Saturday 10 March 2018

Why are doctors being convicted?

Paediatrician Dr Hadiza Bawa-Garba and surgeon Mr David Sellu were both convicted of gross negligence manslaughter in the courts of Mr Justice Nicol in 2015. Mr Sellu's conviction was quashed on appeal. Following the GMC's decision to remove Dr Bawa-Garba from the medical register, there has been widespread condemnation of her original conviction by the medical community.

By Blogtrepreneur (Legal Gavel) [CC BY 2.0], via Wikimedia Commons

What are the key components of the mistreatment of these well-meaning doctors?

1) Sick people sometimes die before doctors can save them
2) Risk intolerance
3) Culture of blaming individuals fuelled by courts and GMC
4) Under-resourcing

These cases tragically highlight the problem with the popular view that no risk is acceptable, medicine can treat everything and if anyone dies after seeing a doctor it is the doctor's fault, usually for not responding quickly enough.

The logical response to this argument is indeed to assess people more thoroughly and treat them more quickly. Most doctors are well aware that all tests and treatments carry risk and cost money and time that taxpayers are unwilling to provide the NHS with.

The reality is that, unpredictably, people become very sick, especially if they have other medical problems and, despite the best efforts of doctors and nurses with the dwindling resources available to them, sometimes, tragically, they die.

The instinct to apportion blame is an entirely understandable component of a grief reaction but is a poor basis for policymaking.

Indeed, blaming individuals discourages candid reflection and identifying the numerous failings across a system usually to be found when errors do occur.

Unfortunately, instead of looking at the all important bigger picture, our courts, the GMC and politicians have all conspired to fuel this blame culture and make patients less safe. The courts rely on evidence not of a doctor's peers at the short-staffed, cash-strapped coalface but disease experts who expect perfection and more. In the Bawa-Garba case, the GMC too yielded to the rule of the mob by rejecting the nuanced view of the doctors of its Medical Practitioner Tribunal Service and instead relied solely upon the arguably flawed judgement of the court. And politicians routinely promise more, better and faster treatment without finding the much-needed money.

Our society has killed the NHS. It must now decide what will rise out of the ashes.


Anonymous said...

Please will the medical profession tell me if they want me to take a senior medical academic to the GMC for testifying as an Expert Witness on a condition that academic had never diagnosed or treated. Confession of this was forced out by solicitors under caution. Please reply to

John Cosgrove said...

Interesting question. I would be interested in people's thoughts. I'm guessing this refers to a different case?

Anonymous said...

Hypothetical situation:
Dr A is an academic. Her expertise is in writing systematic reviews.
She leads a group writing a Cochrane review on treatment X vs treatment Y.
The results are conclusive. Her review concludes overwhelmingly that treatment X is better, and that further research into this question is unnecessary.
She testifies that treatment X is the best treatment but admits to never diagnosing nor treating the condition.

Don't think there's anything wrong with that as such.

Anonymous said...

Dr A does not write reviews on the condition for which he was being an expert witness, since he does not accept the validity of it despite its formal classification. His treatment X was invalidated by the defence's expert and also by the relevant report of NICE.

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Anonymous said...

Thank you for the interest on various fora in my scenario. Allow me to provide some clarification.

The condition in question is not uncommon and there is NICE guidance on its management. As such, a suitably qualified expert witness would be expected to know about the condition. Despite agreeing to be an expert witness, it became apparent that he had personal antipathy towards diagnosing and treating the condition. On meeting the patient, this expert witness even succeeded in making the patient doubt the diagnosis. He failed to tell the solicitors that he had no experience of this condition until, under caution, he was required (ie forced) to tell the whole truth. Although his early statements had such an impact as to prolong the case considerably, the matter mercifully didn't get into court, so a defence barrister did not get the opportunity to pursue the matter.