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Independents' Day

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

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

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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)

  • 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.

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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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  • 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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