Intended for healthcare professionals

Observations Ethics Man

Lessons from the front line

BMJ 2017; 359 doi: (Published 06 October 2017) Cite this as: BMJ 2017;359:j4624

Re: Lessons from the front line

Sokol makes a series of observations on medical practice and malpractice. Most superficial is his comment "Insight can be defined as the ability to understand intellectually and emotionally why his behaviour is wrong". This is--to me--a fascinating comment coming from a barrister whose role is to dissect and analyse conflicts in evidence and opinion.

Insight surely cannot be defined in such an absurdly dichotomous way: what is "wrong" is invariably defined by those in positions of authority or management. As a mentor to doctors in difficulty I am frequently confronted by the phrase "Dr A showed no insight" whose real meaning is "Dr A didn't agree with us" or "Dr A hasn't admitted that he is wrong". This question of "insight" has found its way into disciplinary and regulatory procedures. It might behove us to remember that awkward, difficult and/or rude behaviour may be displayed by those with high professional standards that have a genuine point or grievance and are frustrated--and that their behaviour may protect patients and/or drive up standards. Their apparent lack of "insight" may centre upon the fact that they may consider that their behaviour is appropriate in a system that values non-confrontation over tackling shortcomings in care. Is it wrong to confront problems robustly if quality and patient safety is at stake?

In the same issue of the BMJ we read Tom Treasure's account of the birth of cardiac surgery at Guy's in the 1950s and 60s (BMJ Oct 20th). This pioneering and high risk work has since saved many millions of lives and the spirit of the celebrated cardiac surgeon Russell Brock and others lived on when I was a student at Guy's in the 1980s. From a diary entry in 1951: "Mr Brock remarked that it was easy to go on finding objections, the thing was to get on with the job". Whether this comment can be taken to demonstrate "appropriate" insight to those with objections I leave Mr Sokol to decide.

Competing interests: No competing interests

21 October 2017
Christoph Lees
Consultant in Obstetrics & Fetal Maternal Medicine