The ‘sheer fear’ of life in the NHS
As a paediatrician appeals a lifetime ban today, Dr Kimberlie Garde explains why we all need the NHS to learn from mistakes
Iam not brave. Like many doctors across the country, the case of Dr Hazid Bawagarba made me instinctively want never to return to medicine out of sheer fear. Jack Adcock was a six-year-old boy who died from septicaemia at the Royal Leicester Infirmary in 2011. Despite gross understaffing and IT failures, Dr Bawa-garba, the trainee paediatrician who looked after him, received a 24-month suspended sentence for manslaughter.
The Medical Practitioners Tribunal Service panel decided she should not be struck off – citing “the context of wider failures”, such as a lack of other doctors and nurses and delayed test results – but suspended her for at least a year. In January, however, the General Medical Council won a bid to have her struck off for ever – a decision Dr Bawagarba is appealing in the High Court today.
I did not treat Jack Adcock, but my eldest daughter is nearly six and I cannot imagine the pain his family have experienced. I am so sorry that they were left in a terrifying position, believing that a dangerous doctor was still practising and someone else could suffer the same fate. As a mother, and ex-employee at Leicester Royal Infirmary, I apologise on behalf of the hospital and the staff I used to work with that, collectively, we failed to ease his suffering, and treat him with the standards that he deserved.
Terminating Dr Bawa-garba’s medical career has not made any patient safer. On the contrary, it fuels a culture of blame that encourages doctors to hide mistakes rather than learn from them.
Nobody can make medics feel worse about our own failings than we already do – my own experience of working in the NHS slowly eroded my self confidence, caused anxiety and depression, affected my ability to support colleagues and ultimately my patients. After my maternity leave in 2012, I was not brave enough to return.
Dr Bawa-garba, however, is very brave. Dr Bawa-garba didn’t run, when on her first on-call back from her own maternity leave, she arrived to find she had to work an extra three jobs: her consultant elsewhere, her fellow registrar not there, and her senior house officer away trying to find test results from a broken IT system.
She didn’t jump ship when she also had to carry the crash bleep, and a cardiac arrest on her arrival meant she missed the doctors’ handover to orientate her to which patients were sick, with what, where. She didn’t shirk when she was told she was responsible for the care of patients on six wards, on four different floors. She didn’t run when the only staff to help her were two newly qualified foundation doctors, who would need support and probably her supervision to take blood or cannulate patients. Dr Bawa-garba simply treated to a high standard scores of very sick patients requiring urgent attention under her care for a 13-hour shift. After which, undoubtedly tired, she made mistakes that contributed to her not being able to save Jack Adcock. To save him from an illness that has a 45 per cent chance of death, even when hospitals are fully staffed, with working equipment.
The focus of this case, the media coverage and the activity on social media has centred on apportioning blame: the nurse? The doctor? The managers? The hospital? The trust? Ministers? Jack Adcock’s death was caused by bacteria. He was not killed maliciously by anyone. Despite efforts to treat him, the stretched and understaffed system failed to save him. This is a very important distinction.
This should be a watershed case, not just for Leicester but the entire NHS. Every year, preventable medical error kills thousands. The only way to reduce this is to learn from each case. That will never happen if medics are too fearful of repercussions to be open about honest mistakes.
I arrived at medical school in 2004 a confident, capable young woman. The pressure, however, combined with my fear of failure, made me a perfectionist, a common trait amongst doctors, and I sometimes struggled with basic tasks. I never failed an exam and passed many with excellence, yet when I graduated with a merit, I left filled with anxiety, rather than confidence.
My first job was on the paediatric high-dependency unit at Leicester Royal Infirmary in 2011. I was so terrified I was going make a mistake and hurt someone, especially with the patients on that ward being so sick and complex, that I arranged for my two-month elective period (where you can choose to study anywhere in the world), to be on this ward to help me “practise” what I was going to start doing in work. The staff there – the consultants, doctors, nurses, dietitians
‘Ending her medical career has not made any patient safer’
and physiotherapists – were exceptional. The doctors in my team had inspiring clinical skills. They were caring, kind and utterly dedicated to their patients.
On the few occasions I worked under Dr Bawa-garba, she struck me as someone I should try to emulate and learn from. She was professional, her clinical knowledge impressive, and despite having a huge workload, she made time to support me.
But throughout my time there, rotas were very complicated and the high turnover of seniors meant encouragement was scarce and it was intimidating to ask for help. Frequently I had panic attacks and days off work with anxiety because I was frightened I might put a foot wrong, and hurt someone.
It is easy to forget that the ability to practise medicine is precious. Training involves years of hard work, cost and sacrifice. Threats of criminal charges and punishment by regulators (who can take away ability to practise altogether) mean staff understandably become defensive when an honest mistake is made.
Medics are held to a higher standard than most – our mistakes carry higher stakes. But should we scapegoat individual doctors for the horrific outcome of mistakes made due to countless systemic failings?
Dr Bawa-garba’s mistakes ended her career, her ability to care for other patients and her ability to support her family for six years. Yet all she wants to do is return to work to help others – to return to a system that burnt her.
She not only inspired me when I worked under her, but she has inspired me to face my fears and start my long journey from being a full-time mother to return to medicine. Hopefully, one day, I will become a paediatrician as dedicated and brave as Dr Bawa-garba.