Further Confessions of a GP

The diagnosis of early meningitis is as difficult to make now as it ever was and it is still missed by doctors today, as it was 30 years ago. Losing a child to the disease is as horrendous as it always has been. The difference appears to be that expectations have changed. We don’t yet have lawyers loitering around A&E waiting rooms or chasing ambulances, but there definitely appears to be an increased awareness that medical errors can lead to financial compensation and claims continue to increase year on year.

Annual NHS compensation payouts grew from £277 million in 2000/01 to almost £1 billion in 2010/11. This is partly related to the increase in the number of claims but also to the increased cost of the individual claims, which can be up to £10 million each. Ironically, this increase is in part due to improved NHS care rather than an increase in errors. The young boy with the missed meningitis 30 years ago may well have survived today. The diagnosis may have still been missed early on, but improved intensive care facilities could have resulted in him surviving, albeit with severe brain damage and physical disabilities. The biggest compensation payouts are made to help financially support severely disabled children who may now live for several decades but remain in need of long-term expensive care packages.

So in these times of desperately low NHS resources, what can we do about expensive compensation payouts? The obvious answer is to reduce the number of cock-ups. This may seem simple enough, but unfortunately mistakes and errors will always happen. The causes are multiple and I am not trying to brush over or dismiss them. I am also not trying to excuse them or suggest that the NHS and its staff shouldn’t be held accountable; I am simply stating that as long as health care is delivered by humans, errors will be made.

Every day the tabloid media offer terrifying tales of health-care blunders. It feels like a continuous drip-feeding of the idea that the NHS is broken and doomed to collapse. These stories feed fears that every operation will be botched and every medical decision made will be the wrong one. I don’t begrudge compensation payouts when genuine mistakes have been made and I’m sure the families involved would rather have the good health of their loved one than a damages payment. However, it is important to recognise that the rise in the number of claims isn’t due to standards of care in the NHS falling. We still have a long way to go, but here on the coalface, I genuinely think that overall the quality of care is improving.

As doctors, it is our job to learn from our mistakes, share them, be honest and open about them, and most importantly make sure they don’t happen again. As patients, I would advise that you ask questions, share medical decisions with your doctor and educate yourselves about your own health and illnesses. Medical mistakes have been, are and will always be made, but fortunately genuine cases of medical negligence are still rare. The cynic in me wonders if the constant drip-feeding of medical error stories is an attempt to convince the public that the NHS is failing and therefore dampen down any opposition as widescale privatisation of the health-care system is sneaked in through the back door.

Jimmy Savile

The exposure of child abuse allegedly perpetrated by Sir Jimmy Savile was a massive shock to me. As a kid in the 1980s, I used to love Jim’ll Fix It and was once greatly envious of those children who got to sit on his knee. Not any more. Although never my greatest hero (Daley Thompson wins that award), Savile was nonetheless an integral part of my childhood. A part that has now been completely tarnished.

Were I not a doctor, these allegations of abuse might have felt like a watershed moment for me. They might have ended a certain naivety bestowed upon me by the good fortune of a sheltered, happy and abuse-free childhood. As a medic, that innocence ended when I first set foot on a psychiatric ward a decade or so earlier. I was astounded at how many of the inpatients of both sexes had been abused as children or young adults. In medical school I had learned that mental illness was something that randomly afflicted people due to a combination of genetics and miss-firing neurotransmitters. I had been taught that in mental illness brain chemicals go wrong in the same way that chromosomes go wrong in Down’s syndrome, or blood clotting doesn’t work in haemophiliacs. Reading through the medical records of the female patients on the acute psychiatric ward, there was not a single one who had not suffered some sort of trauma as a child or young adult. Stories of sexual abuse, physical abuse, neglect and usually a combination of all three jumped out from almost every set of notes.