Medical errors and medical culture
BMJ 2001; 323 doi: https://doi.org/10.1136/bmj.323.7312.570 (Published 08 September 2001) Cite this as: BMJ 2001;323:570All rapid responses
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Christopher Price calls for yet more penalties against doctors. He
points out that all other professions have a duty of care to their clients
and implies that doctors alone have immunity from legal redress. If only
this were true.
Few of the professions he quotes can, in addition, lose their
livelihoods because of a single genuine error.The General Medical Council,
now dominated by political appointeees, appears to be only too ready to
remove a doctor from the medical register "pour encourager les autres".
Mr Price appears to have fallen for a political philosophy first used
by the ancient Greeks by blaming the messenger. In fact the current
politically motivated campaign against all doctors is quite Stalinist in
the way that we are blamed for all the failings of our healthcare system.
Is this, I wonder, to enable an effectively privatised corporate NHS
to employ yet more obedient unregistered medical practitioners on their
faceless production lines? As such practitioners are not answerable to the
GMC, only their employers need monitor standards.
Medicine in this country is in crisis. The quality of care will not
improve until doctors are allowed shake ourselves free from increasingly
oppressive state control.
Paul Thomas
Competing interests: No competing interests
Brendon Harrington has some sound thoughts on the culture of blame
but he is at a loss as to how the "seismic change" for the better can take
place.
Undoubtedly the position for doctors has dramatically worsened over
the past four years and one of the main reasons is the attitude of the
present incumbent as Secretary of State. Somewhat deficient in the
skills of man management he has reacted to each new adverse incident by
producing yet another publicity hungry disciplinary QUANGO. CHI was one
of the very early ones, the latest being known as VOICE and a week or two
before that came the Commission for the Regulation of HeAlth Professionals
(known as CRAP) which is designed to oversee and outdo the already
stringent disciplinary work of the GMC.
There are now 30 ways by which the GP can reach the disciplnary
committees of GMC and twelve of them are Milburn-created QUANGOs, each
denying thousands of patients their quota of NHS care.
It is unfortunate that the Secretary of State has been unable to draw
the simple relationship between this plethora of investigative and
disciplinary bodies in medicine today and the medical retention and
recruitment crisis.
It could be, therefore that the alleviation of the culture of blame
should start with either the education of, or, preferably, the removal of
the present Secretary of State.
Competing interests: No competing interests
Increasingly today., and usually as part of the general and age-old
dislike of lawyers, one reads of criticisms which include comments such as
'compensation culture', complaints of the cost to the NHS of medical
negligence cases and a wish for doctors to be exempt from medical
negligence cases. Doctors, politicians and populist journalists <even
those who write in what purport to be broadsheet and supposedly
responsible newspapers> run this line. Material on these lines appear
in the BMJ [1]; However are these attitudes either acceptable and/or
responsible?
A doctor finds that his solicitor bungles his house conveyance so he
has a defective title to his expensive house; his architect fails to
follow elementary rules of structural engineering such that his new
building work collapses; his builder fails to follow proper and well-
established building practices for his new conservatory which then is
uninhabitable; his son is knocked down and killed by a driver running a
red traffic light; his accountant bungles his tax returns so that he has
to pay swinging penalties to the taxman; his new car has a design fault
causing a crash that maims his wife and daughter; and so on and so on.
It is noteworthy that none of the suggested responses to the cases of
medical negligence accept the consequence of fault nor that the case of
the overlooked ECG talked about compensation to the dead woman's family.
Wu's sugggested response [2] to the grieving family was as anodyne as
it was unacceptably dishonest [dishonest because there was no 'probable';
it was a heart attack]: '"I have something difficult and important to tell
you. I regret to say that we made a mistake in your relative's care. When
she first came into casualty, we missed the signs of what was probably a
heart attack. If we had noticed, it is possible that she could have
survived. I am devastated at being responsible for this, and can only tell
you how sorry I am. I am sure this comes as a great shock to you. Can I
answer any questions?"' My response to his patronising and inadequate
remarks would have been to ask for the insurance details of the hospital
and the whole medical teams
Our doctor would not hesitate, and rightly would not hesitate, to
seek compensation from the defaulting parties that had damaged him and his
family, using a lawyer and sue if liability were not rapidly accepted by
the other side.
Why should the medical profession believe that it, and it alone,
should be excused from the legal and compensatory consequences of its
errors and negligence when it would offer no such forbearance to anyone
else? The profession must learn either to eliminate all errors <in
efffect impossible> or to accept the normal consequences of negligently
harming others.
My interest: I am a lawyer <but not one who has ever conducted a
medical negligence case>; and a patient who has suffered from the gross
negligence of doctors.
Christopher Price
Refs
1. Personal views; BMJ 2001;322:1189 ( 12 May )
2. Education and debate; BMJ 2001;322:1236-1240 ( 19 May )
Competing interests: No competing interests
Medical errors and medical culture
Paul Thomas so misrepresents my letter that one wonders if he
bothered to read it properly. His confusion as to my position extends to
his diagnosis of the profession's ills and the remedy.
I did not call for 'yet more penalties against doctors'. The
disciplinary powers of the GMC, and the tortious remedies in the civil
courts for negligence already exist. Nothing I said suggested any extra
sanctions; I was simply addressing the question of existing civil
remedies.
Further, I doubt if a doctor would be struck off for one negligent
error, as he suggests; unless, perhaps, it were particularly egregious.
Nor is the medical profession alone in striking off those members whose
track-record of failings show that they should be banned from practising;
there are many solicitors who have suffered this fate.
I did not imply 'that doctors alone have immunity from legal
redress'. What I clearly was addressing (and which is what my word 'wish'
suggested), was the cry, the desire, from a number of quarters that
doctors should in future be exempted from the full consequences of their
tort of negligence. I simply argued that such a wish was not acceptable;
particularly when all other members of society would presumably continue
to have to accept the consequences of their torts. If such a wish were to
be implemented then the wholly unacceptable result would be: either
doctors alone would be placed in a special exempt category of not being
accountable in the courts for their negligence; or everyone would be
relieved of the consequences of their negligent acts and omissions.
Turning to the letters at BMJ 2001;323:570 ( 8 September ): I share
Professor Lyckholm's disquiet at the attitudes shown by the senior
consultant and of Singer's case comments [BMJ 2001;322:1236-1240 ( 19 May
)] as to ethical situation; though space prevents a fuller analysis of
Singer's errors here. I find myself in considerable agreement with both
Professor Lyckholm's sentiments and language, particularly that there
should not thought to be 'some way around the difficult task of actually
taking responsibility for the mistake'; as Dr Lewis, with his desire to
replace individual responsibility with corporate responsibility also seems
to argue for. Nor, incidentally, do I as a lawyer agree with Dr Lewis as
to the lack of blame attaching to the particular junior physician.
Even if it is possible that the 'systems failure' -- the overstretch,
the lack of resources and so on -- of the NHS is insufficiently taken into
account at present, that is a far cry from justifying a complete
absolution of doctors from any personal responsibility for their own
mistakes.
Dr Harrington's suggestion appears superficially attractive.
However, whilst it would cover employed doctors in the hospitals, it would
not seem to cover GPs (who insisted from the NHS's inception that they
should be independent contractors and not salaried employees) unless GPs
were now to accept an employee status. Further, such a change would
require the employer (the NHS) to have considerable powers to direct and
control the delivery of the service; because if the NHS solely is to carry
the responsibility and financial burden, then it is entitled to take all
steps to minimise the risks. I doubt if doctors would agree to the
surrender of clinical freedom that this would entail.
The issues raise difficult questions; but the solution is not to be
found by evasiveness, dishonesty, and the desire to shuffle off personal
responsibility shown by too many in the profession.
Competing interests: No competing interests