Medicine And The Media

The traumas of casualty departments

BMJ 1997; 315 doi: (Published 19 July 1997) Cite this as: BMJ 1997;315:196
  1. Christopher Bulstrode, clinical reader in trauma and orthopaedics
  1. John Radcliffe Hospital, Oxford

    Trauma care in Britain came in for a battering last week when the BBC's science programme QED screened a drama purporting to show a real life case of medical negligence. Christopher Bulstrode examines the controversy surrounding Cause of Death

    Mark was just a nice, ordinary lad on a big motorbike that crashed. He was fine when he got to the hospital, apart from a few broken bones, but then things started to go wrong. Within a few days he was in the intensive treatment unit after a cardiac arrest. His brain never recovered, and when they switched off the ventilator the family was left devastated.


    The father fights for the truth


    The programme makers say the story is based on real life, but certainly the plot had all the features of a classic Clint Eastwood “I'm gonna fight 'till I get justice” movie. The father (the hero of the drama) nearly smokes himself to death during his solitary quest for the cause of his son's death. He is helped in his search for the truth by a black charge nurse, who whispers that all is not what it seems, and a young female solicitor with an Irish accent, who (surprise, surprise) also feels a little outside the system. The rest of the characters—oleaginous solicitors, pompous barristers, stupid judges, indifferent hospital managers, arrogant consultants, ignorant junior doctors, crass intensive care nurses—all play out their stereotypes like characters in a Punch and Judy show.

    Lorraine Heggesey, the editor of QED, claims that she was determined to use the story to make clear that the system is at fault. QED shared a press conference this week with the British Orthopaedic Association, which was releasing its report on the organisation of accident and emergency departments under the banner that 800 unnecessary trauma deaths occur each year in Britain.

    But what will Joe Public take from this specially commissioned melodrama? I don't know, I'm not Joe Public. I was one of the trauma surgeons who used to have to tell people like Mark's parents that their son had died and please could we have the kidneys, while the denial, the anger, and the grief poured out. Always we would wonder: “Could we have done better?” Sometimes we knew perfectly well that we could. This story was nothing to do with the struggle to have well trained people ready in the right place at the right time for the increasingly rare, seriously injured patient.

    It was perfectly good soap based on a true story, as all the best soap is. We don't know how much TV drama affects public perceptions, but we do know that big motorbikes are enormous fun to ride and that they kill with monotonous regularity. If we want to prevent unnecessary deaths we may find that the best value for money is in the boring field of accident prevention and only secondarily in a nationally coordinated accident and emergency department system. What this programme did show all too well is that the current British adversarial legal system is an insensitive and inappropriate way to handle medical mistakes and should be replaced forthwith.

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