Doctors may make mistakes that are less obvious than lawyers' mistakesBMJ 1995; 310 doi: https://doi.org/10.1136/bmj.310.6995.1671a (Published 24 June 1995) Cite this as: BMJ 1995;310:1671
EDITOR,—The sentiments expressed by Jean Ritchie and Sally Davies are laudable but raise two important matters which were not addressed by the authors.1
The authors refer to “mistakes” and to care which has “gone wrong” as though these were invariably self evident. A lawyer's missed deadline for issuing a writ or a motorist's dented vehicle may easily be recognised as evidence of mistake. It will readily be conceded that amputation of the wrong limb or a gross overdose of a medicine through a misplaced decimal point are, similarly, easily recognisable mistakes. However, most allegations of medical negligence arise from therapeutic interventions or omissions which are not self evidently mistakes or evidence of care having gone wrong. Those whose professional judgments are to be called into question may be forgiven for failing to recognise as mistakes or evidence of care having gone wrong acts and omissions which, though criticised by some, unquestionably have the full support of responsible colleagues of similar training and experience. It would be helpful if the authors could translate the fine sentiments which they express into more tangible practical guidance for members of the medical profession who endeavour to serve the interests of their patients with commendable skill and integrity.
The concept of negligence is not without difficulty for most medical practitioners. The teaching of forensic medicine is no longer part of the medical curriculum and negligence as a civil tort is poorly understood. Our experience is that most doctors who are accused of it still equate it with neglect and do not understand the true legal meaning of the term. One of the principles of natural justice is that no man should be a judge in his own cause. Consequently it is not for the individual clinician to decide whether or not he or she has been negligent—that is a judgment to be made by others. On current tort principles, the allegedly negligent practitioner may well find that he or she has support from colleagues who have reviewed all the facts and the records in response to a formal request for an opinion.
By all means encourage clinicians to give full, honest, and objective information to patients at all times, and especially in response to adverse outcomes which follow therapeutic interventions. However, do not cloud the issue by reference to subjective considerations (“mistakes”) and legal concepts (“professional negligence”) which are imprecise and unclear to those at whom they are directed.