The aftermath of the Bristol case

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7161.811 (Published 19 September 1998) Cite this as: BMJ 1998;317:811

Case arose through a failure of action, not of detection

  1. James A R Willis, General practitioner
  1. Alton Health Centre, Alton, Hampshire GU34 2QX
  2. Ashgrove Health Centre, Blackburn, West Lothian EH47 7LL
  3. Society Clinical Psychiatrists Study Group, Downton, Wiltshire SP5 3HJ
  4. Department of Anaesthetics, Queen Elizabeth Hospital, King's Lynn PE30 4ET
  5. Herefordshire Community Health NHS Trust, St Mary's Hospital, Hereford HR4 7RF
  6. Wynd House, Hutton Rudby, North Yorkshire TS15 0ES
  7. North West Lung Centre, Wythenshawe Hospital, Manchester M23 9LT
  8. National Blood Service Lancaster, PO Box 111, Royal Lancaster Infirmary, Lancaster LA1 4GT
  9. NHS Consultants' Association, Great Bourton, Banbury, Oxfordshire OX17 1QH
  10. Shropshire Health Authority, Shrewsbury, Shropshire SY3 8XL
  11. Princess Margaret Hospital, PO Box D184, Perth, 6001, Western Australia
  12. Stoke Mandeville Hospital NHS Trust, Aylesbury, Buckinghamshire HP21 8AL
  13. Bulletin of Medical Ethics, London N5 1LA
  14. Royal Halifax Infirmary, Halifax HX1 2YP
  15. Pinehill Hospital, Hitchin, Hertfordshire SG4 9QZ
  16. Department of Medicine for the Elderly, Brighton General Hospital, Brighton BN2 3EW
  17. 8 Ellesmere Road, London NW10 1JR
  18. King's Mill Centre for Health Care Resources, Sutton in Ashfield, Nottinghamshire NH17 4JL
  19. Nuffield Provincial Hospitals Trust. 28 Fitzwarren Gardens, London N19 3TP
  20. University of Wales College of Medicine, Cardiff CF4 4XN

    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 …

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