Published 27 October 2009, doi:10.1136/bmj.b4405
Cite this as: BMJ 2009;339:b4405

Feature

BMA view on whistleblowing

¹ BMA, London

doi:10.1136/bmj.b4203doi:10.1136/bmj.b3202

The question "What are doctors for?" has been considered in the BMJ on more than one occasion. The straightforward answer is that our fundamental responsibility is to provide care of the highest possible quality to our patients and do all we can to guarantee their safety—no matter what obligations we have to any other parties, including our employers.

The BMA’s guidance on whistleblowing recognises the huge courage that is often required to act as an advocate for patients.¹ It also identifies raising concerns as a professional duty that needs to be fulfilled in a professional way. Internal mechanisms should be respected and adhered to from the start—we would not argue for the right of staff to bring personal vendettas to the media before employers have had an opportunity to deal with the concerns.

Some behaviour by senior managers is, however, unacceptable. A recent BMA survey showed the extent of the poor treatment of those brave enough to put their heads above the parapet. A significant proportion (15.5%) of hospital doctors in England and Wales who reported concerns said that their trusts had indicated that speaking up could negatively affect their employment.² And although public disclosure of a specific issue may not always be appropriate—for example, when it would jeopardise patient confidentiality—the option to go outside must always be open. To say there are no circumstances in which a concern for patient safety can be raised outside the organisation, or to attempt to enforce silence through a contractual mechanism, is appalling.

The NHS is, and must be, a learning organisation. Processes need to be in place to allow staff to raise their concerns, to reflect on any failings, and to make changes if necessary. Employers who do not promote a culture of openness are failing in their duties to staff and patients alike. The contract doctors have with their patients collapses if they are unable to take their concerns to someone who will listen.

Cite this as: BMJ 2009;339:b4405

doi:10.1136/bmj.b4203doi:10.1136/bmj.b3202

References

1. BMA. Raising concerns and whistleblowing. 2009. www.bma.org.uk/ethics/doctor_relationships/whistleblowing.jsp.
2. BMA. BMA survey: speaking up for patients. 2009. www.bma.org.uk/images/speakingupforpatientsmay2009_tcm41-186796.doc.

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