Concerns about reflection distract from the bigger threat to patient safety
Much of the concern in a number of commentaries about the Bawa-Garba case has been around the purported use of personal reflections to indict her - which the GMC has been clear in rebutting. As a recently qualified GP and patient safety researcher, personally this has not been my main concern at all. Through my research on use of reflection in patient safety (1) I know that clinicians already vary considerably with regards to engagement with reflection, and that portfolio entries are 'sanitised' to varying degrees. For those of us who are not all that keen on portfolios and appraisals, this case will serve to further disengage us from the process. Irrespective of how much the GMC refutes this allegation, unfortunately I fear that the damage has been done. And that is certainly not good for patient safety.
However, the greater threat to patient safety is in scapegoating an individual junior doctor whilst ignoring the significant contribution of systemic failings in the care of Jack Adcock, thereby ensuring that such systemic failings pervade.
My questions to the GMC are three:
1) If we are looking at attributing blame to someone, why has Dr Bawa-Garba been singled out as personally culpable for the death of Jack in the context of inadequate supervision and systemic failures?
2) How can her actions or lack of be regarded as gross negligence manslaughter? I am encouraged by the GMC's intention to explore this, and the proposed rapid review of medical malpractice by the Secretary of State for Health and Social Care today is welcomed.
3) Why did you insist on challenging the MPTS' decision at the High Court to erase Dr Bawa-Garba from the register? The claim was 'to maintain public confidence' when arguably the opposite has been achieved in making the public perceive that the profession are now fighting to 'protect their own' given the huge success of the Crowdjustice campaign. As Ladher and Godlee already point out there are cases of other doctors with criminal convictions who have been allowed to continue to practise (2).
I hope that these questions can be answered in due course and that the public, profession and regulator can work together to address the real threats to patient safety and hold the government to account.
(1) Ahmed M, Arora S, Carley S et al. Junior doctors' reflections on patient safety. Postgrad Med J 2012;88:125-9
(2) Ladher N and Godlee F. Criminalising doctors. What must we learn from Jack Adcock's death? BMJ 2018;360:k479
Rapid Response:
Concerns about reflection distract from the bigger threat to patient safety
Much of the concern in a number of commentaries about the Bawa-Garba case has been around the purported use of personal reflections to indict her - which the GMC has been clear in rebutting. As a recently qualified GP and patient safety researcher, personally this has not been my main concern at all. Through my research on use of reflection in patient safety (1) I know that clinicians already vary considerably with regards to engagement with reflection, and that portfolio entries are 'sanitised' to varying degrees. For those of us who are not all that keen on portfolios and appraisals, this case will serve to further disengage us from the process. Irrespective of how much the GMC refutes this allegation, unfortunately I fear that the damage has been done. And that is certainly not good for patient safety.
However, the greater threat to patient safety is in scapegoating an individual junior doctor whilst ignoring the significant contribution of systemic failings in the care of Jack Adcock, thereby ensuring that such systemic failings pervade.
My questions to the GMC are three:
1) If we are looking at attributing blame to someone, why has Dr Bawa-Garba been singled out as personally culpable for the death of Jack in the context of inadequate supervision and systemic failures?
2) How can her actions or lack of be regarded as gross negligence manslaughter? I am encouraged by the GMC's intention to explore this, and the proposed rapid review of medical malpractice by the Secretary of State for Health and Social Care today is welcomed.
3) Why did you insist on challenging the MPTS' decision at the High Court to erase Dr Bawa-Garba from the register? The claim was 'to maintain public confidence' when arguably the opposite has been achieved in making the public perceive that the profession are now fighting to 'protect their own' given the huge success of the Crowdjustice campaign. As Ladher and Godlee already point out there are cases of other doctors with criminal convictions who have been allowed to continue to practise (2).
I hope that these questions can be answered in due course and that the public, profession and regulator can work together to address the real threats to patient safety and hold the government to account.
(1) Ahmed M, Arora S, Carley S et al. Junior doctors' reflections on patient safety. Postgrad Med J 2012;88:125-9
(2) Ladher N and Godlee F. Criminalising doctors. What must we learn from Jack Adcock's death? BMJ 2018;360:k479
Competing interests: No competing interests