Lessons from the Bristol case

More openness on risks and on individual surgeons' performance

News p 1691

Papers pp 1697, 1701, 1705

Education and debate pp 1734, 1736, 1740

Personal view p 1756

Medicine and the media p 1757

Cardiac surgery has changed within living memory from desperate attempts to achieve miracles for a few to the present situation where there is high expectation of a good result for tens of thousands of patients each year. It is easy to recall the surgeons who performed the first heart operations, who used cardiopulmonary bypass while it was still in its infancy, or who started transplantation — all undertaken with a high initial mortality. They worked on doggedly, in the face of doubt, scepticism, and often widely publicised criticism. They are now remembered with respect as having had “the courage to fail.” Many others, equally determined, did fail and are not remembered.1

Some of that determination, in the face of possible failure, is necessary in every surgeon. But the congenital heart surgery undertaken in Bristol in the past 10 years — the subject of the General Medical Council's most recent, and arguably most important, disciplinary case (p 1691, 1740) 2 3 — was within the realms of routine practice, for which there are known and well established standards. In heart surgery accountability supplemented doggedness a long time ago. The present arrangements, however — which rely on local monitoring of results, clinician based judgments about acceptable standards, and continuing referrals — failed to avert the situation in Bristol, which we have seen spelt out in distressing detail before the General Medical Council and the …