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Death by 1,000 arrows

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I am a big fan of those BBC4 documentaries where a presenter visits a green field somewhere and describes the events of an historic battle that took place hundreds of years ago.

There is something very thrilling about the drama of a bloody battlefield; the archers, the artillery and steam coming off galloping horses. But I have to remind myself every time that for the soldiers involved it must have been a extremely grisly experience.

I was reminded of this whilst reading the recent report commissioned by the GMC into 28 doctor suicides during fitness to practise procedures. It described the feeling of being investigated as ‘death by 1,000 arrows’.

The GMC says that complaints are an ‘occupational hazard’ and that doctors need the equivalent of a flak jacket and a helmet, in the form of resilience training, like soldiers in Afghanistan.

But it seems wrong to simply suggest that doctors need to toughen up.

And as an extraordinary study published today shows, there are disturbing affects on doctors and patients from the rising number of complaints to the GMC and others.

In the biggest study of its kind in the UK, nearly 8,000 doctors were asked about their mental and physical health after a complaint.

They found that doctors with a recent or ongoing complaint had significantly higher rates of depression, anxiety and relationship problems, compared with those without a recent complaint.

But more worryingly, the paper shows a drift towards defensive medicine that could cause harm to patients. Doctors with a recent or ongoing complaint were significantly more likely to change their practise, displaying ‘hedging’ or avoiding behaviour.

Shockingly, nearly a quarter said they had suggested invasive procedures ‘against their professional judgment’.

The researchers from Imperial College admit that they did not control for previous mental illness, and of course this could have played a role. Disciplinary procedures will inevitably be stressful and there are good reasons why complaints procedures are in place. It is preposterous to say that doctors who have done something wrong should be given an easy ride.

But the authors are convinced that it shows a relationship between complaints and actual harm that cannot be ignored.

There is no turning back the tide on what some call the ‘complaints culture’ in our society, but there has to be a way to minimise its damaging effect on doctors and patients.

Sensible suggestions – such as establishing a ‘national support service’ for all doctors – should be put into place as soon as possible. The length of investigations into complaints should be shortened and made less intimidating. Communication with doctors improved. Doctors not made to feel they are guilty before being proven innocent.

We need to pull the troops back and try to demilitarise medicine as much as possible.

Then, leave the battlefield to historians.

Nigel Praities is editor of Pulse.

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Readers' comments (9)

  • "It is preposterous to say that doctors who had done something wrong should be given an easy ride." Agreed. But it is also preposterous to expect doctors to perform a good and safe job in an ever-increasingly dangerous climate. It is simply not possible to practice good medicine in 10 minute appointments, and with everything else going on at present. Unless someone addresses the deep and complex problems in medicine soon (and especially in General Practice), we are likely to see a further haemorrhage of the workforce - abroad, to private practice or a complete career change. There is evidence that all of these are already happening, and this latest BMJ Open report will only concentrate minds more on making a rapid exit strategy.

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  • They cut 300 front line staff at Mid-Staffs. It collapsed from a 3* hospital to utter chaos - any hospital would if you cut 300 staff. But the 13 million pound Francis report blames staff left behind.
    Neither the BMA nor RCN protects its members by stating safety protocols ie number of patients to be seen in a day nor 15-20 minute appointments or staff to bed ratios.
    To the contrary, we doctors are used to working 80+ hours on 2-3 hours sleep, a total and utter torture abomination, which the BMA did not correct. It took the EWTD to sort that and I see today that NICE have given guidelines on nurse - patient ratios in A+E.
    The truth is this, the BMA, our Union does nothing to protect us from excessive workloads that cause serious harm to doctors nor does it speak up for our human rights to a work life balance. I there anyone anywhere that worked 80+ hours continuously on 2-3 hours sleep, only BMA members, Consultants still do these weekends up and down the country.
    That is the measure of our trade Union, we pay 14% for pensions, judges pay 3%,

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  • Vinci Ho

    Everything in the universe is about getting the balance right but I am afraid on this matter , it is certainly not the case.....

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  • simple answer.........make the gmc funded by the taxpayer and subject to public sector cuts like everything else in the real world.
    when a complaint is made, the person making the complaint is required to fund at least 50% of the costs of investigating the complaint and taking it to a Fitness to Practice Hearing - non payment chased up through usual means - baliffs, courts, criminal records how sharply the free for all vexatious complaints drop.

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  • If you are a trucker, there is a tachograph to monitor your speed and the hours you drive. If you are a pilot your hours are limited by law. If you are a doctor, you are expected to work for days with very little rest and with no limits on the number of patients you are expected to see with a shrinking number of resources at your disposal in an NHS in crisis, a working environment that is so unsafe that it manages patients in cupboards.

    Woe betide you if you make a mistake. The system will pin the blame on you and destroy your family life.
    This is modern day slavery.

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  • If you make a mistake you can not turn around and blame it on the fact you were overworked, tired and stressed - It will be seen pure and simply as your mistake...protect yourself - practice defensive medicine.

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  • I think we pay 29% and not 14% for pensions.

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  • Defensive risk averse medicine is the only way. Investigate everything, refer most things and admit if in any doubt. You get nothing for managing something, but if something goes wrong it is your potential career at risk. Not worth it, you get nothing for risk, and you never get a complaint for admitting or investigating. Never ever.

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  • A big thank you to PULSE for keeping this alive.

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