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The GMC says that one of the primary duties of a doctor is to be ‘open, honest and [act] with integrity’. Whatever your reservations about the GMC, this is very hard to disagree with. Naturally, everyone would wish doctors to be honest and truthful, and the damage that can result when they aren’t is potentially profound.
I’ve never met a doctor who would deny that it is their duty to be honest. Sure, we may all have slightly different thresholds concerning telling the whole truth – is our confident reassurance to a dangerously-ill patient always strictly truthful? – but very few of us would be willing to tell an outright lie.
Or so you might think. Now, kindly turn to your hospital’s blood transfusion policy. Most hospitals require that before blood can be issued for transfusion, two samples for crossmatching must be supplied, taken by different individuals on separate occasions.
This is national guidance and has been shown to improve transfusion practice. (The direct evidence that it actually improves outcomes seems pretty limited – two single-centre observational studies– but leave that to one side for now.)
In lots of cases, the two-samples rule works fine. It’s not a big deal to obtain a second blood sample from a reasonably healthy elective patient. But for people with learning disabilities, young children, needle-phobic adults, or those unlucky enough to have difficult access, a second episode of venepuncture can be a very big deal indeed.
Where taking blood involves physical restraint or sedation – and when the patient doesn’t understand what’s being done to them it sometimes does, despite Ametop and distraction – repeating the process can seem like needless cruelty.
The Secret Doctor values their GMC number and therefore for the purposes of this article has never taken two crossmatch samples simultaneously and podded them to the lab half-an-hour apart, with different signatures on the tubes. But I have certainly heard of it being done, by colleagues about whose integrity I otherwise do not have the slightest doubt.
Were they wrong? If they were, what should they have done instead? Strict honesty clearly requires that they undertake venepuncture twice, but if that was your screaming two-year-old, or your terrified autistic sister, being held down, what would you want them to do?
The result is that large numbers of doctors and nurses end up, essentially, lying. Most of them feel bad about it, but they’d feel even worse about the alternative. Surely, any rule or system which forces people into either dishonesty or (as they see it) acting against a patient’s best interests can’t be right? We need to give senior clinicians the flexibility to make exceptions, even to the most well-intentioned rule.
By the Secret Doctor. Read the blog and follow @TheSecretDr on Twitter and on Facebook
Totally agree! Another recurring example is moving to a new hospital trust with no ability to log in to any of the vital systems required for weeks on end despite starting on call duties immediately. We are explicitly told not to share, or use shared, log in details, but cannot work without doing so. Rules need to reflect the working reality or they are of no use whatsoever and put us at risk.
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