When childcare becomes a clinical risk
Recently, the news headline of a GP suspended for five months for dishonesty has been making the rounds. Dr Eisenhauer was found to have made false patient appointments in her calendar to prevent overruns and leave on time. A workaround that looks like individual misconduct, until you ask what kind of culture makes that feel like the safest option.
This is a fitting example to highlight leadership accountability and how fundamental it is to have policies that serve the business in place to protect and enforce the ways of the culture. Recognise who is ultimately preserving what is being built and the response of the leadership when clarity is missing.
The diary is a culture report
What “blocked slots” and “protected time” really say about leadership priorities.
Having witnessed phantom meetings first-hand, seeing a GP openly named and shamed for resorting to such actions offers a stark insight into the culture of the practice. This wasn’t just diary management; it was a signal that the system did not provide a legitimate way to respect the individual and the rules they put in place.
I’ve spoken before about diary etiquette and the quiet disregard for other people’s time. There is usually someone who follows protocol to the letter, booking into any available gap, irrespective of whether it’s first thing in the morning, lunchtime, or just before closing.
That behaviour isn’t malicious. It’s procedural, making it precisely the problem. Building an internal community cannot come from standardised rules alone. When “desk time” or “no appointments” cannot be entered or is routinely overwritten, that absence speaks loudly. It’s a form of silence that tells people their boundaries are conditional.
When coping strategies fill the gaps, leadership leaves
In her personal reflection, the GP outlined the “strategies and support mechanisms” she has now put in place:
- Asking early for help when struggling with workload or time pressure
- Using double appointments appropriately for complex patients
- Following appointment-booking processes strictly rather than trying to “create time”
- Improved childcare arrangements, with more stable routines and shared responsibilities*
- Better personal boundaries, including recognising when fatigue affects performance
- A commitment to immediate honesty, even when uncomfortable or embarrassing
- Regular reflective practice to recognise risks early
Let’s be clear, the only item on that list (the one I’ve *) sits solely with the individual because the business shouldn’t be expected to manage people’s personal lives.
Every other point is a shared responsibility between the individual and leadership because the consequences do not fall on one person alone (even when only one person is subsequently suspended).
Autonomy without permission creates shadow policies
When people need unofficial workarounds, the official system is not fit for reality.
Policies and procedures are meant to structure the business and define its boundaries; leadership is accountable for how those boundaries are upheld and lived within the culture. Normalised deviation is what happens when policies exist, but safety doesn’t. Left unaddressed, it will spread and wreak havoc in the business.
Only then will leadership and the managers acting on its behalf be left with no alternative but to face tension within the team. Until that pivotal point, some will replicate the protective under-constraint behaviour, while others remain silent. In this instance, it is strongly implied that support staff identified the discrepancy and brought it to the attention of the partners.
That intervention occurred long before the tribunal and without it, the conduct may never have been formally addressed.
“Leadership only found out because the support team chose integrity.”
If this is starting to raise questions about how boundaries are being maintained in your business, the private mailing list is where these Ethical Insights are explored with continuity and care.
When accountability arrives too late
While an internal investigation process was followed, the GP did not believe she had done anything wrong, even as matters progressed toward a tribunal. This detail matters because it does not point to defiance; it points to normalisation.
Leadership did not own escalation, even once aware. Instead, the GP made a self-referral, with partners later providing recommendations at the tribunal hearing. Without the intervention of support staff raising the discrepancy in the first place, this conduct may never have reached formal scrutiny at all.
This is not a failure of insight at an individual level. It is evidence that the boundaries set by policy weren’t utilised in practice. When rules exist on paper but are not actively upheld, monitored or reinforced by leadership, people stop recognising when they have crossed them.
That’s exactly how someone can move through an investigation and still believe they have done nothing wrong.
Shadow policies don’t emerge from rebellion
They emerge from necessity (at least that is the belief of the person going against the structure of business).
Stories like this are rarely driven by ill intent. By following the trail, a familiar pattern appears:
- sustained pressure creating an imbalance,
- fear overrides competence, and
- two competing priorities collide, both carrying judgment, both risking failure.
It’s the ultimatum of being seen as an unreliable professional or being seen as a failing parent. It’s not a moral failing. It is a structural one.
“Dishonesty isn’t the first step. It’s the final coping strategy.”
Would concealment have been necessary if an adequate structure had existed?
This question surfaces repeatedly during ethical discussions about work culture, especially when the “benefits” listed don’t actually support people when pressure peaks.
Perhaps a more palatable question for founders is: What would have made honesty easier than hiding? Unless uncomfortable questions such as these are answered, meaningful change will never take place.
It permits the next person faced with a similar strain to choose the same deception because the system leaves no clean exit. When the 3Es Filter is applied, there is no plausible deniability; this isn’t a one-person story.
Patient safety includes records, not just care
Removing a GP from practice inevitably increases pressure elsewhere, redistributing strain across an already overextended ecosystem. However, ignoring the dishonesty isn’t a viable option because it corrodes trust just as quickly. We hear the stories time and time again where a person becomes “Teflon” because they are deemed indispensable.
This undermines the very foundations that patient safety depends on (and the safety of the culture). Either way, the cost does not disappear; it is simply transferred. That shouldn’t prevent the leadership team from enforcing the rules if they are serious about preserving the relationships and environment they have nurtured to this point.
Why “it was only two appointments” still matters when systems depend on truth
Some will argue this was a minor lapse; a small misjudgement in an overstretched profession, where punitive action ultimately harms the public more than it helps. This is often framed as compassion, but more often it’s avoidance; leadership choosing short-term relief over long-term integrity.
Without consequences, rules lose meaning. Those who try to do the right thing begin setting private boundaries that make sense only to themselves. This case illustrates why leadership carries responsibility for ensuring the right policies exist and are monitored, not merely enforced when brought to their attention.
A point to make very clear, monitoring is not about suspicion; it is about recognising when rules no longer serve the people expected to live by them.
When pressure becomes a safety issue, not a personal problem
Accurate patient records are a matter of health and safety, as is the well-being of those providing the care. The GP herself acknowledged that her practice served a large number of elderly and infirm patients, already under strain due to staff shortages. Her absence would place additional pressure on colleagues and while locums could be recruited, continuity of care (home visits, care home oversight) could not be fully replaced.
Along with that observation, she also admitted to being sleep-deprived and stressed. Both symptoms have the potential to have significant detrimental effects on performance when caring for others as a professional. There is no mention of what the practice had in place to be aware of such behaviours, especially in an understaffed environment.
While the reality doesn’t absolve the behaviour, it does widen the lens. When systems fail to support people properly, the cost is never contained. It ripples through teams, through services and ultimately through the very patients those systems exist to protect.
Ethical final orders
Support staff noticed and spoke up, bringing the issue to leadership’s attention. Yet the first decisive boundary was set not by the practice itself but by a tribunal.
When someone can work around policies, be investigated internally, and still believe they have done nothing wrong, the issue is not a lack of ethics; it’s a lack of lived boundaries.
This is where founders should feel uncomfortable
The question is no longer whether the GP’s actions were wrong. The question is why it took an external authority to clarify the matter. Take a pause and reflect on your own business.
If your rules only become real when someone junior risks their position to speak, then leadership isn’t managing culture, it’s living off other people’s courage.
When it isn’t clear who has been carrying that burden in the business, leadership isn’t watching.
Some founders prefer to sit with these questions on their own. Others recognise it as a conversation worth having.
