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GPs buried under trusts' workload dump

'Dr Bawa-Garba could have been any one of us'

Dr Punam Krishan reflects on a ruling with potentially enormous ramifications for all doctors

punam krishan 3 x 2

As a passionate and dedicated doctor and as an equally tired and often exhausted mother, I read the verdicts of our GMC and judicial system about a fellow doctor mum with gut wrenching sorrow and insurmountable rage.In many ways words come easily, in many more ways words cannot be expressed in any comprehensible manner. 

A little baby has died, never an outcome wished by anybody. I cannot imagine how the family are feeling and truly pray that wee Jack rests in peace. On the other side, there is a mother who has been robbed of her entire existence with a criminal record and is now a blacklisted doctor. How is she? What is her life now? What future do her kids have? I cannot even try to imagine the darkness over this family. A death of many sorts, something that has left us - as a nation - numb. 

This could have been me. It could have been my friend. It could have been any doctor anywhere in the world who goes out to work everyday with the sole intention to do no harm. Never does it cross our minds that anything less than perfect is acceptable. We are intuitively this type of person. This then gets engrained through military medical training and further through our daily practise. We do not want to harm. 

Left hung out to dry by a blame culture profession and an unforgiving society, this is the fate of medics today

We wake up in panic, we obsess over detail. We cry into our pillows and pray only to deliver our best. Many of us end up on medication to manage our work related anxieties because we are terrified of this very outcome that we have watched take place in modern day Britain today.

To go beyond the duty of care is a concept we understand, for we do it on repeat every single day. We leave our own babies, our own elderly, unwell or vulnerable relatives, our own domestic turmoils at home to come out and take care of all of yours. Is this even a consideration for mankind these days? 

I understand, from speaking to several paediatric colleagues, that Dr Bawa-Garba was arrested two weeks post-partum, torn away from her exclusively breastfed baby on a charge of manslaughter. Questioned for over seven hours, putting her own baby at risk of dehydration, this has been allowed in our country today. Is this what our society now accepts as right? Prior to this the same people would have praised her for being an exceptional and outstanding doctor. Left hung out to dry by a blame culture profession and an unforgiving society, this is the fate of medics today. 

We are doctors. We are not God. We are not superheroes and do not have special powers to transform life. We can also make mistakes but the difference between our job and every other person’s job out there, is that our mistakes can directly harm life. 

That is why when we say, ‘we are tired working these horrifically long hours back to back’, the government needs to listen to us. When we say we are hungry, having not had a bite to eat in 12 hours, management needs to factor in time for our breaks so we can feed ourselves. When we are stressed, the NHS must recognise the need for support to be given to us. If we cannot have these basic rights, how can we be expected to perform at 110%? How can we never misjudge or make an inadvertent error? We are struggling as a profession and yet today we witness brutality to someone who was trying her best to medically manage many sick patients without any senior support. 

Even at a supermarket checkout, one customer gets managed at a time. Everyone is happy to wait their turn. People still go off sick with stress. We manage a hundred patients a day, sometimes at the same time. We have hundreds of results thrown at us all to be actioned there and then. We have bleeps going off every few minutes, charts being presented, relatives questioning, managers moaning and not to mention the ticking clock constantly echoing in our ears. We are one person. Help us. 

We don’t moan for money, we moan for our sanity because long after our patients leave us, we still go over their story in our heads and reflect on anything else we could’ve done to be that extra bit more perfect. 

We get let down by everyone and are respected by few. The only one thing we all had until now was hope that our own medical council would look out for us; that our council would review the blame culture and understand a team is what delivers good patient care, not an individual person. Our council needs to look beyond inaccurate data and look at the facts without fear of what ‘everyone will think’. 

For the public to understand, we do what our medical council set out for us as good medical practice. We can recite these principles for they are our daily mantra. We do our annual appraisal and we log our personal development journey, which is experiential. We are the most self-critical beings out there who are constantly striving for perfection. We rarely compliment ourselves but rather focus on our flaws. But now we learn that all of this could actually be used as evidence to condemn us of crime in the absence of professional integrity by fellow colleagues. Wow! 

Moving forward, shall we be practicing defensive medicine or shall we be doing the right thing? Will the right thing cause us harm later down the line? We are truly damned if we do and damned if we don’t. I don’t think a junior doctor will ever want to reflect again which is a sad sad loss to what was a highly effective and useful personal development tool. 

A message to those senior doctors too who are out there, who may find it easy to sleep whilst their juniors are doing their work, afraid of not wanting to disappoint their bosses. Let this case be a learning point for you. Do your job, be where you’re meant to be and never forget your professional integrity and responsibility to your trainees. They look up to us to teach them through example. Let us all work together and support one another because the powers that be will never do this. If we can’t take care of our own, we may as well all quit medicine and live with mistakes that won’t tear us away from our entire existence.

Dr Punam Krishan is a GP in Glasgow

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Readers' comments (35)

  • Bye bye reflection. GMC in one swoop managed to undermine the one thing that they were task to do- further patient safety. Now doctors will not communicate, will not reflect, will not share information and will practice defensive medicine. More doctors will stop working in under- resourced environments because they now know that if things go wrong- then for sure they will be held criminally responsible for systemic problems.

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  • I hope that doctors do not forget this case next week and that collectively something can be done.

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  • Thank you Putnam. That's a descriptive and thoughtful insight into the mind of a young doctor and mother. It deserves wider publication.

    More outrageous facts about this case seem to be coming to light (wasn't aware about the circumstances of her arrest).

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  • https://www.gponline.com/gps-boycott-reflective-entries-appraisal-bawa-garba-case/article/1455704

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  • Maverick

    Thank you Dr Krishan. Your article eloquently summarises the detail of this horrific miscarriage of justice perpetrated by the GMC against Dr Hadiza Bawa-Garba. Your article deserves to be published in the national press and viewed on our TV News Channels. It should be presented to Parliament for debate.

    Well done Nigel Praities (editor of Pulse) for supporting the overwhelming opinion of your readership and campaigning so hard to see justice done. It's great to read that you're behind poor Dr Bawa-Garba and that your publication is working tirelessly to overturn this travesty. Thank you for engaging with the national press to ensure that the voice of UK medics is not ignored.....

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  • In this whole mess, I still see a glimmer of hope looking at the mobilization of Doctors this GMC intervention has resulted in. GMC won it's case but lost the precious little credibility it had left. This is something they should have let go instead of over-riding and degrading the Medical Tribunal. The feeble attempt at appeasing Doctors by minimal reduction in annual fees was a wasteful half hearted effort to make amends. GMC has proved once and for all - it is not there to protect patients or Doctors. It has it's own agenda and mind, irrational and vile. It needs to go to a Fitness to Practice panel where the Medical Community will give its evident verdict. Erase into oblivion.

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  • Just noticed my misspelling of your first name Dr Krishan. Profound apologies.

    Your post still inspires me and I believe it would give patients and their relatives an insight into the reality of medical provision.

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  • The anger in the piece is real and, I suspect, is shared by many of us.

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  • Cobblers

    I believe this is the final nail in my career's coffin. I have enjoyed being a locum after a long time as a GP Principal. Now I look at Appraisal, Revalidation in 2019 and now this travesty of justice which frankly deserves to make each doctor look after number one. Themselves. Goodwill has gone. The NHS is dying, get away from the sinking ship or it will take you down with it.

    I will enjoy cancelling my direct debit to the GMC in August. And await their impotent emails and letters.

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  • Just Your Average Joe

    The GMC has lost its way - It was meant to be self regulation of doctors, and has sacrificed itself at the altar of patient protection, when there was no reason to punish a doctor who was sadly let down by systemic failures hidden from the Jury in the criminal case.

    The high court judgement is therefore flawed in expecting the panel who spared Dr Bawa-Garba erasure from the register, to act in the same way as directed by the jury verdict.

    The panel did not have a legal duty to follow the flawed verdict, as they were aware of the full situation of that sad day, where Dr Bawa-Garba was left to carry the burden of the days events and the sad death, whereas the jury were only given a piecemeal of information that suited the prosecution case.

    Hence the judge in the original case allowed a flawed trial, and failed to allow justice by refusing leave to appeal.

    This is what the GMC should have appealed, the GMC that should be supporting doctors, while protecting patients. Like the thousands of patients who benefited from Dr Bawa-Garba's time and care in the time she was allowed to continue working before she was given her flawed verdict.

    The time she was working and learning her speciality so she could continue to help other children, who will not be protected as there is one less doctor in the NHS which is crying out for more doctors.

    GMC - the management and leadership who were involved in prosecuting Dr Bawa-Garba should all resign in shame, and if they refused be sacked by us, the doctors who pay for our own self regulation, as I hope I speak for many if not most, do not want a regulator who persecutes doctors.

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  • Vinci Ho

    Question: what will the future doctor-patient relationship become?
    The 'healing hands' must put on their most secure gauntlets before providing the remedy.
    The 'sufferer' demands zero mistake and any deviation is unforgivable .
    Should something goes seriously wrong , shackles will be applied permanently to 'a pair' of hands.
    This will be compounded by the inevitable outcome of working by scale in bigger institutions , hence , sacrificing continuity .
    Thanks to GMC , this represents the beginning of the end of the most respectable relationship in human history........

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  • I would have been broken by this, yet Hadiza Bawa Gabra carries on. Awesome!
    Hadiza, you are inspiring. You have probably saved innumerous doctors and the health-care they provide. There will be few able to claim that. Salutations
    P

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  • A sad article but true. I could relate myself and my colleagues. Defensive medicine is what we practice now and I can see the reason! What a tragedy. This is high time we should look after yourself because truly if you cannot look after yourself how can you look after others!

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  • Thank you Dr Krishan for speaking out our hearts. You have expressed every one of our’s life.
    We are doctors, not to harm anyone
    but we are not God.
    This article deserves to be published on national levels.
    I always wonder there is a lot for patients care, who is there for Doctors Care ?

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  • Many thanks for the comments and for taking the time to read this article. At least in dark times though, we can learn that we are protective of our own even if powers above do not support us. Solidarity within our profession is what should never ever be compromised.

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  • CENSORSHIP?

    lETS NOT FORGET THE POOR NURSE ... Scapegoated for organisational deficiencies

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  • CENSORSHIP?

    ?? foreign nurse doctor
    Easy targets

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  • CENSORSHIP?

    I Agree Maverick .....
    Well done Nigel Praities (editor of Pulse) for supporting the overwhelming opinion of your readership and campaigning so hard to see justice done. It's great to read that you're behind poor Dr Bawa-Garba and that your publication is working tirelessly to overturn this travesty. Thank you for engaging with the national press to ensure that the voice of UK medics is not ignored...

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  • GMC has certainly lost its way. If they cannot understand the pressures we work under and then fight with their own tribunals and hunt out doctors like this then they are now a truly finished. Not fit for purpose. shame on you GMC

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  • Thank you for this article. All fair minded people would agree we work in intolerable unsafe conditions and our goodwill is taken advantage of at every opportunity by the government, NHS and ultimately by patients. Now we risk criminal prosecution too. This is too far and the GMC as well as the NHS is guilty and have blood on their hands.
    I qualified in the 1980s and strongly feel I have been exploited throughout my career. I worked inhuman hours along with my junior colleagues supported by seniors who said helpful things like " I have every confidence in you" instead of coming to help with a procedure you'd never seen or done before. The pressure has never been worse than now but never been better either.
    I am immensely relieved none of my children have followed me into medicine and until we have humane working conditions with proper support I cannot encourage anyone to become a doctor.

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  • Excellent article. GMC needs Urgent Review!
    Workforce Challenges Just Got Much Harder!!

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  • Thank you Dr Krishan for writing such an insightful piece which articulates how a significant number of us feel. This is a sad case on so many levels and you make a lot of very relevant points which will resonate amongst all Doctors. Keep up the good work - I am looking forward to reading your next article/blog.

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  • "We are doctors. We are not God."

    Yes - but some of us have been playing God. How? Trying to cure everybody when we're covered with excessive workloads and poor resources, just like in the Bawa-Garba situation. Some even believe that God will help them for being godlike. Well, Bawa-Garba is a wake up call for everybody. You account to the courts - not God!

    The issue is not about defensive practice as something new under the sun. The issue has always been about delivering a reasonable standard of practice.

    Crazily, the GMC have issued guidance that when a doctor know that they are working in unsafe conditions, it is the doctor's responsibility to pass this up the tree - but not withdraw services. So in other words, doctors must continue to deliver unsafe medical services that risks people's lives until some plonker at the top do something about it. The guidance is pure nonsense!

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  • Well done Dr Krishan for the impressive and detailed report . It is shame how Doctors are treated by the GMC
    We are working under enormous pressure, underfunded NHS , but expecting that we do miracles .

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  • This is a very nicely put together article. I have been greatly troubled for a long time about the conditions medical doctors have to work in. I came into medicine after I had another long successful career in IT and engineering and I was horrified by the conditions all doctors in most parts of the world have to work in. Why work 12 hour shifts for 10 or 11 days in the row? Why not 8 hour shifts? Why many senior doctors and consultants treat trainees with disrespect? Why not have proper breaks? Why all this pressure and stress? In this day and age these are inhumane working conditions. I have read the case of Dr Bawa-Garba with great sorrow. I am very sad that a young life was lost, and very upset that a medical doctor was treated in the way she was. I have seen a lot of incidents during my training and I understand the pressure and stress doctors are in when a patient arrests. Whatever mistakes were made, the doctor should not be punished for the faults of an entire process/system. The General Medical Council needs to review how doctors are treated and not enforce punishments, but find solutions to improve working conditions and minimize and hopefully eliminate mistakes that affect patient care and lives. Please remember the Hippocratic Oath - Do not harm - but this should apply to us medical doctors as well. We are not looking after ourselves as human beings and individuals. If we are not in peak condition how can we take care of our patients?

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  • I can only add this...

    Petition to Parlament. Make the GMC a tax-payed funded organisation.

    https://petition.parliament.uk/signatures/42283534/signed?token=VIYhYATfYj88mqoDh2cM

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  • Give it a few weeks and it will all be water under the bridge.
    Human nature.

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  • As a retired GP I would like to comment on 2 things.
    First, who made the decision to prosecute in the first place?

    Secondly, I read that the expert witness called this a 'barn door' case of sepsis.
    I am not party to all the facts, but in my opinion this is very strong, emotive language which should not have been used n court.

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  • Exactly my thoughts. The Old System is still propagated by blaming the lowest denominator and although I'm not a House Officer anymore being shat on by that consultant who used to buy me an ice cream then ask me to work the next weekend too, I can now walk out of dangerous clinics as a GP and have done so. Dr. Bawa-Garba's main mistake is that she took on a very dangerous situation and didn't call a stop to the antics of the hospital staffing soon enough. . Where is the 'lessons learned' that those senior GMC and educationalists like talking about, and cojuld the GMC be found liable of defamation? I certainly will be squeaky clean with everythng I write in my Appraisal, as we are clearly workng in a Stalinist system.

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  • This comment has been moderated

  • Good write up..But do not agree with your observation of future of Dr Bawa Garba. In my view she will be much relieved to get out of the mess the NHS. She is an educated person and she can another career easily, I agree there can be starting trouble but if her partner had a job I think she can just be fine out of NHS.. In fact I know many people who had decided to either get out of UK or NHS altogether...

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  • Thank you for your comment SK. I disagree strongly with your sentiment however as leaving the NHS through personal choice is empowering. Leaving with a criminal conviction and erasure is not. I cannot, in any way, believe that this is something that one can easily come to terms with. Many of us have worked hard to get to where we are. We deserve integrity and respect for the work we do and recognition and support for the hardships we endure. If we choose to leave, we should be able to say it with pride and not be ashamed for being scapegoated for manslaughter.

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  • CENSORSHIP?

    LETS HELP NURSE ISABEL ADARO ASWELL
    Dr Hadiza Bawa-Garba, Junior doctor
    Nurse Isabel Amaro,

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  • CENSORSHIP?

    INTENSIVE CARE NURSE Struck off even though death after child transferred out to ward ???

    https://www.nmc.org.uk/globalassets/sitedocuments/ftpoutcomes/2016/august/reasons-amaro-cccsh-36269-20160804.pdf

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  • Great article. Many do not realise that the GMC is a registered charity. They have now taken over the regulation of undergraduate and postgraduate medical education, as well as medical trainer registration. Correspondence to doctors being investigated is sent via normal mail, not signed for, emails are not encrypted. Sadly it is not longer a chase of if you will over be investigated by the GMC, but WHEN !

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  • I am a GP myself, with a background in junior (non-consultant) hospital posts prior to qualifying as a GP. This case is truly tragic for all concerned and it is understandable that the family feel very aggrieved and look to apportion blame as a way to help them feel just a tiny bit better about all they have been through. That is often a natural human instinct and reaction.
    However, the blame is being directed at two individuals (I believe a nurse was struck off as well and there should be a similar campaign for a thorough review of the nurse's case as well) for what are not only a number of systemic problems and issues, but also the realities of working in that environment-where junior doctors are frequently pressured into working long shifts, providing far more cover and responsibility to far more patients than they ought to be, with little or no protections and safeguards in place.
    I've experience of this-working as a newly qualified SHO in general medicine, in my first medical post after gaining my full GMC registration, being the most senior medical person in the hospital, with responsibility for patients over several wards, supervising a JHO and with a consultant at home who 'will come in if necessary' (and we all know how much inferred or actual pressure juniors can be placed under to avoid disturbing the consultant, who is either at home or attending to alternative duties elsewhere)
    At least my medical SHO post involved working no more than fifteen hours without any sort of a break.
    In other SHO posts it was common to start work at 9am on a Saturday morning and work through to 5pm (theoretically, but often later) on a Monday evening, with perhaps no more than three hours sleep per night possible, if that (due to being in theatre in the middle of the night doing caesarean sections, attending to sick babies in the SCBU etc)
    Cognitively you feel absolutely knocked for six and close to collapse with sleep deprivation and stress often putting junior doctors in a situation where they are as cognitively impaired as if they were well above the drink driving limit-so it's okay for senior doctors, management, the government to put a doctor in that position, but if they turned up for work drunk then that wouldn't be okay?!
    Most doctors have been placed in that situation and there has been the potential for significant patient harms as a result and we think ‘there but for the grace of god’ that this tragic event that has happened could have happened to any of us.
    It's also (naturally) the case that non-medical people do not have an appreciation for the difficulties of decision making within medicine, how situations often change and how doctors (and nurses) often do the best they can in extraordinary circumstances, within the confines and limits of what they have at their disposal-then risk getting hung out to dry when something goes wrong.
    Sometimes there are situations (not in this case) where all the assessment/clinical care has all been beyond reproach, but then a patient still deteriorates quickly with devastating consequences eg the child who has early meningitis who presents with non-specific features. If all patients were sent into hospital in that situation or if every patient with a headache had a brain scan in case it was a tumour or if every patient with heartburn had an endoscopy to rule out stomach cancer as a cause then there would be less ‘missed cases’, but there would also be a two year waiting time even for urgent scans/endoscopies, huge additional cost and the potential for significant harms to healthy patients.
    Patients also sometimes give widely different accounts of what are objectively the same presenting features and that can make decision making difficult, when there is naturally a large degree of subjectivity in the way that patients often present.
    It is also the case that we all make mistakes, sometimes with tragic and awful consequences, because we are not infallible and cannot be held to be infallible anymore than any other profession. Some serious mistakes thankfully do not result in serious harm and some much less serious mistakes unfortunately do result in serious harm.
    If it is truly the case that Dr Bawa-Garba has truly reflected on what she has personally got wrong here (eg failure to spot the early signs of sepsis or act on the patient’s blood test results, even though in fact she does seem to have acted on them, in one sense, by discussing the patient’s results with her supervising consultant), rather than what has gone wrong in this case as a result of system problems or factors outside of her control, such as the giving of the enalapril and if it is also the case that she has an otherwise 'unblemished record' and was deemed to be very competent, safe, trustworthy and a credit to her profession over a number of years, then she is actually one the 'good doctors' and not the 'bad doctors' who fail to reflect, cover mistakes and have an arrogance about them that is often misguided.
    It is also the case that there are other doctors/nurses/professionals who have been found guilty of dubious, untoward, dishonest practices etc where the resulting punishment has been far less than complete erasure from their professional register, whereas in this case the punishment seems to be for clinical error only, with no suggestion that Dr Bawa-Garba is guilty of anything other than working extremely hard, trying to do the best she can and being upfront and honest about her failings.
    I obviously do not know all the details of this case, just what I have read-but what I am certain of is that she deserves a lot of support in order for her to receive a fair and objective assessment of the situation and what happened and that given what I have read and what seem to be the facts about this case, rather than opinions, then this doesn’t seem to have happened thus far.

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