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Medicine, Malpractice and Misapprehensions

GP Dr Clare Etherington finds Vivienne Harpwood's book looking at ethical and legal problems in UK healthcare heavy going, but a worthwhile read.

GP Dr Clare Etherington finds Vivienne Harpwood's book looking at ethical and legal problems in UK healthcare heavy going, but a worthwhile read.

This book is written by a barrister who runs the medico-legal studies programme at Cardiff University Law School. It forms part of a series of biomedical law and ethics books aimed to stimulate debate and interest in ethical and legal problems in UK healthcare.

The book gives a very detailed account of compensation claims and trends in the NHS and questions the reasons for the increase in claims and the reputed existence of a ‘compensation culture'. There is a specific section on the role of the media in focusing public attention on compensation issues. The author puts the patient at the centre of the debate and postulates that in a system of ever-increasing regulation and litigation, many patients are victims of the system and are under not over compensated.

In the chapter debating the controversial issue of pay, regulation and status of doctors she looks at the complex blame-centred, target-driven working environment of the NHS and expresses concern that this drives the balance from risk management to defensive medicine, at a cost to health care professionals and patients alike.

She discusses the series of government and legal initiatives culminating in the Compensation and NHS Redress Acts of 2006 to try to halt the spiral of increasing claims and limit the role of ‘claim farmers'. She looks at attempts to reform the NHS complaints system, including involvement of patients, clinical governance, evidence-based medicine, audit, use of guidelines and targets, inspection and monitoring to ‘treat the affliction' of compensation claims.

In the final chapter she attempts to pull the threads together and suggest possible (if difficult) ways of reducing medical errors and compensation costs. She acknowledges that progress will be slow.

She specifically recommends better data collection systems, including compulsory publication of retrospective data so that despite the long delays between claims and rulings on compensation, sufficient information can be available to allow prediction of trends and long term budgetary planning.

She also proposes a cultural sea-change within the NHS to incorporate a willingness to admit mistakes and, along with this, a move to agreeing primary liability so that it becomes unnecessary to find particular individuals to blame for errors. Her final recommendation is for the NHS to work on improving communication within the system, because communication problems are a major source of errors in healthcare.

For a doctor with no legal training the chapters are heavy going. I think to appeal to the average GP she could have made her arguments with fewer direct references to legal precedent and detail of procedure and process, and would personally have been more likely to read this as a series of short articles rather than collected in book form.

For a GP with interest in the legal process her arguments are thought provoking, and more patient and less doctor-centred than much discussion in the medical press, and so worth a read.

Rating: 2/5


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