I am a doctor. I am human. I will make mistakes.
With very rare exceptions, all of us who work in the health service go in to work every day intending to look after our patients as best we possibly can. We never intend to cause harm either by what we do or by what we decide not to do. However, we are all human and from time to time we all get it wrong. Sometimes terribly wrong.
One of the markers of a safe, modern health service is that it recognises that we are fallible and allows for and protects against human error.
With the right systems and safety nets in place, we can minimise the chances of one human being’s mistake damaging another human being.
We can never completely prevent it and we should not pretend that we can but we can reduce the chances of harm.
We can only protect against errors if we know what mistakes people have made, or are likely to make and we will only know that if we are willing to talk about it. A system where I can say, openly: ‘Things went very wrong today,’ is the beginning of a safe system. A system where the response is: ‘Tell me what happened, and why, and let’s work out how we can stop it happening again,’ is a system that will help us keep our patients as safe as possible.
In contrast, a system where I am too frightened to admit my mistakes, for fear of the consequences, will lead, sooner rather than later, to patients being harmed, entirely avoidably.
Medicine has, in recent years, borrowed and adapted much of what gives the airline industry such an enviable safety record: team-based safety checks; a focus on identifying and solving problems, rather than apportioning blame; and recognition that we can deal with even rare and catastrophic events well and safely if we have planned and practised. We need to keep this approach and develop it.
There is, however, one way in which the health service is completely different from the airline industry. If your flight is supposed to have a pilot, a co-pilot and four cabin crew, all properly trained and familiar with the aircraft, then that it is what it will have. If the airline is short staffed, with rota problems, and it has no co-pilot and only three cabin crew, then you will simply not fly.
They could try to juggle to cover the gaps. One of the cabin crew from another flight has already done all his legal hours and he never crewed on this aircraft before but he’s willing to help out. And the co-pilot from the incoming flight is willing to work a double shift, even though she is over her hours, too. The airline industry recognises this isn’t safe. So, it won’t happen, your flight will not take off.
In the health service, we often work with not enough staff. Staff often work longer hours than they should. We work in unfamiliar areas because that is where we are needed. We all know that when we are tired, overstretched, and under pressure we are more likely to get things wrong. But cancelling a flight is not the same as closing the hospital to admissions. A four-hour flight delay is not the same as being unable to provide out-of-hours cover. Except in the most extreme of circumstances, all of us believe, or used to believe, that ‘the best care I can provide in these circumstances’ is better than no care at all.
Many doctors, just now, are worried and confused by what is expected of us. This has been brought into sharp focus by the recent case of Hadiza Bawa-Garba, who has just been struck off the medical register. It would be wrong to speculate or comment on her specific case.
However, it has raised real concerns for many of us. We do not know whether it is truly safe to be open and transparent about the mistakes we will undoubtedly make. It will make for better, safer, care for our patients, but at what personal risk? We know that where we have inadequate staffing for all the patients in front of us, then of course we must flag that up. But what do we do when we put the phone down from that call? Do we carry on and do the best that we can with the staff that we have? Or do we close the doors and turn patients away?
A week ago, all of us thought we knew what to do. Be open, be honest, and, except in extremes, keep doing the best you can in the circumstances you find yourself in. Just now, for many, that feels like something that could have too high a personal cost, which is the worst backwards step for patient safety I have seen in my medical lifetime. Because I am a doctor. I am human. And I will make mistakes.
BMA Scottish council deputy chair Nikki Thompson
- - - provoke any criticism : not no criticism.
"Hyponatraemia Inquiry chair Sir John O'Hara QC said medical professionals should stop treating their own reputations and interests first and put the public interest first." Your article is enough to make me weep.