Doctors have consistently been named the profession most trusted by the British public
Over the last quarter century, doctors have consistently been named the profession most trusted by the British public. In a year when trust in politicians and other public figures has fallen through the floor, a survey this September found that 92% of British adults, or more than nine in ten, trust doctors to tell the truth. Politicians, on the other hand, are at a 26-year low, with just 13% saying that they trust politicians. For doctors, this trust factor is at a 25-year high, with most other professions trailing well behind.
However, despite these surveys, when you speak to doctors they believe that they are a profession under sustained attack. Not only is the press filled daily with sensational stories of failing hospitals, medical disasters and sexual impropriety by clinicians, but there has never been a time when doctors are under so much scrutiny with potentially career-threatening outcomes. So how can these two apparently conflicting positions be explained?
Everything should be done to try to minimise those avoidable errors but there must be an acceptance that some will occur – it is how we react to these events that is vital
The problem to me is that clinicians and the government between them have persuaded the public that they are entitled to expect perfect outcomes – the surgery will always be successful, a full recovery will be made and mistakes are unacceptable and must never happen. I can well remember John Major’s Patients Charter that was announced in 1991, which, although laudable in many respects, promised a great deal without the resources to deliver.
It was also totally one-sided, with nothing mentioned about the responsibility of patients. It could be coincidental, although I don’t believe it is, but 1991 saw the beginning of an exponential rise in claims and complaints against the NHS and, just as worrying, a similar increase in the number of attacks by patients on hospital staff.
Most days, most people will make a mistake, normally small and inconsequential ones that are never discovered or result in no harm, although occasionally they will be serious or embarrassing. The point is that everyone makes mistakes but most people are fortunate enough not to be a doctor who can be formally investigated two, three, possibly four or even five times over, concerning the same incident. It is a fact that adverse events will happen. Everything should be done to try to minimise those avoidable errors but there must be an acceptance that some will occur – it is how we react to these events that is vital.
My fear is that if doctors continue to believe that they are under sustained attack and fear the stress of prolonged investigation for one or two mistakes in a career, then many of those who are the most caring and conscientious will decide to leave the profession early or, even worse, decide not to train in medicine in the first place. We have now reached the stage where there are more than 5,000 GMC investigations a year and there were 360 fitness to practise hearings in 2008.
This means that a cohort of 100 newly-trained doctors, assuming they each have a 40-year career, can collectively expect to undergo more than 100 GMC investigations and seven or eight will be subject to a fitness to practise hearing. Can you imagine the uproar if members of other professions could expect to be investigated at some stage in their career?
The move towards the harder-nosed, thick-skinned, more money-orientated doctor has already happened in the USA and has perhaps started here. If it gathers pace, then it will be to the detriment of society as a whole.
The move towards the harder-nosed, thick-skinned, more money-orientated doctor has already happened in the USA and has perhaps started here. If it gathers pace, then it will be to the detriment of society as a whole.
I think that without doubt there must be a better solution than the one we have today. To my mind the key is to ensure that patients continue to have the highest levels of trust in their doctors and that the doctors are allowed to do what they do best – which is care for their patients in the knowledge that they will not be pilloried for the rare mistake but rather that everyone can learn from what has happened.
My list for what is needed to achieve this is:
- A recognition and acceptance by the public that mistakes will always occur and that perfect outcomes should not be taken for granted. When mistakes do occur, every effort must be made to minimise the chances of them happening again in the future.
- Adverse incidents should be investigated in an open manner, with all members of the clinical team encouraged to speak up in a “no blame” environment and with no fear of reprisals for any critical comments made. Patients should be encouraged to trust the investigating team to ensure that the appropriate action is taken and not pursue personal retribution, provided their other needs are met.
- Regulators should only investigate cases where there is a real and justified risk of significant impairment in a practitioner’s fitness to practise. Doctors are also ordinary citizens but the standards of behaviour that are expected, not only in their working environment but also their private lives, make it virtually impossible for them to live up to those standards every waking moment of the day.
- Patients should receive swift and fair compensation for harm as a result of proven negligence.
To sum up, I believe there is nothing more important than ensuring the continuance of a strong doctor–patient relationship if we are to have a first-class health system that continues to improve. At the core of this is trust between everyone. I would value your comments on this or any other aspect of MPS work.
Yours faithfully
Tony Mason
Chief Executive