NEWS
Medical manslaughter investigations rare but take toll on doctors
T
he Medical Defence Union has revealed that it sees very few medical manslaughter investigations a year against doctors. But the UK’s leading medical defence organisation says that the criminal investigation is often just the tip of the iceberg and that many other investigations often follow, which can have a devastating effect on a doctor’s life, reputation and career.
The Medical Defence Union helped 18 members with manslaughter investigations in a clinical setting between 2000 and 2010, with just 5 cases progressing to trial and 3 doctors being convicted.
Articles in the latest edition of the MDU Journal point out that
while such cases are of course catastrophic for the patient who dies and their family, it can be extremely distressing for the doctor involved, who can face a series of lengthy investigations.
Author, Dr Michael Devlin, the MDU’s head of advisory services, said: “It is right that doctors should be subject to the same rules that apply to other professionals who cause death by gross negligence but there is a huge difference in their ability to mitigate risk.
As has been recently seen in the news, airline staff can take planes out of service if there is a safety concern but doctors have a duty to provide the best possible treatment in the patient’s best interests, even if
the circumstances are not ideal. “In many cases the fatal mistake leading to a manslaughter investigation is a combination of human error, system breakdown or failure at a higher management level. But individual doctors can still be singled out for blame.
“An incident can trigger a whole series of enquiries whose aim is to establish the truth and punish the doctor, if appropriate. For example, as well as the manslaughter prosecution, the doctor can face a GMC investigation and fitness to practise hearing, an inquest, an employer’s investigation, a compensation claim and trial by media.
“The one consolation is that the
MDU can help and support the doctor at every stage.”
Dr Devlin believes the number of criminal investigations against doctors could be reduced if organisations learnt from mistakes and near misses by encouraging healthcare staff to analyse what went wrong and develop strategies to prevent a recurrence.
“He says there is no need to wait for the terrible outcome that leads to a manslaughter prosecution to do this, commenting that “such opportunities arise in less dramatic circumstances every day, such as when the notes that mention a drug allergy are missing or a patient’s abnormal test results are not followed-up.”
Experts question whether patients will use performance data to choose their care
E
xpectations are high that the public will use performance data to
choose their health providers and so drive improvements in quality. But in a paper published on
bmj.com, two experts question whether this is realistic.
They think patient choice is not at present a strong lever for change, and suggest ways in which currently available information can be improved to optimise its effect.
Research conducted over the past 20 years in several countries provides little support for the belief that most patients behave in a consumerist fashion as far as their health is concerned, say Martin Marshall and Vin
12 nhe
McLoughlin from The Health Foundation.
Although patients are clear that they want information to be made publicly available, they rarely search for it, often do not understand or trust it, and are unlikely to use it in a rational way to choose the best provider, they write.
They suspect that these problems are not just due to inadequate data, but may be the result of “unrealistic expectations” and “inappropriate assumptions” by advocates of public disclosure where health decisions are concerned.
They argue that the public “has a clear right to know how well
their health system is working, irrespective of whether they want to use the information” and they suggest several ways in which currently available performance data could be made more useful.
For example, it is important that users perceive the information as coming from a trusted source, they say. It also needs to be of interest to the target audience and presented in a visually attractive way.
Patients also need to know how the NHS works before they can realistically judge comparative performance data, they add, while personal stories can also be compelling and influential when used alongside numeric data.
“In this paper, we present a significant challenge to those who believe that providing information to patients to enable them to make choices between providers will be a major driver for improvement in the near or medium term,” they write.
“We suggest that, for the foreseeable future, presenting high quality information to patients should be seen as having the softer and longer term benefit of creating a new dynamic between patients and providers, rather than one with the concrete and more immediate outcome of directly driving improvements in quality of care.”
Nov/Dec 10
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