It is a sobering reality of medical practice that doctors can find themselves in the firing line, even when they have done nothing wrong.

In this issue of the journal we have a textbook case from the MDU's files. Despite a thorough examination and history-taking, the GP concerned could find no obvious cause for the patient's symptoms. Although the patient didn't meet the criteria for an urgent referral, the GP did refer him for further investigation and the patient was subsequently diagnosed with colorectal cancer. The patient later made a claim against the GP, alleging that an urgent referral could have avoided weeks of pain, suffering and anxiety.

In the face of a robust response from the MDU the claim was discontinued, but it illustrates perfectly the different perspective of doctors and patients. It is a fact of medical practice that things can and do go wrong, symptoms can be ambiguous, and doctors must sometimes live with a degree of uncertainty when making a diagnosis.

For patients, uncertainty is difficult to understand and may be even harder to accept if the eventual diagnosis is poor or life-changing. A poor outcome is, not surprisingly, one of the most common reasons for patients to bring a claim against a doctor, though it is unusual to find evidence that the doctor had acted negligently.

The MDU assists many doctors who have to live with the fact that there will be patients they were unable to help. At the same time, they have to live with the possible consequences, including the likelihood of criticism from the patient and their family and possible medico-legal proceedings. Indeed, Dr Christine Walker's article draws attention to the phenomenon of multiple jeopardy, whereby doctors faced several investigations into a single incident or allegation, from their employer, the GMC, the coroner or even the police.

There are many who are quick to infer the doctor is at fault because something goes wrong, whether or not the doctor has fallen short of the high standards rightly expected of them. In practice, much more often than not we are able to show that the doctor was not at fault, or there were other contributing or mitigating factors at work such as staffing levels, computer systems, or training.

As reported in this year's Annual Report, the MDU successfully defended members in 80% of medical claims. At the GMC, more than 96% of GMC cases handled by our in-house lawyers were resolved without a formal hearing in 2014, and over the last six years, our in-house team achieved a finding of no impairment for 55.8% of members who went before a panel, compared with the GMC's four-year average of 23.6%.

There are many who are quick to infer the doctor is at fault because something goes wrong, whether or not the doctor has fallen short of the high standards rightly expected of them.

Doctors should be held to account when their conduct or performance poses risks to patient safety. However, in the MDU's experience this is not the case for the overwhelming majority of doctors who are considerate, conscientious and trying their excellent best. As all the evidence shows, clinical outcomes are improving in general practice and hospital settings.

The impulse in public life to impose a flawed doctrine of infallibility on medical professionals and then seek to punish individuals for perceived failures is pernicious. It is evident in the expanding list of 'never events' which are deemed 'intolerable and inexcusable' within NHS hospitals. As Dr Michael Devlin points out in this issue, the term 'never events' engenders emotions of disbelief and outrage which can be a distraction from ongoing and necessary patient safety initiatives.

I believe the blame culture has detrimental effects on doctors, the health service and society at large. As the Health Secretary acknowledged:

'The rush to blame may look decisive. It may seem like professionals are being held accountable. In fact, the opposite can happen. By pinning the blame on individuals, we sometimes duck the bigger challenge of identifying the problems that often lurk in complex systems and which are often the true cause of avoidable harm.'

Climate change

In my view there is a very real danger of creating a climate where this unremitting focus on failure and individual culpability has a corrosive effect on public confidence in the profession and on the professionals on whom we all rely to care for us when we need them.

The MDU believes doctors should not have to practise in fear but be able to focus on providing the best possible care for their patients. We have long called for an open and transparent culture in which errors are reported and learning is shared to improve patient safety. Since the 1950s, we have advised members to tell patients when something has gone wrong, apologise when appropriate and make every effort to put things right, and we stress that patients are entitled to a prompt, sympathetic and truthful account of what has happened.

However, fundamental cultural change is needed to reverse the blame culture that has taken hold in the health sector, before the damage it does is irreversible. This requires a renewed focus on fair and transparent incident investigations by hospital trusts, the responsible and proportionate exercise of scrutiny by the regulators, and reform of the civil litigation system.

The MDU is campaigning hard to achieve these goals. But in the meantime, our members will always be able to call on us for support and representation if they become the focus of blame.


This article was correct at publication on 09/08/2016. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.

Dr Christine Tomkins

Chief executive of the MDU

BSc(Hons) MBChB(Hons) DO FRCS FRCOphth MBA FFFLM FRCP

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