Why Michael didn’t blow the whistle: pub scene

 

In this imagined scene I explore the reasons why junior doctors rarely blow the whistle on poorly performing senior colleagues. I have not been in this situation, and the words I place in the mouths and minds of my protagonists are based on supposition. Of course, real whistleblowers would be able to shed a more penetrating light on this dilemma. Their descriptions would have far more validity. But many junior doctors will have observed poor practice, and they will have considered the question – should I tell somebody? Perhaps this post goes some way to explaining why they hardly ever do.

Readers of this blog will know my methods – I take the true essence of a problem and enlarge it in my imagination. I do not pretend to justify actions or omissions here. It is merely an attempt to explain how people think.

oOo

A junior doctor called Michael observes that his consultant, Doctor G, has made what he believes is the wrong diagnosis on three separate occasions. Michael thinks he has detected a pattern of medical inadequacy. The first time, Dr G failed to detect or interpret the signs of early septic shock on a post-take ward round. Two hours later the patient was in intensive care, on quadruple strength noraderenaline, having been transferred in a state of peri-arrest. On the second occasion an elderly patient with leg weakness was assumed to be ‘off legs’ due to a urine infection, but the following day, after the man had been examined more thoroughly, a spinal cord tumour was found on an MRI scan. He was rushed to a neurosurgical unit for emergency decompressive surgery. And on the third occasion a patient with liver cirrhosis was, in the view of the junior doctor, written off without serious consideration being given to organ support and transfer to the intensive care unit.

 

Michael brooded on these examples. One evening he begins to moan about Doctor G in the pub. He relates the three incidents. His friend, another doctor, nods with common feeling. Michael realises at once that this consultant had an established reputation, a bad one, among other juniors .

 

“So what has been done about it?” he asks.

“The guy’s been there for years, he’ll be retiring in another couple.” says his friend.

“So?”

“He trained in a different era. Half the diseases and treatments that we see now he didn’t even learn about.”

“That’s no excuse.”

“What do you expect the trust to do?”

“Take him off the rota. Patients are being exposed to him every week.”

“And what would that cost? They’d have to employ another consultant.”

“Does it matter?”

“No, of course not. But can you prove that he has actually caused a patient to suffer or die.”

“Well we have just discussed cases where that has obviously happened. I can’t believe nobody has ever said anything.”

“So are you going to do it? Whistleblow?”

“I’m tempted to. Who should I talk to?”

“You’re educational supervisor. That’s who I would go to. Is he friendly, your supervisor?”

“She’s a she. A surgeon. I’m not sure she would have a strong opinion on the medical detail.”

“It doesn’t matter. She doesn’t have to. She just has to acknowledge your concern. She’ll have an obligation to go up the chain. What about the GMC?”

“What will they do?”

“I’ve heard there’s a hotline they’re setting up.”

“You know what I think would happen if I told them?”

“What?”

“I think it would ruin my life.”

“Why?”

“Because for the rest of my time here I would be thinking about what was going to happen.”

“In what way?”

“Well…I’m sure they would be discrete, but they would need evidence from me. I would have to provide            some reports or they would have to come down and find them. That would become the focus of my life. Makes me feel ill thinking about it.”

“We had something like this on the ethics station in our exam. If there
was a real, imminent risk of patient safety the answer was easy. You have to remove the doctor from the clinical environment.”

“Yes, but that was for doctors on drugs, or drunk .”

“What’s the difference? A danger is a danger. If you really think he’s a danger then you should go to someone. The medical director or something like that?”

“Didn’t you work out with them a while back? Didn’t you notice anything?”

“Yes, I thought he was crap.”

“So did you go and speak to anybody?”

“No. He wasn’t that crap.”

“But now you know, having spoken to me, that he is that crap. We agree. I’m sure if there were a few others in here we’d all agree. Shouldn’t we all do something about it?”

There is a silence. What is going through their minds?

Perhaps this: it was not clear to either that Doctor G was a genuine danger. For prior to their arrival in the trust, just two and half months ago, this doctor had been employed for over 20 years without serious complaint. So why should it come to them, these young doctors at the beginning of their careers, to raise the alarm? Surely, if no-one else had detected his deficiencies it was more likely that they were wrong.  Perhaps their inexperience had led them to misinterpret the things they had witnessed. There was more to medical decision making than they currently understood. It was more subtle than right or wrong…

 

And after all, did those patients really suffer more because of Doctor G’s decisions? The man with septic shock recovered eventually. The liver patient, a dyed in the wool alcoholic, was always going to die anyway. The intensive care docs were bound to have said no. And the patient with the spinal cord tumour was making a slow recovery; those extra hours without a diagnosis had not rendered him permanently paralysed. You could argue that it was responsibility of the A&E staff, or the admitting medical registrar, to examine him more thoroughly and detect the tell-tale sensory level. Can you expect consultants, who see each patient for ten minutes after they have already been the hospital for up to twelve hours already, to make every diagnosis, to make no errors? And hadn’t the consultant seen another 15 patients on that post a ward round, making the right diagnosis and the right decision for the overwhelming majority?

 

Michael begins to feel better, more settled. The dangers, to himself, melt away a little. He isn’t betraying his patients’ trust by avoiding the confrontation. Doctor G is different. He has strengths… and weaknesses. Clinically suspect, perhaps, but part of the old guard. And, when it comes down to it, Michael is pretty sure he does a lot more good than harm in the hospital.

 

“Where do you rotate to next?” asks Michael’s friend.

“Ortho.”

“Life might be a bit more straightforward there.”

“I know it will.”

“ Two weeks.”

“Head down mate.”

 cover to tweet

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2 comments

  1. This is exactly the kind of situation I dread. What on earth do you do? I would feel obliged to say something, but would fear the consequences to the extent where instead of saying something I would just freeze up.I don’t even like giving bad feedback about educators because of their high up position in the medical school and deanery.

  2. So how do doctors feel when they cover up a medical error by manipulation of medical records? Their cover-up escalates. A solicitor refuses to obtain or disclose the medical records that have been with-held from the patient. When the patient’s health deteriorates, the GP refuses referral to a consultant and says “what’s the point, you aren’t going to recover anyway”. So the patient is denied health care, the error made by a nurse practitioner, a junior doctor and possibly a registrar is covered up by a consultant, a solicitor, two or three GP’s, and any other doctor with whom the patient may have contact. So what error is so important that all these professionals actively prevent the patient getting medical evidence and deprive the patient of healthcare? Actually two cases – (1) the patient has multiple spinal fractures including unstable fractures at C6 and T8/9. The fractures are misdiagnosed as whiplash, moved during clinical examination and because the right C6 nerve root is deficient due to previous polio, I got arachnoiditis – in ALL the places my nerves were damaged because of errors by a GP, consultant and physiotherapist. – (2) the patient was exposed to abnormal high temperatures, dry air and occilating fans. Her daily disposable contact lenses stuck to her eyes. In despair, the patient ripped the lenses out, unknowingly tearing off her tear films with the lenses. It took three visits to Eye Casualty before her injuries were taken sufficiently seriously to merit referral to a consultant one month later. When she was discharged some ten months after the injury, her eyes had not recovered. Some three years after the original injury, she went for an eye test because her sight is deteriorating. An OCT exam revealed damage to both retinas, slight nerve damage in one eye and significant nerve damage in the other eye. In my case (1) I haven’t been able to work for twentythree years because of the damage caused consequential to my misdiagnosed injuries. In my daughter’s case (2) the doctors concerned seem to have taken the decision that it is better to allow her to go blind than to own up to their mistakes and provide clinical care.
    Yes, doctors make mistakes, but their victims suffer far more because of doctor’s errors than do the doctors who make the mistakes. Instead of moaning about it, why don’t you all get together and support a campaign for a “no blaim” culture? Perhaps in that case, people who suffer as a consequence of clinical errors may not hate the medical profession as much as they do.

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