Medical mishaps

Pieces of the puzzle

Edited by Marilynn Rosenthal, Linda Mulcahy and Sally Lloyd-Bostock Open University Press 265 pages£16.99

Medical mishaps have an impact on the doctor or nurse who might have made the mistake and on managers who have responsibility for many of the organisational factors which provide the backdrop to the errors committed, but they will all move on. The patient and their family, however, can be left to deal with the consequences of that error for the rest of their lives.

The main focus of this book explores the complex web of factors that contribute to errors in medicine. It offers an insight into many of the issues from the viewpoint of patients, doctors and managers and gives a legal perspective. These are issues which need to be openly debated at different levels in the NHS, professional bodies and patient groups in order to reduce the alarmingly high rate of error by the medical profession.

The book is divided into four parts in which different authors discuss possible contributory factors, such as the culture in which experienced doctors practise and into which medical students are apprenticed, and systems that might contribute to errors.

Historical and international perspectives, the needs of victims and attitudes to litigation are also examined, as well as responses to complaints - to which solutions are suggested. These are all explored in an easily readable style, highlighting the fact that many medical accidents are caused by human errors which may be the last in a long line of factors that have been neither recognised nor investigated.

Interesting parallels are drawn with other high-risk fields such as the airline and nuclear fuel industries. These highlight the complacency with which the medical profession and NHS managers have often viewed complaints and claims, and the wasted opportunities for learning valuable lessons. 'Near miss' investigations in the other industries provide valuable data with which to improve systems and prevent future incidents.

Anecdotes about the reaction of doctors and managers to complaints confirmed my view that the negative attitudes towards patients who complain and defensiveness on the part of the professionals - to the point where they question whether there has been any error at all - are fundamental problems that must be addressed before any real change will happen. I have witnessed at first hand situations where this attitude pushed patients towards litigation.

The book suggests that the recent changes in the NHS relating to regulation, clinical governance and the National Institute for Clinical Excellence will bring about changes to the way standards are set and monitored, which should lead to fewer mishaps. This may be the case, but I think that following Bristol, we can no longer accept complacency and defensiveness where medical mishaps are concerned. The mechanisms for reporting mishaps and 'near misses' need to be improved and the attitudes of doctors and managers to complaints must change in order to create a climate in which, when things go wrong, patients can expect an apology and redress, and doctors can get the support they need to acknowledge their mistakes and learn from them.

This book gives the reader much to reflect on and I hope it will motivate those who read it to do whatever they can personally to influence change.

As Gandhi said: 'Be the change you want to see in the world.' Everyone has a role to play in making it better.

Gillian Fletcher

Trainer, College of Health voices in action project.