Case arose through a failure of action, not of detection

EDITOR—Smith refers to “key protagonists overreacting” in his editorial on the Bristol case.1 He joins “even the strongest supporters of the Labour government” in bemoaning “its excessive concern with media opinion.” Yet he tells us (and, from his privileged platform, the world) that this case is a “once in a lifetime drama…, Shakespearean in its scale and structure,” which will have the result that “the trust that patients place in their doctors…will never be the same again.”

This is a strange stance for the editor of a scientific journal committed to encouraging rational ideas in medicine. Dramas like this (even dramas that occur more often than once in a lifetime) are certainly “powerful levers for change.” But that is not a reason for senior medical journals to seize on them and use them to promote pre-existing agendas of change that have only a tangential bearing.

The lesson of the Bristol tragedy, when the dust and the shouting outside the General Medical Council have subsided, is that there was an inexcusable failure of existing mechanisms of control. The tragedy provides no rational support for the wholesale imposition of systems of monitoring and control on doctors in general. Such systems may or may not be necessary, and the BMJ should be arguing that if they are introduced it should be only with proper testing, so that ill effects (which I2 and others have predicted) can be determined and weighed against the benefits predicted by Smith among others. But that has little to do with the Bristol case. Here the problem was not a failure of detection; it was a failure by those in authority to take any action on the warnings that they repeatedly received. What purpose will all the monitoring in the world serve if society cannot respond to …