Saturday, January 27, 2018


This week- no surprise- a blog to reflect upon the Bawa Garba case. This isn't one to discuss the intricacies of the case (its been already played out widely in the media -general or social) or the "closing of ranks" -as some have suggested- but a personal viewpoint from someone who has been in the NHS for 20 years now.

To begin with, my views as a parent. Whatever the rights & wrongs of this case, a father & mother lost their child- and nothing in the world can equate to that sorrow- unless one has faced that sort of tragic circumstances. My blood turns cold at the very thought of even the slightest harm to my children- and simply put, there is no words to comfort them enough for their grief. However much time maybe a healer, the scar will remain- as will the fact that errors contributed to a child passing away.
It also makes me wonder whether, we as a system, have contributed to the whole murky saga too. Past examples of patient harm- have never quite ended up anywhere much- beyond "We will learn- and move on". For the individual who has lost a loved one, its perhaps all vey good for someone else to say "we are looking to learn"- but the physicality of seeing an individual who you believe has caused the ending of life to your loved one, continue working…sucks. Its not unnatural to say "accountability needs to lie at the doorstep of someone- not the ethereal system" . I suspect those of us who- fortunately- haven't faced anything of that magnitude may not realise that sometimes in the cold light of day- the passion is likely to be ignited more when the harm is your "own".

Then comes the reaction of some professionals towards those who raise issues. I will give you the example of James Titcombe- some of the vitriol he takes is pretty..well…special. Comments such as "using his child death to make a point" angers me, annoys me- and belittles us many folds over. Cue? Entrenched camps where strong patient voices- driven by personal hurt- clash incessantly with many- strengthening the confirmation bias that professionals are just out to cover their own backs- losing out attempts at rational discussion. For many, there has been-frankly- no closure.

But none of these irk me- my views above are reflections of what I see- and part of me understands the angst. What irks me about this whole thing are a few other bits- and thats more about us, as the NHS, than anything else.

First- the factor of responsibility. However you want to couch it, this junior doctor was left high and dry by her Consultant. Period. The Consultant was aware of the pH and Lactate of the patient, wrote it in his notebook but decided not to review the patient as he expected her to "stress" the results.
I don't even know where to begin with this- but frankly? That irks me. I have always maintained that the Junior doctor strike/ contract issue was a reflection of something much bigger, a lack of support, many instances of seniors not standing by their juniors- and here we have the tip of the spear. Its little things you know, annual leaves, unjustified demands from management, making sure they are safe….and then the culture gets further worse- and there we have it.
Then there is the issue of corporate responsibility- how does any of this not reflect on the Trust and Execs/Managers at that time who allowed such conditions to appear- well, another bit which makes me shake my head. Basically, when it came down to it- and the system needed a "head", it was the junior doctor- someone who could be sacrificed as collateral damage.

Second- the issue of race & colour- that uncomfortable fact. Many many papers etc have been written about GMC convictions and how things are judged- and the perceived bias. Would this case have been looked at differently if the said person was locally trained & white? Its an uncomfortable question which the system needs to be keep asking- but my belief is Yes- it would have been.
Lets give you a simplistic example- a liver surgeon has a bit of lark, plays God- and brands his initials on a liver- gets a 12 month community order and a fine of 10K. Different case- but I can bet you if that surgeon was non-white, he would be doing a bit more than that. I say that from personal experience- the system struggles with anyone who doesn't fit the mould, the judgement of "success" or " failure" is different- however many powerpoint presentations or committees you create to make yourself feel a bit better.

Third- the long term implications. I have always debated here the issue about whether being a medic is a vocation or a job. If its the former, how far does that take you? How far would you cover- how far is that rubber band of safety? How far do you keep trying as "otherwise who will help the patients?" This ruling will challenge that more- and frankly? We are poorer for that. I may smile at their vocational drive- but privately I admire them- and appreciate them for that extra they do.
The impact on personal reflection has been well rehearsed already- and that irks me. A bugbear of mine is improving insulin safety in hospitals…this drives a spear through that endeavour…with a big part of this taking away reflective practice in a safe environment. It drives defensive medicine further up- the system is already creaking with the unnecessary tests we do- "just because" or "what if". This now changes that fact…lets be honest, you would rather organise a CT scan- rather than face the possibility of missing something which could compromise your career, yup?

A murky place indeed- much of our own doing- and some of it the GMC bid to appear muscular- when in the past, they and the NHS have been accused of being far too lenient to medical staff in the face of patient errors- its a crying shame that the pendulum swing has taken us to this place. It irks me especially when there is a such a strong commitment to improve safety for #diabetes patients within hospitals from our end.

If there is any silver lining to this cloud, it perhaps also bares some uncomfortable truths to us as a system- the role of seniors, the issue of race- and the culture of safety we love talking in aviation terms.
Ask any aviation expert, someone would certainly be accountable- its unlikely it would be the first officer flying the plane. The NHS just got a bit more murky.


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