To err is human - but not if you're a doctor

Is a blame culture really the best way to get doctors to admit their mistakes? [Ethics article from 'Summons' Summer 2009]

  • Date: 01 July 2009

A RECENT EPISODE of the BBC daytime drama series Doctors – set in a GP group practice – featured a doctor who failed to spot the tell-tale symptoms of angina in a patient.

Luckily, her professional instincts rang alarm bells and she got to him shortly after he suffered a heart attack, saving his life.

How realistic is that scenario? Doctors are undoubtedly human like the rest of us. It’s just that clinical mistakes can have dire consequences. Mention Dr Melody Bell’s failure to spot a condition to any doctor and you’ll hear them muttering "there but for the grace of God, go I…”.

NHS figures suggest that 850,000 patients suffer what experts call “adverse events” every year: clinical negligence, missed diagnoses, medical mistakes and more. The toll in terms of human grief and misery is incalculable. The cost to the NHS – in effect, a cost to us – is around £6bn. But doctors suffer too.

As Sir Liam Donaldson noted in a recent Scrubbing Up (online BBC News Health page), victims of medical mistakes want an apology and an assurance that the mishap won’t recur. Yet the current blame culture in healthcare risks crushing individual medics for one regretful error.

Failure a ‘team effort’
Take the case of Dr A, a surgeon who mistakenly removed a functioning kidney. At a hearing of the doctors’ regulator, the General Medical Council, he admitted his fault. The GMC panel hearing his case accepted that shortcomings by his hospital had contributed to the mistake. It acknowledged that support from the hospital was poor. It observed that doctors, nurses and managers all communicated badly, leaving our medic – and through him, the patient – vulnerable. Failure was “a team effort”. But it was the surgeon who took the rap. He was found to have seriously failed in his clinical responsibilities and suspended for a year.

Consider also the experience of Dr B, a young GP who was called to the home of a 15-yearold girl complaining of a severe headache, fever and pains in her legs. The GP examined the girl for any rash or bruising, the tell-tale signs of meningococcal septicaemia – a bacterial infection of the blood, commonly known as blood poisoning and didn’t see any. He did the right thing in examining her, but crucially made no medical note of it.

‘Not reckless’
Medical tragedies are awful disasters for patients and those near to them. This is what makes the practice of medicine unique. Patients rightly trust doctors. The point is, doctors tend not to be reckless. They don’t set out to slip up. Yet the consequences for a doctor who blunders may be dire, particularly if a patient dies.

Being called to give evidence at an inquest is the least of it. They may be suspended from duty, face an NHS enquiry or disciplinary proceedings, and be dismissed. They may be suspended in advance of a GMC hearing, and then “erased” following it – that is, stripped of their licence to practise. The career that they loved is at an end. They can face a police investigation and criminal charges, and a civil trial for negligence. Public vilification is bad enough. Guilt and self doubt are arguably worse.

You might think that one or two of these consequences might follow a professional mistake. But at the MDDUS we have heard of many cases where all have followed.

Yes, doctors have to account for themselves when things go wrong. But perhaps a blame culture is not the best way to encourage them to “fess up” to such mistakes.

And mistakes are so easily made. Just ask Dr Melody Bell.

Dr George Fernie, Head of Medical Division, MDDUS
This article was published 15 April 2009 in Scrubbing Up – a regular online BBC News Health column aimed at a mainly non-medical audience


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