The BBC commissioned 2014 Reith Lectures started this week and it looks to be an interesting series. In his first lecture, the Harvard Professor of Medicine, Dr Atul Gawande, spoke on the subject of "Why do Doctors Fail?". This is very relevant to the issue of openness within the medical profession says Manori Wellington and well worth a listen.
Dr Gawande's interest in the subject matter is very personal. His son, Walker's life had been put at risk by a near miss in the treatment he received when he was a 11 day old baby and was found to have heart abnormalities. Walker's life was saved but he witnessed the suffering of another baby in the hospital who had the same condition but had not been so fortunate.
Dr Gawande voiced the reality of what doctors face day to day in dealing with a human body that is such a complex entity. He described there being 60,000 ways that things can go wrong. Medicine to him was "the story of how we deal with the incompleteness of our knowledge and the fallibility of our skills". He spoke about what it meant to be fallible as a doctor and for him the root causes were either ignorance or ineptitude. There have been so many advances in the understanding of how our bodies work and in medical science. Our doctors know a lot and are expected to have a high skill level but can we expect them to always have the necessary knowledge or apply that knowledge correctly? Do doctors expect it of themselves to get it right all the time? Of course that is not what happens in practice. Doctors like anyone are fallible and can make mistakes. The issue that remains is how the medical profession responds when that happens.
Does the fear of failure and the perception of infallibility in medical care impact on what happens in day to day practice? Dr Gawande believes so. He spoke about how he had tried to process what had happened to his son and the near miss of there being a very different outcome. To avert mistakes, to improve patient care, the answer he felt was greater transparency - "Only by removing the veil over what happens in the clinic and hospital, only by making what has been invisible visible."
Dr Gawande's practice has been in America but the lack of transparency remains a real issue in the care given in this country. In the late 70s and 80s you would have struggled to get answers if something had gone wrong with the medical care you had received. Questioning the care provided by doctors was just not considered acceptable. Over the years a complaints process has been put in place to enable patients in theory to raise concerns and this is, of course, progress. However the response to a complaint is often considered by patients to lack transparency. Explanations are communicated in a way that leave patients feeling that they have not been told the full story. Often that leads to the patient or their families consulting a solicitor to investigate a medical negligence claim.
There has been some advancement following the report of Sir Robert Francis Q.C. on the issue of a duty of candour. Candour was identified in the report as "The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made." The underlying theme within Mr Francis' report is the need for openness and transparency. There is now a statutory duty of candour for all NHS bodies in England and from next year for all other care providers registered with the Care Quality Commission. It waits to be seen what changes this will bring in practice. This is a real opportunity of change.
Dr Gawande appears to be speaking about transparency in a wider sense coming from a willingness within the medical profession itself to embrace this. It would be a real change if the culture did change so the professionals felt a "near miss", where a mistake happens but does not result in injury, is something to be recognised as an opportunity to learn. For that learning process itself to be dealt with without there being a sense of failure attached. When a mistake is made that leaves a patient injured, you are often left with the feeling that the individuals involved or the system within the department would have had problems, near misses, which if they had been dealt with, with openness and transparency would have prevented the injury to that patient.
Dr Gawande's interest in the subject matter is very personal. His son, Walker's life had been put at risk by a near miss in the treatment he received when he was a 11 day old baby and was found to have heart abnormalities. Walker's life was saved but he witnessed the suffering of another baby in the hospital who had the same condition but had not been so fortunate.
Dr Gawande voiced the reality of what doctors face day to day in dealing with a human body that is such a complex entity. He described there being 60,000 ways that things can go wrong. Medicine to him was "the story of how we deal with the incompleteness of our knowledge and the fallibility of our skills". He spoke about what it meant to be fallible as a doctor and for him the root causes were either ignorance or ineptitude. There have been so many advances in the understanding of how our bodies work and in medical science. Our doctors know a lot and are expected to have a high skill level but can we expect them to always have the necessary knowledge or apply that knowledge correctly? Do doctors expect it of themselves to get it right all the time? Of course that is not what happens in practice. Doctors like anyone are fallible and can make mistakes. The issue that remains is how the medical profession responds when that happens.
Does the fear of failure and the perception of infallibility in medical care impact on what happens in day to day practice? Dr Gawande believes so. He spoke about how he had tried to process what had happened to his son and the near miss of there being a very different outcome. To avert mistakes, to improve patient care, the answer he felt was greater transparency - "Only by removing the veil over what happens in the clinic and hospital, only by making what has been invisible visible."
Dr Gawande's practice has been in America but the lack of transparency remains a real issue in the care given in this country. In the late 70s and 80s you would have struggled to get answers if something had gone wrong with the medical care you had received. Questioning the care provided by doctors was just not considered acceptable. Over the years a complaints process has been put in place to enable patients in theory to raise concerns and this is, of course, progress. However the response to a complaint is often considered by patients to lack transparency. Explanations are communicated in a way that leave patients feeling that they have not been told the full story. Often that leads to the patient or their families consulting a solicitor to investigate a medical negligence claim.
There has been some advancement following the report of Sir Robert Francis Q.C. on the issue of a duty of candour. Candour was identified in the report as "The volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made." The underlying theme within Mr Francis' report is the need for openness and transparency. There is now a statutory duty of candour for all NHS bodies in England and from next year for all other care providers registered with the Care Quality Commission. It waits to be seen what changes this will bring in practice. This is a real opportunity of change.
Dr Gawande appears to be speaking about transparency in a wider sense coming from a willingness within the medical profession itself to embrace this. It would be a real change if the culture did change so the professionals felt a "near miss", where a mistake happens but does not result in injury, is something to be recognised as an opportunity to learn. For that learning process itself to be dealt with without there being a sense of failure attached. When a mistake is made that leaves a patient injured, you are often left with the feeling that the individuals involved or the system within the department would have had problems, near misses, which if they had been dealt with, with openness and transparency would have prevented the injury to that patient.