There is nothing more unifying in life than fear and threats to your freedom. It is the reason why we often refer to the ‘military family’, and the mental health issues experienced by veterans are likely to be as much related to the break-up of this family as to PTSD.
So it comes as no surprise that doctors, nurses and other members of the healthcare family are all united in fear of one issue – a criminal manslaughter charge. We have had a spate of them in the news recently.
The fear of being caught up in such harrowing medical negligence cases has already driven us to practise defensive medicine
The first, back in May, saw two GPs accused of manslaughter, following the death of a boy with Addison’s disease. Although they were both acquitted, social media went into overdrive. The following month a nurse in Bristol appeared in court after incorrectly inserting a gastrostomy tube, which resulted in the death of a child. She was acquitted. Finally, in July, an optometrist was found guilty of manslaughter through gross negligence after failing to identify signs of papilloedema in a child who died five months later of hydrocephalus.
The fear of being caught up in such harrowing medical negligence cases has already driven us to practise defensive medicine. This trend will only be reversed when there is a successful prosecution for harm caused by too much care, rather than too little. Until that time, the dangers (and cost) of over-investigation and over-treatment are all too apparent.
So what do these cases have in common? It is striking that they all involve children. Of course, it’s natural to feel sadness when we hear of the death of a child, but the Crown Prosecution Service is expected to rise above emotion. This is why we don’t allow vigilantes to take to the streets and why we repealed the death penalty.
The other commonality is that, in each case, there were many factors contributing to the eventual outcome of death. These healthcare professionals are not working in isolation; they are part of a team and a system. A system that is underfunded, unsafe and unfit for purpose. This is why the criminalisation of these individuals has led to despair.
We are currently all working in these toxic environments. We are all aware of the decision fatigue of seeing our 80th patient contact of the day. We all know the sinking feeling when an urgent visit request comes in after we have been at our desk for 10 hours. Or the difficulties in trying to get a patient out of our room in less than 10 minutes because there are four others waiting and we haven’t even started on the paperwork.
We have become the scapegoats for a state that accuses us of negligence while we work under conditions it has sanctioned. It’s criminal for the state to hand us these responsibilities and expect perfection, without furnishing us with the tools to fulfil them. If anyone should be taken to court, it is the state – for corporate manslaughter in the NHS. But it is far easier for them to tie the noose around an individual’s neck. We are being hung by the state and as professionals we need to make a stand.
Dr Shaba Nabi is a GP trainer in Bristol