The eyes and the ears: why Adam blew the whistle

Previously I wrote a dialogue between two junior doctors. They discussed why Michael would not report, to some higher authority, the dangerous incompetence of a consultant. In this second dialogue, Adam explains to his friend why he phoned the GMC to report dangerous staffing levels. This dialogue seeks to illustrate why a doctor might feel compelled to act, rather than just watch, shake their head and move on.

This is imaginary, obviously. It is intended to describe the thoughts that a whistle blower might have.

Adam and his friend sit in a beer garden. Adam occasionally looks over his shoulder to check who has taken the adjacent table.

“Was it you?” asks Adam’s friend.

“What?”

“Who called the GMC.”

“What did you hear?”

“That someone blew the whistle on A and E.”

“What else did you hear?”

“That it was about staffing levels, lack of support…it was you wasn’t it?”

“Why do you think it was me?”

“Because you’ve been going on about it for ages.”

“That’s the point I guess. I wasn’t seeing any changes at all. I was out of ideas.”

“So did you actually complain first, officially…through proper channels?”

“I told the clinical lead that I thought we were too thin on the ground. Several times.”

“And what did she say?”

“That it ‘will get better’. That ‘when the deanery send us more juniors we’ll be fine’. Mañana, mañana.”

“Did you have examples, of poor staffing leading to bad outcomes?”

“How can you get that evidence? We’re working on the ground, struggling, we work our arses off to keep the ship afloat, some people die, most don’t, how do I know if any particular death is directly related to not enough staff? How do I know if our department has got more deaths or delayed diagnoses that average? I don’t have that overview.”

“So how can you justify blowing the whistle? You don’t know that the department was actually under-performing.”

“If you follow that line of reasoning, no-one would ever stand up and say anything, they would have no confidence in their own opinion. ‘I’m just a cog in a machine, I’m not driving the machine’. To justify NOT saying anything you have to have complete faith in the driver. Do I have faith in the driver? I don’t know, I don’t know the people who run the hospital . All I know is that sometimes it’s hell in that department and patients are falling off their chairs in the waiting room.”

“And despite not knowing, you made the call. Where did you develop that confidence in yourself?”

“It’s not confidence. It didn’t come easy. I waited for months and months before making that phone call. Nearly a year in fact. But nothing was changing.”

“It has now.”

“I know.”

“You should feel proud.”

“I don’t. I just feel sick when I walk through A and E. At least staff move through it so quickly the current set of juniors don’t recognize me as the troublemaker. The consultants do. But a few have told me that they are pleased I did it.”

“Weren’t they embarrassed?”

“No, I don’t think so. They thought the same as me. When someone actually does it…does something positive, everyone suddenly says ‘Yeah, I agree, it’s unacceptable…’. Like the emperor’s new clothes, everyone pretends it’s fine, they can manage, then someone pipes up and the truth becomes clear to all, undeniable. Weird psychology.”

“But why did it take your call? The Trust knew about the situation, the department was aware…not just from your comments…but it took the fear of a GMC investigation to do anything.”

“I honestly don’t know.”

“Has anyone from senior management spoken to you?”

“Yep.”

“And…?”

“It was all very reasonable, understanding, respectful in fact.”

“Fake?”

“Actually no. We got into a good discussion. He made me feel relaxed, and we went into it in some detail.”

“Such as?”

“The bigger picture. He allowed me to push him…to draw him out…to reveal HIS thoughts about whistleblowing. It wasn’t the greatest example of whisteblowing in history was it, really, more of an alert I think…so I don’t think he minded talking about it. So we got into the bigger picture. He encouraged me to think about scale, to think about the hospital as a unit, providing care to all of its patients and to the whole community. Elective and emergency. Babies, kids…not just the sort of patient I was seeing. Those in charge have to decide where to put the resources, where to place the staff…”

“So only they have the overview, and the knowledge…”

“Perhaps, but it went further. I said yeah, you have to make hard decisions, to ration basically, but you in turn are being rationed, by the government, who have demanded that you save x million this year as a share of the £20 billion of efficiency savings. He liked that.”

“He didn’t really agree to pass the buck onto the government did he?”

“Not as such. But perhaps he should have. I might have sympathised with him.”

“You can take the bigger picture further you know Adam.”

“How?”

“To society as a whole. Why does the government demand we save £20 billion?”

“Because the economy is screwed. Austerity.”

“Yes, that’s the environment we live in. But within that environment the government has decided to squeeze the health service because it has a duty to maintain other parts of the state at the same time. Defence, social security, prisons…so in their eyes, the bigger picture demands that Trusts feel the pain. That’s the price of austerity, of long term economic stability. We don’t have that overview, the really big overview.”

“You really believe that? No wonder you didn’t make that call. You’ve intellectualised it to death.”

“Perhaps.”

“I said I sympathized with the big picture, but ultimately it doesn’t cut it. Because it’s not our business to care about the bigger picture, don’t you see? Resources are be sent down according to the best judgements or intentions of our political masters, or moved around the Trust by our senior managers, but we must concern ourselves with what the effect of those decisions is at ground level.”

“Humour me a minute Adam, I’m not criticising you…but why whinge about those decisions? We live in the big picture. We are citizens in a democracy, we, as a society, voted for austerity and hardship. We ARE cogs. That’s the state we’re in, we should just do our best within it. ”

“It doesn’t matter. We, as doctors, work in a small world, the hospital…and we are there to make patients better. We are the ones with the eyes and the ears to tell the ones who move those resources around that their decisions are proving destructive. We are the ones who must tell them if minimum acceptable standards are not being maintained. Who else is going to spot that? If not us, who?”

“But doesn’t everyone think that their little domain is under resourced, straining to maintain minimum standards? We can’t have all of them ringing the GMC helpline.”

“I agree. And that’s why it took me a year. I challenged myself over and over again, told myself it was just me, just a bad run of shifts, that my seniors had recognised the problem and were dealing with it…but nothing happened! So I did it. I reassured myself that it was up to me to tell them that here, in this case, the balance wasn’t right.”

“Eyes and ears.”

“Yep. That’s what Francis said.”

“And mouths too.”

 

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