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Editorials

In harm’s way

BMJ 2019; 365 doi: https://doi.org/10.1136/bmj.l2037 (Published 08 May 2019) Cite this as: BMJ 2019;365:l2037
  1. Liam J Donaldson, professor of public health1,
  2. Claire Lemer, consultant paediatrician2,
  3. James Titcombe, patient safety campaigner3
  1. 1London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
  2. 2London, UK
  3. 3Rowe Head Court, Pennington, Cumbria, UK
  4. liam.donaldson@lshtm.ac.uk

Redefining professional accountability for everyday healthcare

The tide of emotion, controversy, and judgment surrounding paediatrician Hadiza Bawa-Garba1 has now retreated, leaving behind deep uncertainties about the future handling of such situations.

Avoidable harm is at its most contentious when the focus is on accountability. Demand for accountability is fiercest when a patient dies after care has fallen below acceptable clinical or compassionate standards. Individual providers are often in the frame, but these debates rarely threaten the health systems that manufacture risk and harm as a byproduct of their work. Nor do the public or the media seem too horrified by the lamentable failure of the NHS to learn from the past; despite the heartfelt wishes of grieving families, too many patients are still dying in vain. The victims of harm can be ignored and denied access to the truth.

Classic patient safety incidents (sometimes called “medical errors.”) are well defined, well documented, and circumscribed within familiar aspects of care.2 They include wrong site surgery, medication errors, failure to recognise and act on deterioration of an acutely …

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