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Readers respond to the Hadiza Bawa-Garba case

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k1031 (Published 08 March 2018) Cite this as: BMJ 2018;360:k1031
  1. Birte Twisselmann, obituaries and editorials editor
  1. The BMJ
  1. btwisselmann{at}bmj.com

We’ve received correspondence from readers around the world expressing their concerns about system failures, using e-portfolios in legal proceedings, and the threat to duty of candour

Since November, we have received more than 120 responses to our coverage of the Hazida Bawa-Garba case (http://www.bmj.com/bawa-garba)—our most popular research papers usually attract about 15. Although most came from the UK, the case has affected doctors from around the world including those in Australia, Egypt, France, India, and New Zealand. They are predominantly from medical professionals, with journalist Nick Ross, and his three high profile contributions, being a notable exception.

The overwhelming majority rallied behind Bawa-Garba, while expressing compassion for Jack Adcock’s bereaved parents. Supporters with personal knowledge were Lyvia Dabydeen, consultant paediatric neurologist, who worked with her at Leicester Royal Infirmary; Martin P Samuels, consultant paediatrician at Royal Stoke University Hospital and Great Ormond Street Hospital, who acted as a defence expert in the criminal trial; and Jonathan Cusack, consultant at Leicester and Bawa-Garba’s clinical and educational supervisor, who gave evidence to the Medical Practitioners Tribunal Service.

Themes that came up repeatedly included possible racial bias, Islamophobia, and misogyny; egregious examples of “far worse” doctors who were let off comparatively lightly and are still practising; and frank admissions by doctors of their own mistakes leading to patients dying under their care. Christoph Lees, an obstetrician from Imperial College London, wrote: “What is missing is an understanding that doctors who make mistakes are almost always doing so in an effort do ‘do the right thing’ and are very rarely acting deliberately recklessly and an empathy that the consequences of a severe adverse outcome may spell the end of a career or lead to a permanent and deleterious change in practice.”

A few readers were concerned and surprised that the BMA, as the doctors’ trade union, had not publicly expressed a view on the General Medical Council’s actions. Some took issue with our house style, which refers to doctors by their surnames without their title—one correspondent felt that this implied alignment with the tabloid newspapers.

Many were worried about the use of Bawa-Garba’s e-portfolio reflections in the trial—as Margaret McCartney wrote in a response to her own article: “More broadly, recorded reflections (such as e-portfolios) are not subject to legal privilege under UK criminal law. As a result, these documents might be requested by a court if it is considered that they are relevant to the matters to be determined in the case.”1 Johan M van Schalkwyk, perioperative physician at Auckland City Hospital, concluded: “Use of a doctor’s e-portfolio to condemn her sends an unequivocal message to doctors in the UK, and perhaps even to those around the world. The message is this: Lie. Unless you are certain that your e-portfolio is completely protected against legal might, this is your only sensible recourse. Lie with enthusiasm. Lie constructively. Lie consistently. Lie even to yourself.” Respondents to ethicist-barrister Daniel Sokol’s column largely agreed that coaching may be more helpful than written reflections for improving performance.2

Systemic failures were a great cause for concern, as was the question of what doctors should do when faced with an unsafe working environment. But the GMC was the main target of correspondents’ criticism; some called for a full investigation into its functioning. Retired physician, writer, and broadcaster Michael O’Donnell shared his insider knowledge of the organisation and questioned its fitness for purpose after plans for reform have stalled for decades. A much expressed view was that the GMC has dealt a blow to doctors’ duty of candour and patient safety and may have lost the profession’s trust. Jonathan Coates, a GP in Newcastle, wrote: “Instead of placing the blame with those ultimately responsible for these systemic failings, this appeal seems to vindictively target the individual clinician who happened to be the last link in the chain. For the tabloid press to do this is bad enough, but the GMC?”

The airline industry is a popular analogy used in medicine, and Michael Apple, a retired GP in Watford, sums up what several others also pointed out: “This is equivalent to blaming the pilot whose plane crashes despite the airline having failed to maintain it.”

Nick Ross made a further request of the GMC: “Since neither Bawa-Garba’s consultant nor her NHS trust were on trial, their roles largely slipped into the shadows. To put it bluntly (forgive me, but I am a journalist at heart): she was abandoned by her consultant, shafted by her employer, tormented by the courts, and finally persecuted and made unemployable by you. I wonder if you looked behind the court decision at the staffing levels and the workload on that fateful day—an absent consultant, a woeful shortage of trained nurses, no rest break, and so on—and whether you would consider them to be prudent and acceptable. If so, perhaps you would be kind enough to publish them so that we can all see what the GMC regards as a safe working environment.”

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