Letters Bawa-Garba case

Second letter to the GMC chair regarding Hadiza Bawa-Garba

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k667 (Published 13 February 2018) Cite this as: BMJ 2018;360:k667

Medical students’ views on the Dr Bawa-Garba case

Dear Editor,

The case of Dr Hadiza Bawa-Garba has left many medical students like us, soon to become doctors in the NHS, with a sense of trepidation. We wholeheartedly empathise with the family’s grief over losing their 6-year-old son, Jack Adcock. Important concerns have been raised by our peers regarding the General Medical Council’s (GMC) decision pertaining to Dr Bawa-Garba. We hope to add our perspective as medical students to the discussion of this case.

Throughout medical school, the value of reflection as an educational tool has been continuously impressed upon us. Although there is uncertainty surrounding the extent to which written and verbal reflections were used in the trial, it is disconcerting to think that reflective practice, a valuable tool for trainee development, could be used in a court setting. We feel uneasy about a future that impedes reflective practice and have no doubt that doctors will be more conscious about what is included in their portfolio in the future. We fear such practice may also extend into medical schools, where students are cautious about reflecting openly on mistakes. This may not only impact a student’s educational development, but may further act as a negative driver against ensuring probity in light of errors in practice [1].

We therefore fear a shift in focus amongst medical students, where avoiding litigation is prioritised over reflection and learning. Ultimately, this could engender a culture of defensive medicine which could take precedence over the best interests of the patient and the public [2]. The consequences of defensive medicine include, but are not limited to additional costs to the NHS, along with patients being subject to unnecessary and potentially risky procedures [3].

We find it disheartening that despite what appears to be a clear series of systematic errors, the principal fault in this case was placed on individual members of staff. A blame culture in the workplace coupled with a constant fear of litigation results in poor working conditions and reduced job satisfaction. To add to this, the handling of cases involving Dr Bawa-Garba, Mr David Sellu, Dr Chris Day and others cause significant confusion and uncertainty among medical students.

The cumulative result of these feelings is a rise in the likelihood of doctors moving away from the UK or considering a career other than medicine [4], something which we have increasingly seen discussed by our colleagues. Lambert et al. identified that recent UK-trained medical graduates are more commonly considering medicine outside the UK [5].The GMC have stated that they are here to ‘protect the public, and not to protect doctors’ as well as ‘maintaining public confidence in the profession’ [6]. While this may be their aim, should the outcome of this case drive more doctors away from the NHS then this may have the paradoxical effect of an increasing frequency of medical errors due to understaffing. The public and physicians already perceive understaffing to be a significant factor in causing medical errors [7].

Medical school has taught us methods to deal with pressurised environments, yet this case infers the need to carry out jobs equivalent to multiple doctors’ workload. We have not identified an area of the medical curriculum which prepares us for such quandary. Dr Bawa-Garba was described as being an ’above-average doctor’, which leaves us in a state of uncertainty as we question what it takes to successfully cope with the strenuous workload of the NHS and the repercussions of being unable to do so.

In conclusion, at the heart of this case is the tragic death of 6-year-old Jack Adcock and we reiterate our empathy towards the family’s loss. The case has provided many notable points of discussion, however, the overarching sentiment is one of fear and uncertainty which have been exacerbated by a lack of clarity surround the case. The ramifications of cases like these have a wide-scope impact on not only the public, patients and physicians, but also medical students – the next generation of doctors.

References
[1] A. S. Detsky, M. O. Baerlocher, and A. W. Wu, “Admitting mistakes: ethics says yes, instinct says no.,” CMAJ, vol. 185, no. 5, p. 448, Mar. 2013.
[2] T. Bourne, L. Wynants, M. Peters, C. Van Audenhove, D. Timmerman, B. Van Calster, and M. Jalmbrant, “The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey,” BMJ Open, vol. 5, no. 1, pp. e006687–e006687, Jan. 2015.
[3] M. S. Sekhar and N. Vyas, “Defensive medicine: a bane to healthcare.,” Ann. Med. Health Sci. Res., vol. 3, no. 2, pp. 295–6, Apr. 2013.
[4] A. Sharma, T. W. Lambert, and M. J. Goldacre, “Why UK-trained doctors leave the UK: cross-sectional survey of doctors in New Zealand.,” J. R. Soc. Med., vol. 105, no. 1, pp. 25–34, Jan. 2012.
[5] T. W. Lambert, F. Smith, and M. J. Goldacre, “Why doctors consider leaving UK medicine: qualitative analysis of comments from questionnaire surveys three years after graduation.,” J. R. Soc. Med., vol. 111, no. 1, pp. 18–30, Jan. 2018.
[6] General Medical Council, “FAQs: outcome of High Court appeal – Dr Bawa-Garba case – Medical professionalism and regulation in the UK,” 2018. [Online]. Available: https://gmcuk.wordpress.com/2018/02/02/faqs-outcome-of-high-court-appeal....
[7] R. J. Blendon, C. M. DesRoches, M. Brodie, J. M. Benson, A. B. Rosen, E. Schneider, D. E. Altman, K. Zapert, M. J. Herrmann, and A. E. Steffenson, “Views of Practicing Physicians and the Public on Medical Errors,” N. Engl. J. Med., vol. 347, no. 24, pp. 1933–1940, Dec. 2002.

Competing interests: No competing interests

14 February 2018
Mohammed Abdul Shafi
Medical Student
Mohamed Rimzy Mohamed Riza, Muhammed Shaan Riaz, Abdurahman Bareh, Faisal Siddiqui, Saeed Azizi
St Georges, University of London
St. George’s, University of London. Cranmer Terrace, London, SW17 0RE