctory.
Mr Dhoorah is a registered nurse. The NMC found he had discussed the perineum with a student nurse, locked himself in a bathroom with that student nurse, unzipped their trousers and pulled down their boxer shorts, exposing his genitals, and touched the student nurse on his inner thighs. He told the student nurse not to tell anyone. All but the first act were denied. The panel concluded that Mr Dhoorah's actions were inappropriate, sexually motivated and lacking in integrity. The panel concluded his fitness to practise was impaired on the ground of public interest and suspended his registration for 12 months followed by a review hearing. They advised that any review panel would be assisted by a reflective piece on the learning Mr Dhoorah had undertaken around professional boundaries.
Mr Dhoorah did not attend the review hearing but his representative sent in written submissions along with a reflective piece written by Mr Dhoorah, two testimonials, a list of reading that he had undertaken, and a CPD certificate. The review panel concluded that Mr Dhoorah's fitness to practise remained impaired. Of the reflective piece, they said:
"Mr Dhoorah’s reflective piece read like an academic essay, and did not address the concerns raised by the substantive panel. The only part of the reflective piece written in first person concerned the impact of the suspension on him personally."
The review panel also expressed their reservations about the two testimonials, commenting that they attested to his clinical practice but were silent on the issue of an abuse of power and sexual assault on a junior colleague. They imposed a further period of suspension.
Mr Dhoorah appealed. One ground was that the review panel was wrong to disregard his reflective piece and testimonials. Though the review panel was entitled to criticise his reflective piece, he had attempted to do what the initial panel had recommended.
Mrs Justice Eady agreed with the review panel that the reflective piece read more "like an academic essay". Further, "the problem with this evidence was not one of form but of substance". The review panel had to assess whether Mr Dhoorah had demonstrated insight into his serious misconduct. Mrs Justice Eady noted that it was "entitled to find that could not be done by means of a highly theoretical work focusing on nurse-patient relationships rather than the specific misconduct found in this case". The testimonials had similarly failed to engage with the substance of the misconduct. The appeal was dismissed.
Reflective pieces are more than a hoop to jump through. They should be properly focussed, concrete and – it should go without saying – reflective. The registrant should genuinely reflect on how the public would view their behaviour, how the profession views it, and how they view it in hindsight. Repeated reflection across months can show the development of the registrant's insight over time. This case is also a reminder that insight does not mean an admission of the allegations, but it can be difficult to have the former without the latter.