Blame and secrecy prevent doctors from avoiding future mistakes
SIR – Niall Dickson (Comment, February 2) is correct in calling for a change in the method of compensation for episodes of clinical negligence, but he approaches the problem from the wrong direction. Reducing the incidence of negligence claims must take priority, rather than limiting compensation.
As a medical expert regularly instructed to report on such cases, I observe the same errors repeated time and again. However, as a consequence of the blame culture, managerial and medical secrecy, and the long delays from event to resolution, there is no learning from negligent care. Doctors and others repeat errors as their training fails them.
There is no communication between lawyers who act in these cases and the medical profession to allow dissemination of causes of negligence and how to avoid them. Critical reports from experts and judicial determinations are routinely kept secret, as well as costs.
With a new system of communication and teaching, NHS staff might avoid harming patients in the first place, and costs might fall dramatically.
Gavin R Tait FRCSED
East Kilbride, Lanarkshire
SIR – Your report on compensation highlights the fact that, if present trends continue, up to half of the annual NHS income could be consumed by such payments.
As long as claims are controlled by our adversarial legal system there will always be the necessity to apportion blame. An obvious solution would be to adopt the New Zealand system of “no-fault compensation” and remove the necessity for lawyers. This works extremely well and not only results in prompt settlement of claims, for appropriate amounts, but also allows doctors to feel able to admit, document, discuss and learn from apparent errors openly, without fear of legal action against them.
We also need to address the current culture that encourages people to blame systemic failures rather than take personal responsibility for their actions, something that would come naturally in New Zealand.
Simon Marsh
Consultant Surgeon, Colchester Hospital University NHS Foundation Trust, Essex
SIR – In the practice of medicine as in any other profession mistakes are made. Mistakes made in medicine can result in increased suffering or even loss of life but no amount of attempted suppression by legalistic means will eradicate them.
Not only hospital trusts but also the nurses and doctors who work in them are punished with increasing severity for what are often just straightforward mistakes. This results in defensiveness rather than best practice by doctors, which is not in patients’ best interests.
We appear to have developed into a blaming society in which any accident or mistake has to be someone’s fault.
Nigel Dwyer FRCS
Solihull