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Independents' Day

Perfection in an imperfect world

Dr Shaba Nabi

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One of the mantras adopted by educators within our GP training programme is being ‘good enough’. It is a challenging concept to convey because good enough isn’t in the DNA of someone who has achieved A* grades, breezed through medical school and is training in one of the most competitive parts of the country.

Yet even for the academically gifted, arriving at the doorstep of general practice is like being parachuted into a foreign country where no one speaks your language and there are no interpreters. Trainees try to counter this amorphous uncertainty by staying later and later, poring over results, writing copious notes and documenting safety netting.

And who can blame them? There are myriad ways for people to complain about us: anonymous posts on NHS Choices, vindictive comments on Facebook and the more career-changing GMC and medicolegal routes. So acceptance of complaints and adverse events is a crucial part of learning – the alternative is lifelong anxiety.

Of course, in core general practice we don’t clock off when our shift ends. We can only leave when the work is done, no matter how exhausted we are. Having a triage screen of 20 patients to call back, and six more in the waiting room is no defence in the eyes of the law. No allowances are made for the day a GP is off sick when another two are on leave, and you are left managing an outbreak of measles. The impossibility of our day is never a factor when we perform less than perfectly; the tunnel vision with which each patient contact is viewed ignores all peripheral activity.

Despite the flaws of the creaking NHS around us, the pursuit of perfection is still our goal

It is this relentless expectation that is leading GPs and trainees to burn out and causing mental health issues, although support is finally filtering through in the form of the GP Health Service. The pressure also obviously extends to our nursing and paramedic colleagues in general practice.

A good friend of mine recently told me of the suicide of her colleague – a nurse with an impeccable career. She’d been badly affected by the death of a young patient she’d seen a day earlier. The nurse left behind three small children. I was struck by the similarities between this tragedy and recent experiences of my own, and experienced acute survivor’s guilt. Rationally, I knew that although lessons can be learned, some deaths are unavoidable. Yet emotionally, I felt the all-consuming responsibility many healthcare professionals endure when faced with an adverse event.

Sadly, case law has not helped. Bolam’s test, which was established in 1957 and holds that a health professional is not negligent if acting in line with accepted practice, has been undermined by the 2015 Montgomery case, meaning the action another reasonable doctor would have taken in your place is immaterial. But other countries, such as New Zealand, have taken steps to protect doctors by adopting a no-fault compensation scheme.

So, despite the flaws of the creaking NHS around us, the pursuit of perfection is still our goal. If the GMC was serious about reducing clinician suicide, it would be advocating a no-blame culture for us to work in.

Dr Shaba Nabi is a GP trainer in Bristol

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Readers' comments (15)

  • Just Your Average Joe

    We need to row back hard on the patient has free rein and encouragement to complain as much as possible and over misunderstandings and miscommunication.

    If serious harm, then complaint should be made and investigated, learnt from and ideally shared to try and prevent recurrence.

    A panel to make a fair compensation payment if appropriate when serious harm took place, but in a no lawyer environment so no wasted NHS money defending nefarious complaints from ambulance chasers.

    This is a world were colleagues can continue to work and thrive., and patients will be happier too.

    Recycle all the wasted money from Quangos and lawyers into improving patient care.

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  • "Enough said as the trainees may be listening......."

    The trainees have already heard the miserable tales of GP land and have fled.

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  • The Bawa Garba case is frightening. The expert witness stated that though Jack Adcock was bouncing about at 1630, though he was deemed well enough to be transferred to a general ward at 1900 by another clinical team [ not BG ], poor Jack was ' beyond the point of no return' already.
    Dr BG apologised in court for MISTAKING his IMPROVEMENT as recovery. Yet she was found guilty of manslaughter for ' ignoring deterioration' and ' neglect of decline' at the same time apologising for improvement.
    It is beyond any logic this case, never mind the fact that she was covering upto 5 doctors.
    How come the clinician that ordered the transfer at 1900 hours who made that clinical decision is not even mentioned. Where is the famed British Justice?

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  • Not sure where the GMCs priorities lie now. Putting hard working registrar's in jail or allowing fake PMQ's to practice for 22 years:

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  • Let's not overcomplicate it.This is how the average Brit's mind works:GPs are not specialists because they're failed hospital doctors but they're bloody overpaid for what they know.They failed to spot my diagnosis and I'm going to sue their pants off!

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