- Results from survey on “doctors.net” of almost 1500 doctors from across medical practice
- 85% of medics believe bringing criminal prosecutions into post-death investigations encourages a culture of secrecy and cover-up
- 90% of doctors admit to practising more defensive medicine techniques, in light of increased culture of fear, subjecting patients to additional, often intrinsically risky and intrusive tests, sending costs per patient soaring
- Fewer than half considered they were delivering safer care as a result of increasingly defensive medical practice
A survey of 1443 doctors, conducted by ‘Doctors and Manslaughter’ a campaign group working to raise awareness of the effects of the recent trend towards the criminalisation of healthcare, has uncovered alarming findings in light of the increased involvement of criminal process following unexpected hospital deaths and complications.
Police investigations into healthcare has escalated in recent years following the conviction of respected surgeon David Sellu (now the subject of an appeal). In the past year alone, 9* healthcare professionals have either been charged, prosecuted or convicted for Gross Negligence Manslaughter. These recent prosecutions, with the prospect of jail sentences for doctors when patients die, has alarmed many in the profession who say there is no evidence that a ‘blame’ culture actually makes patients safer. There is also a growing body of opinion that the charge of gross negligence manslaughter is being used inappropriately to prosecute doctors in some specialties who, in their daily lives, work in an inherently high risk environment.
Of the 1443 UK doctors responding to the survey, nearly 90% of doctors admitted to being more defensive (ordering more tests for patients than they might need, as a result of the fear of litigation), but less than half admitted that they felt they were delivering safer care as a result. 85% agreed, or strongly agreed, that being open about mistakes was less likely with increasing involvement of the law.
Most health-care professionals accept deaths and complications are best discussed in a transparent, no-blame environment. This allows lessons to be learned and future care to be improved in much the same way that pilots analyse aviation incidents. The threat of criminal sanctions leads to the practice of defensive medicine in which healthcare professionals order more investigations than necessary and the patient may be exposed to harmful procedures they do not actually need. Surgeons are circumspect about operating on high risk patients in case they end up accused of manslaughter if the outcome results in death of a patient – this results in those patients with other underlying health problems potentially losing out on operations from which they have a chance of recovery.
Defensive medicine provides no benefit, other than perhaps to the doctor, and in contrast may cause actual patient harm as well as significantly increasing costs at a time when NHS budgets are under massive pressure. The survey also shows a growing concern that the brightest doctors will not choose to enter high risk specialties such as anaesthetics, obstetrics or emergency surgery as they risk future jail sentences if they do. This could mean that a future generation of patients are made even less safe.
Mr Ian Franklin, consultant vascular surgeon, said:
“Transparency and openness are threatened once the criminal courts become involved. All parties seek to minimise their involvement with a bad outcome case for fear of police investigation, arrest, and prison. Cover-ups will become the norm. This is not good for the wellbeing of future patients.”
For more information and requests for interview, please contact:
Co-founders of www.doctorsand manslaughter.org.uk
Mr Ian Franklin firstname.lastname@example.org
Professor Roger Kirby email@example.com
Dr Jenny Vaughan firstname.lastname@example.org
Notes to Editors:
*GNM PROSECUTIONS: Between December 2014 & December 2015, 9 healthcare professionals plus one hospital Trust have been brought before the criminal courts on charges of gross negligence manslaughter. This follows the conviction of respected surgeon David Sellu, albeit his conviction is now subject to appeal.
- Vincent Barker death: optometrist locum charged with GNM
- Frances Cappucini. Tunbridge Wells: 2 doctors (incl 1 ethnic minority anaesthetist) charged with GMN & first NHS Hospital Trust on corporate manslaughter charge
- Jack Adcock Death: Ethnic minority Doctor and 2 Nurses
- Phoebe Willis Death: 1 Nurse
- Marie stopes abortion clinic death
- Joshua Gaffney death: 1 nurse
Quotes from the 1443 doctors surveyed anonymously www.doctors.net.uk , the UK’s largest online network of doctors:
“There is absolutely no incentive for me to take on the higher risk case since if it goes badly then not only will I be castigated by my colleagues (who decline such cases) but I will be unsupported by my hospital management. “
“If we are to be prosecuted for errors then every doctor will have to face this – none of us are perfect. If we behave recklessly then prosecution may bejustified but the context of the actions is vital. Reckless to one may be an appropriate and measured response in a given situation to another.”
“Feel constantly under siege, expected to deliver high quality but with less time. Situation is unsustainable and quality will suffer and safety will be compromised in the system as a whole if doctors are held ‘to gunpoint’ by fear of litigation but at the same time expected to see more patients, do more operations, but not given the proper time to see the patients, the proper well managed, designed and run systems with proper competent staff to support them.”
“There is no question the increasing threat of medicolegal consequences directly impacts on patient care choices.”
“I may be less inclined to offer major surgery to less fit patients in future.”
“I am a retired practitioner (Thank goodness)”
“I have been qualified as a doctor for 30 years. I spend a much greater proportion of my time on [administration] and much less time face to face with patients. Yet I feel less confident and safe now than then partly because I am more aware of what can go wrong but also because I am so busy with the above tasks that I have less time to take good care of patients and have proportionately less time gaining actual clinical experience.”
28 January 2016