BMJ 1998;317:811 ( 19 September )

Letters

The aftermath of the Bristol case

    Case arose through a failure of action, not of detection
    Doctors should not have to fail before they are given support
    Society of Clinical Psychiatrists supports doctors who have been suspended
    Benefits of openness and teamwork must be emphasised
    Armed forces need independent civilian adviser who can be approached in confidence
    Deaths are acceptable in some specialties but not all
    Series of operations with low mortality may exhibit high average mortality by chance
    Concept of collective responsibility is important
    General Medical Council's disciplinary hearings should be confidential
    Returning contracts to regional level might prevent such cases
    Airline pilots are assessed every six months, so why shouldn't doctors be?
    Supraregional neonatal cardiac surgery works in Western Australia
    Techniques for measuring quality of care need to be assessed
    Students must be taught more about ethics
    Bristol case highlights potential weaknesses of Calman system
    Private practice has similar problems
    Formal mentoring might have helped
    Roles of GMC, royal colleges, and Department of Health remain unclear
    Routine monitoring of mishaps would be valuable way of improving care
    Doctors have surely forfeited privilege of self regulation
    Poor performers will need remedial training

Case arose through a failure of action, not of detection

The first 150 words of the full text of this article appear below.

EDITORSmith refers to "key protagonists overreacting" in his editorial on the Bristol case.¹ He joins "even the strongest supporters of the Labour government" in bemoaning "its excessive concern with media opinion." Yet he tells us (and, from his privileged platform, the world) that this case is a "once in a lifetime drama..., Shakespearean in its scale and structure," which will have the result that "the trust that patients place in their doctors...will never be the same again."

This is a strange stance for the editor of a scientific journal committed to encouraging rational ideas in medicine. Dramas like this (even dramas that occur more often than once in a lifetime) are certainly "powerful levers for change." But that is not a reason for senior medical journals to seize on them and use them to promote pre-existing agendas of change that have only a tangential bearing.

The lesson of . . . [Full text of this article]

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