Defensive culture of British medicine needs to change

EDITOR—It was brave to devote a whole issue to medical error1—how to recognise, how to investigate, how to analyse, and how to change systems to improve patient safety.1 However, we regret that the edition was dominated by American studies, ignoring the British contribution of confidential inquiries and analyses of closed claims, which have significantly improved safety in some well defined areas of medical practice.

In the United States the insurance industry provided the impetus for the study of adverse events,2 and in Australia the government funded a similar study3 because it was considering “no fault” compensation.3 In the United Kingdom, for 25 years the Department of Health has financed all successful claims against NHS hospitals and their staff. As a result the need to take a British study beyond the pilot phase may not be supported.4

Be that as it may, an important issue was not addressed in the BMJ. Behind each adverse event there is a patient, a doctor, and a doctor-patient relationship. A patient must be told when things have gone wrong. Every effort must be made to minimise the after effects, including financial compensation where necessary. Most patients wish to know in detail what happened and what is being done to reduce the possibility of a recurrence. And members of healthcare teams need mechanisms to come to terms with their fallibility. It is to be hoped that clinical governance will make a difference.

Meanwhile a change in the ethos of medical practice is required, and it is to this end that Action for Victims of Medical Accidents has set up a group for doctors. Action for Victims of Medical Accidents is often regarded as dealing solely with compensation and litigation, but its raison d'être has always been to improve …