Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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![[Read Rapid Response]](/icons/misc/sectionDOWN.gif)
Accountability - a simple soultion.
- Gurli Bagnall (6 April 2002)
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Things aren't so bad, really
- doctor pangloss, Le baron de Thunder-ten-tronckh, Mlle Cunégonde, and Candide (6 April 2002)
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Another complex, malicious and vexatious complaint.
- P Finch (6 April 2002)
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Re: Another complex, malicious and vexatious complaint.
- Gurli Bagnall (7 April 2002)
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Re: Re: Another complex, malicious and vexatious complaint.
- P Finch (8 April 2002)
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Re: Another complex, malicious and vexatious complaint.
- Lisa C Blakemore-Brown (10 April 2002)
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How can we improve investigation of complaints involving F.I.I?
- Richard G Wilson (12 April 2002)
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Re: How can we improve investigation of complaints involving F.I.I?
- Michael D Innis (13 April 2002)
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First do no Harm
- Lisa C Blakemore-Brown (15 April 2002)
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Public Inquiry
- Brian Morgan (15 April 2002)
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RCPCH "GUT FEELINGS"
- Michael D Innis (16 April 2002)
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Feeling in ones water?
- Brian Morgan (16 April 2002)
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Gurli Bagnall, Patients' Rights Campaigner
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There is a very simple solution to the problems which concern consultant paediatricians R.A. Smith, D.W. Beverley and R.J. Ball. Iatrogenic illness is synonymous with fabricated induced illness (FII), the name by which Munchausen Syndrome by Proxy is now known. Smith, Beverley, Ball, Marcovitch et al, expect accountability from the parents, so why should the parents not expect accountability from them? The iatrogenic statistics should make that mandatory. In dismissing the parents’ concerns, one assumes the physician is confident he is doing the right thing and that the child will respond positively. He should therefore have no qualms about accepting responsibility for his diagnosis and treatment in the form of a "To Whom It May Concern" letter in which he: (a) acknowledges the parents concerns; (b) is prepared to allow a physician, chosen by the parents, to check on the child’s progress at frequent intervals and (c) will take full responsibility for all costs incurred as a result of adverse consequences. It really is very simple. Gurli Bagnall, Patients’ Rights Campaigner, Otago New Zealand |
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doctor pangloss, professor of primary care University of Thunder-ten-tronckh, Le baron de Thunder-ten-tronckh, Mlle Cunégonde, and Candide
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Editor, At times it can be difficult being a doctor. Sometimes we think that we may have made mistakes and that our patients do not love us. Clearly Smith (1) and Marcovitch (2) are suffering from such feelings of disappointment because their patients appear to have maliciously reported them to the GMC they think that means that their patients don't love them anymore. But fortunately nothing could be further from the truth, this is really a strong and reliable sign of their patients' hidden love for them. Their patients are like naughty children who by misbehaving show that they are looking for more attention. Of course we don't expect children to understand why they are misbehaving, why should we expect more from our patients? Smith and Marcovitch shouldn't despair. Fortunately the BMJ is here. Just flicking few the last few editions there are plenty of good ideas on how they can improve their practice. They could invite the editor of the BMJ could come and give them some tips on how to empower these patients, make them partners in planning their care (3). After all as the Government has said we mustn't forget that patients are doctors "equals with different expertise" (4) As our colleague Pr Alberti suggests they could sit down with some members of the government (maybe that nice sincere Tony Blair might come, he seems committed to excellence in the NHS) Some patient representatives (may be they could invite MAMA (Mothers against Munchausen syndrome by proxy allegations) .This would have the added benefit that Smith and Marcovich could show those mothers how much they really do love them. And they could also invite some of their colleague who expressed such helpful comments in their rapid responses to Marcovic's original letter. They could also think about integrating some complementary therapies into their practice, that always pleases the patients. Of course there is bound to be room for them to improve their consultations skills, lengthen their consultations times, provide 24 hour access, with immediate access to the doctor of their choice. I wish them luck, after all they are in the best possible of all professions, and with the BMJ to help them soon they will be able to get back to really helping their patients, and the patients will grow and mature and love their doctors for having helped them so much. Doctor Pangloss. Professor of General Practice Department of Primary Care University of Thunder-ten-tronckh Westphalia (5) email doctor.pangloss@virgin.net 1 R A Smith, D W Beverley, and R J Ball Pattern of some parents' complaints against doctors must be recognised BMJ 2002 324: 852. 2 Harvey Marcovitch GMC must recognise and deal with vexatious complaints fast BMJ 2002 324: 167. et al 3 Smith R. The discomfort of patient power. BMJ 2002;324:497-8. 4 Coulter A. After Bristol: putting patients at the centre. BMJ 2002;324:648-51. 5 Vol |
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P Finch, non medical Oxford
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Like Marcovitch1 and co-signatories, and Smith et al 2, a colleague of mine has been subjected to similar complex, malicious and vexatious complaints from the same small group of people who contribute to the "Mothers against Munchausen syndrome by proxy allegations" (MAMA) website. Since their case was resolved, they have been advised by their employer and Royal College not to discuss the issue in public fearing that it will spark further malicious complaints by this small group of people. My colleague was alerted to this group’s activities by Marcovitch’s article3 on the subject published in the BMJ back in 1999. Out of curiosity, they periodically looked at the website and in particular the ‘Heart to Heart’ discussion board. To their surprise, their name started appearing on the discussion board. This was particularly unexpected as they had not been involved in cases of child abuse for some years. On closer inspection, the website stated “We need copies of depositions, court orders, court transcripts and civil complaints. Give us the names of any physicians, nurses, CPS workers, or anyone else who has made an MSBP allegation”. A regular dialogue between established and new members of this group took place on the discussion board resulting in the construction of complex, malicious and libelous complaints which were sent to my colleague’s professional body, employer, the Police, Members of Parliament and the media. As they had witnessed events unfolding on the website, they preempted any complaints by writing to their professional body and employer with the evidence. They also contacted numerous colleagues to let them know that their names had appeared on the website. Indeed, my colleague had seen the complaints on the website concerning the professionals that Marcovitch and Smith et al elude to. When the anticipated complaints concerning my colleague arrived, their employer already had a strategy in place to deal with them quickly and effectively. This included a strategy to deal with enquiries from elements of the media that inevitably followed. My colleague was also provided with training in how to handle the media should they be ‘ambushed’ on the doorstep. My colleague’s professional body undertook a painfully slow and time consuming preliminary investigation that lasted 18 months and found no evidence to substantiate the allegations. Since being exonerated, they have continued to follow this saga in the media and was interested to see that Penny Mellor, who has been involved in many complaints concerning professionals, was jailed for two years for her part in a conspiracy to abduct a child in a child protection case 4. It is time to recognize this group of vexatious complainants and how they can paralyse the complaints system by constructing multiple and complex malicious complaints. 1. Marcovitch H. GMC must recognise and deal with vexatious complaints fast. BMJ 2002; 324: 167-168. 2. Pattern of some parents' complaints against doctors must be recognised. R A Smith, D W Beverley, and R J Ball. BMJ 2002; 324: 852. 3. Marcovitch H. Diagnose and be damned. BMJ 1999; 319: 1376. 4. White C and Freeth R. Woman at centre of Southall case faces prison sentence. BMJ 2002;324:693. |
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Gurli Bagnall, Patietns' Rights Campaigner
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It is quite extraordinary how outraged P. Finch and others are that people who have been accused of MSbP have the nerve to get together for mutual support. The outrage is even more amazing when one considers the iatrogenic statistics. That an unacceptable number of medical errors have been made and continue to be made, is hardly a secret, yet Finch and others simply ignore this fact as if it is of no consequence. Parents have as much right to defend themselves as the medical profession does. To try and deny it, is to rub more salt into the wounds. I draw attention to one incident in New Zealand that shook the profession, the government, the judiciary, social services and the police to the core. People throughout the length and breadth of the country, rose up in defence of a family that was being targetted by the medical profession.1 Malicious and vexatious? I think Finch has the boot on the wrong foot. Gurli Bagnall, Patients’ Rights Campaigner, Otago, New Zealand. 1. “A Wake-up Call” - G.Bagnall: http://bmj.com/cgi/eletters/324/7339/693/a#20809 |
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P Finch, non medical Oxford
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I fail to see the connection between being maliciously accused of amongst other things participating of an international baby racketeering scam and iatrogenic illness? |
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Lisa C Blakemore-Brown, Independent Psychologist and Author UK
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I have contributed to the MAMA website for a couple of years now. I do so not because I am part of a small group of malicious vexatious complainants - I abhor vexatious complaints - but because I seem to be one of the very few professionals who is willing to admit that some mothers have been wrongly accused of causing their children's medical problems. I felt that by being associated with the site innocent mothers would know that they were not alone amongst other mothers and other non professional supporters. I have been told that this was very reassuring for many innocent mthers and their children victimised by the system. When slanderous comments were made about those who contribute to the website, I did not respond. This is a very difficult area which is proving nigh on impossible to expose to the public view and I have always known I was taking a risk every time I posted anything and even if I simply looked on it - especially once it was mentioned in the BMJ. The prevailing assumption is that those who contribute to the site are either guilty mothers or duped professionals/supporters. The argument is wearing thin - how about supporting a call for a public inquiry to look at real false cases to understand the utter despair of the falsely accused? |
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Richard G Wilson, Consultant paediatrician Kingston Hospital NHS Trust KT2 7QB
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The discussion on complaints against professionals involved in cases of possible child abuse is at risk of engaging in a sterile flagwaving confrontation. First we need clarification of some facts- 1. Paediatricians do not accuse parents,even though that is how parents feel. They identify concerns about a child which they share with the statutory authorities. This is what society , through government has instructed them to do. 2. Parent profiling cannot establish child abuse. Never the less it can raise concerns about a child's need, it may help in assessing the risk of recurrence of abuse,and it is a part of the understanding of behaviour which might assist in prevention 3.Responsibility for the outcome of child protection investigations lies with A.C.P.C. Advocates of parents' rights should address their concerns to the joint agencies and ultimately to the Courts. Second we need a process which can deal with complaints competently. 1. During investigations, even when action has been taken to protect the child, it must be made clear that no judgement has been made that the child has been abused or who the abuser is. The child's interests come before the parents', but they must be looked after too. whatever the outcome the family will need continuing care. 2. High quality multi-agency work requires high quality staff in adequate numbers, but not at the expense of other important work. This will mean extra money as well as a restoration of respect and support from government. 3. The usual health service complaints procedure deals with issues of care of a patient raised by a patient or someone acting on their behalf. In child abuse scenarios the complainant is acting on their own behalf although they are not the patient. They may in some cases be responsible for the child's problems and this raises a major conflict of interest. These complaints must be addressed swiftly and that means expertly from the outset. Many health service tribunals will lack expertise in child abuse or the law, and the responsibility to protect their own organisation may be a priority. There is multi-agency responsibility for guidelines, procedures, and resources. One suspects that government departments will resist change from single agency procedures, but it would be logical and more effective if the A.C.P.C. were to initiate investigation of all complaints. They should swiftly establish whether their procedures were followed. Individuals could then be protected while the rest of the investigation proceeds. It is equally uncertain whether the G.M.C. or the U.K.C.C. are currently able to investigate these complaints swiftly and effectively Finally although legal remedies may be needed for some issues, we could improve our present procedures. None of this debate must be allowed to distract from our duty to safeguard children. Richard Wilson. [ Chairman R.C.P.C.H. working party on Fabricated or Induced Illness by Carers published by R.C.P.C.H. Feb. 2002 ] |
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Michael D Innis, Director Medisets International
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Editor, Richard Wilson says “Paediatricians do not accuse parents, even though that is what parents feel. They identify concerns about a child which they share with the statutory authorities. This is what society through government has instructed them to do.” But are their concerns always justified? Could they not sometimes erroneously notify the statutory authority with devastating consequences for the family? Two cases have recently come to my notice. In one the child had all the symptoms of Severe Combined Immune Deficiency and the other had both clinical and laboratory evidence of Kawasaki Disease. In both instances the label of “Munchausen Syndrome by Proxy” was appended and caused untold suffering to the mothers. A Paediatrician, questioned on the nature of bruises seen on a child said, “All I am saying it is bruising that is abnormal and non-natural, caused by heavy pressure, trauma or whatever. It’s non-accidental and could have occurred in the context of smothering or any other injurious actions to the baby.” No thought was given to the possibility that the bruises could have resulted from a coagulopathy. And furthermore, one has to ask, how do Paediatricians differentiate between a “natural” and a “non-natural bruise”? These are examples of the danger to which the public is exposed and which Richard Wilson and his co-authors fail to recognize. Paediatricians are not infallible and the consequences of their misdiagnoses can be horrendous. The law needs to be changed. Anyone wishing to make a complaint of MSBP/FII should be obliged by law to get the opinions of at least two other knowledgeable specialists before considering a report to the authorities. Penny Mellor and Sally Clark would not then be victims of the current system of Justice. Michael Innis FRCPA; FRCPath |
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Lisa C Blakemore-Brown, Independent Psychologist and Author UK
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If paediatricians merely register their concerns, why is it that the label of MSBP cannot be removed in false cases from the parent or children's medical records - even after Social Services have removed the children from the At Risk Register? Why is it that Social Services tell parents 'Its not our responsibility - its a medical diagnosis.' Then when the parents approach the medic - if they can find out who made the original referral - they are told that it is a `multi-disciplinary diagnosis.' If it is a multi-disciplinary diagnosis - why do Social Workers not think so? and why is there not a multi-disciplinary way of removing it in false cases? In the RCPCH document on Page 37, the very first `concerns` are triggered `in the mind of the paediatrician`. The document informs its readers that 'The concerns may be raised by non-specific feelings that the account does not feel right, or from the attitudes, behaviour and responses of the carer.' I wonder how confident the `jobbing `paediatrician really feels about these `non-specific feelings` when he will have heard more about Factitious Illness than, for instance, autism or the various complex medical disorders discussed by Dr Innis. In essence, paediatricians are being asked to register concerns on the basis of: 1) a hunch about the psychological presentation of adults - not their profession 2) being baffled about child presentations - without recourse to other specialists. On this basis, I would respectfully suggest, the potential for harm by formalising false fears through referral is colossal. |
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Brian Morgan, Freelance Journalist Cardiff CF11 6LF
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It is going to be difficult to avoid the 'flagwaving' confrontation Dr Wilson warns about without there being a full public inquiry (as in the Cleveland scandal) in which the complaints of parents falsely accused of MSBP and others campaigning on unethical paediatric research are fully aired. The medical, social work and legal professions and the government have for the best part of a decade resolutely ignored the many campaigners who have, incredibly, sustained their pressure throughout this period. It is simply not acceptable for paediatricians to say (as they do) that there have been no false allegations and that the campaigners and their supporters are either proven child abusers, or with dubious sources of funding and motives. No less reprehensible is it to accuse campaigners on the issue of flawed paediatric research of being similarly dubiously motivated or inspired. Campaigners for an inquiry will surely, in due course, be joined by the children wrongly removed from their parents, placed in foster care, put up for adoption even, and the children involved in unethical research. I know of single figure cases already where they have begun legal proceedings, and their number can only grow significantly and rapidly given that the potential pool of cases runs into many hundreds. There is only one way to avoid 'flagwaving' - the authorities should give in now, as gracefully as possible given their refusals in the past, call a 'Cleveland' style inquiry and let the parents, their children and their supporters give evidence in public. The scenario presented by Dr Wilson is very much how things should have been or should in future be handled. The reality was and remains very different. Over zealous paediatricians have directly accused parents, they ignored multi-agency working, they pursued parents by every possible route imaginable including turning up at their homes and directly trying to have them prosecuted outside the aegis of the ACPC, through the Crown Prosecution Service. They may have stopped doing it or been told to stop doing it, but we cannot be sure and we certainly should not let the same paediatricians loose on cases again without a proper reckoning of their past performance (as in Cleveland and the Bristol babies scandal) and retraining or restriction of practice. A false allegation of MSBP is a false claim as to a child's real illness. When Dr Wilson says parents who complain about their child's treatment in hospital may have a conflict of interest, if they were responsible for the admission, he may not know about the documented cases where the allegation emerged only after the complaint about the paediatrician's management of the child had already been made. There is more than one kind of conflict of interest. Brian Morgan |
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Michael D Innis, Director Medisets International Home
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Editor, The RCPCH advises its members that concerns of child abuse “…may be raised by non-specific feelings that the account does not feel right, or from the attitudes, behaviour and responses of the carer.” These “non-specific feelings” are sometimes referred to as “gut feelings.” One of my Registrars used to refer, irreverently, to them as “a feeling in one’s water”. When Paediatricians are advised by their College to heed the feelings in their water one must be highly suspicious of the diagnosis. It’s almost sure to be FII. Michael Innis |
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Brian Morgan Cardiff CF11 6LF
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Perhaps in future the suspicion of MSBP should be accompanied by a urine sample from the paediatrician concerned. The test result would be every bit as scientific as the profiling of the mother the RCPCH says should not be used, but as we know still happens. When will paediatricians who ignore RCPCH guidance, and continue to use profiling as part of their highly remunerative assessment as to whether MSBP abuse has taken place, not as part of the future risk assessment (which is not their job anyway) despite all the warnings to the contrary, be held accountable and prevented from giving expert evidence in the courts? Is there any way, short of suspending their medical registration, that this can be achieved? Brian Morgan |
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