Feeling guilty? Jury service for doctors

You come home after a busy day at work to find a letter on the doormat. It looks important. Opening it you notice the imposing red font and realise it is a court summons and your first thought is ‘what did I do!’ Quickly you realise it’s not you who has to stand in the dock but it is instead a jury summons. ‘But I’m a doctor, I don’t have the time for jury service. I can’t attend, I’ve got fully booked clinics and I’m on the on-call rota. Surely they’ll understand my special circumstances… won’t they?’


Learning objectives

1. Managing a jury summons as a doctor (your Honour)

2. Considering the potential implications of jury service on your work, training and finances (my Lady)

3. Exploring the nature of democratic decision making in medicine (my Lord)


Beside wondering how you address the Judge, you may have a number of other pressing thoughts running through your head.

But other people get out of jury service all the time, so I can too!

Almost immediately after you receive the summons you may consider how you might be excused. You ask your family, friends, colleagues and look at online comments. They may all provide ‘useful’ advice but often you’ll receive supposed anecdotal examples of how someone said this thing or that to evade duty. Often these excuses relate to issues of impartiality. Look at the example of what some of the the jurors said in the case of Martin Shkreli, the man who increased the cost of Daraprim in the US by 5,000% and disrespected the Wu-Tang Clan.

In many of the examples you encounter, the excuses relate to the specifics of a particular case, not the idea of being a juror in itself. Being impartial in one case doesn’t necessarily mean you’ll be impartial in all cases. There are indeed legitimate reasons for not being able to participate in jury service that allow deferral or excusal such as: booked holidays, planned medical procedures (in the context of being a patient), being detained under the Mental Health Act, lacking mental capacity, being on bail in criminal proceedings, being sentenced to imprisonment/detention (within a specified period of time) or having recently served as a juror.

But doctors are special. Doctors have important responsibilities, even public service responsibilities. Surely it’s not only an inefficient use of resources to deploy doctors to jury service but also potentially unsafe for patients.

Prior to the 2004, doctors (and some other professionals) could ask to be automatically excused from jury service in the UK. However, this is no longer the case and doctors are like everyone else. Junior doctors, senior doctors, salaried doctors and self-employed doctors are all equally un-special. Excusal only happens in exceptional circumstances. The expectation is that everyone summoned will serve.

You may be able to defer jury service if your absence will have a serious effect on business, but you must explain in writing why this is the case (and your reasons may be deemed insufficient). Seeking specialist advice from your medical union/association would be advisable in such circumstances. You may only defer once a year and provide your future availability. You should think carefully about deferral; providing potential dates for availability will reduce scope for flexibility in the future should your circumstances change.


Questions

What feelings might you experience if summoned?

Do you think you have a sense of over-responsibility for patients and colleagues?


But what about my colleagues, I can’t dump my workload on an already overstretched department!

Many doctors work in busy environments. This has become normal. Either as a result of cost-cutting, profit making (or perhaps even managed decline), many healthcare facilities are considered understaffed and/or under-resourced. There is little to no flexibility in the system.

As juror you need to be alert while the case is being heard. The recommendation is that jurors avoid night shifts before a day in court or work weekends if it means jurors haven’t had a break from jury service or work for 7 days. Some rota managers may try to make doctors called up for jury service to ‘pay-back’ their missed on-call days once they have returned to work. This insidious request may require the intervention of your medical union; imagine how dangerous the working week might be when you returned to work with multiple on-calls in a short space of time potentially without any breaks. I’m feeling tired just thinking about it.

If one doctor being called up to jury service is going to be catastrophic for patients and colleagues, it should tell you more about the resilience of the department than the doctor being summoned to be a juror.


Questions

How do you think your colleagues will manage with your absence?

Should doctors or administrators be responsible for rota management?

Who is responsible when a tired doctor makes a mistake?


But what about the impact on my training!

There have been concerns that time spent away from training will have an impact on junior doctors. Although jury service is not specifically mentioned, in the UK the General Medical Council (GMC) have determined that 20 days is the maximum permitted absence in each year of the FY1 and FY2 Programme. This is echoed by Health Education England (HEE) who do specify jury service as a reason for absence. Seeing that jury service usually lasts up to 10 working days the 20 days rule should generally be be enough for trainers to allow trainees to be summoned without too much concern.

Interestingly however, one Foundation school advocates deferral for FY1 or FY2 doctors stating that attending jury service will delay trainee sign-off. This seems peculiar not only because of the GMC guidance but also since if someone is planning to defer they must provide the periods in which they will be available for service over the subsequent 12 months. Not only is this generally impossible for many trainees to provide (since rotations are not usually planned very far in advance and may cover a number of different employers) but also deferral will presumably just affect their sign-off in subsequent training (e.g. ST1).

A number of specialist trainee/vocational training schemes appear to have their own bespoke rules regarding jury service absence, although I struggled to determine how these decisions were made or the thought process behind them to try and explain the variation. One even advises no more than 1 weeks leave in any single post; this advice is therefore incompatible with the current demands of jury service creating an impossible situation for trainees.

As for medical students, they should contact their medical school since they may be able to defer to avoid clashes with examinations .

Personally I do think it is important to remember that doctors in training shouldn’t be bullied or punished by their seniors or schools for being randomly selected for jury service, something that we should all remember is beyond trainee control. Additionally, for one training institution to merely pass the buck to another by asking trainees to defer when really they shouldn’t have to also seems selfish and parochial. It would be nice if as a profession we could remember to be compassionate not only to our patients but also to our doctors in training.


Questions

What is your local advice for absence related to jury service?

Does it need to be amended and if so, who is responsible?

Is the process on how are such decisions made transparent?


But what about the impact on my finances!

There appears to be a myth that the court will cover your lost earnings during your time as a juror. This is indeed a myth. They are measures to reimburse but there is a cap. At the time of writing this post, the daily cap in the for loss of earnings was about £65 per day. Compare this to the daily rate of a locum GP at approximately £500 (depending on where you work and the duties performed). There is a similar daily cost for a hospital locum, although there is considerably more variation in secondary care depending on speciality or seniority. In any case, the costs of replacing a doctor are much more than the jury service daily cap allows. Be prepared to be asked to take unpaid leave.

Some organisations may have jury service insurance cover for their employees, or indeed, some self-employed doctors (e.g. GP Partners or locum doctors) may have personal cover too. One factor to consider is that there may be a maximum limit to any single claim. This limit may become important when factoring in the length of time jury service may potentially last as well as the costs incurred to replace a specific clinician. Such claims may also require proof of the juror’s daily income, a certificate of attendance from the court (indicating the dates and number of days attended on jury service) and a breakdown of any payments made by the court directly to the juror.


Questions

Do you (or your employer) have Jury Service insurance cover and if so, what is the maximum payout?

How much would another clinician charge to cover your duties for two weeks (or potentially even more)?

If you are self-employed, your income may vary significantly throughout the year, so how will you be able to provide accurate information about your daily income?


But err…

Jury service is an interesting experience for individuals used to working in healthcare. The lack of interruptions, the opportunity for a guaranteed lunch, getting home as panned and the luxury of time to make a decision with others. It’s an alien environment that will make you reflect on your normal working life.

Doctors can bring their skills and experience to the jury. Critical thinking, communication and leadership are a few. You may also need to remember your stockings if you’re not used to sitting down for long periods as there are case reports of DVT.

Are there perhaps some more fundamental issues with doctors and jury service? Medicine isn’t a democracy; we are experts in our field and holding a public vote on what should be done the next time someone presents with cellulitis sounds ridiculous. Shouldn’t the jury be made of experts who can understand the specifics of the case and reach an informed decision?

We are also often used to making important decisions alone even if we don’t work in isolation. That’s the nature of the job. Perhaps the idea of reaching a consensus verdict sits uneasy with many healthcare professionals. We often search for binary solutions to managing even complex medical problems. Patients also normally expect a clear cut answer or plan of action. But as medicine becomes more complex with a multitude of guidelines and ever increasing research data, uncertainty in medicine is increasingly unacceptable despite simultaneously being inevitable. Doctors have become experts in managing uncertainty, but how does that manner of thinking work in the context of a jury trying to reach an unanimous verdict?


Questions

Wouldn’t you want a doctor as a juror if you were the one on trial?


If you have any experiences of jury service as a medical professional, please consider sharing some thoughts in the comments section below.


Summary

A contingency plan for jury service is something that all doctors and employers of healthcare professionals should consider. There are potential implications for training but local guidelines on the issue may not be compatible with the demands of being a juror. Overstretched healthcare services should factor doctors being absent due to jury service. Blaming the doctor and burdening them with the responsibility to manage the situation is unfair. The financial implications of jury service can be considerable and individual doctors should consider their personal circumstances and what measures are in place to prevent hardship. After all that, doctors may find jury service a refreshing change where they have an opportunity to reflect on their normal working lives and they way in which they think.


Further resources

Jury service (UK government website)
https://www.gov.uk/jury-service

Jury service guidance for medical practitioners summoned for jury service
https://www.lmc.org.uk/visageimages/guidance/2005/juryservicenov05.pdf

A juror’s verdict
https://www.bmj.com/content/336/7635/s11

It could be you … jury service
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2042565/

Jury service for GPs
https://www.wessexlmcs.com/juryservice

A salaried GP is called for jury service: what comes next?
http://www.firstpracticemanagement.co.uk/blog/posts/a-salaried-gp-is-called-for-jury-service-what-comes-next/

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