LITFL • Life in the Fast Lane Medical Blog
LITFL • Life in the Fast Lane Medical Blog – Emergency medicine and critical care medical education blog
Doctors, the world over, are reeling. The global telegraph (#BawaGarba) has been alight with conversations, most of them uncomprehending, shocked, dismayed, fearful. In several swift and definitive decisions, a UK paediatric trainee, Dr Hadiza Bawa-Garba was not only erased from the GMC register, but charged with manslaughter.
This was in response to several medical errors – most of them oversights when the details are examined – which contributed to the death of a child in hospital. I have no intention of going through the case here, which has been expertly picked over by a good many sources. Suffice to say that Hadiza was slung to the lions, the consultant in charge leaving her naked, her hospital, her trust, the regulatory bodies entrusted with safety of both doctors and patients, all turning their backs to leave her to her professional demise. All for several decisions made when she was covering extra shifts, in a climate of heinous understaffing, and trying to manage a deluge of patients when she had just that day returned from maternity leave, unsupported and abandoned to her fate.
So much is baffling about this case and its horrific outcome. Nobody wants a child dead from misadventure. It is tragic beyond the reckoning. But for the regulatory bodies to kick back with the tendon strike and sacrifice an individual so? Is Hadiza supposed to be an example, like a spiked head at the entrance to the Thames? Unquestionably these decisions will serve to endanger patient safety in the future. Individual blame always does this, driving self-reflection and honesty underground.
Hospital systems are almost incomprehensibly complex. Patient safety is paramount, but the infinite interactions that occur within them will likely always outfox the desire to provide foolproof polices and structures. You can’t legislate for the illimitable.
The outcome of this case is extreme, but so many of the occurrences are commonplace. Without any desire to misappropriate a worthy movement, is this another instance of #MeToo?
We inside the beast are always going to make mistakes. Always. Most of them are small; oversights, errors of judgment, succumbing to biases, betrayal by the impossible circumstances in which we sometimes work. Most picked up by the lumbering checks and balances designed to avoid them.
No doctor ever wants to make mistakes. In fact, cheered on by cases like Hadiza’s, we, and the world we serve, see medical error as utterly unforgivable, a deep personal failing. Doctors, for many reasons, are not very good at failing. I know what it feels like. I expect my experience is nothing special, but I know what it’s like to wake repeatedly in the early hours, my gut twisted and writhing re-asking myself why I thought a certain thing, or missed another. I know what it’s like to hide in the department toilets, trembling and wiping away unstoppable tears. I am on intimate terms with disgust. I know what it’s like to think, perhaps if I end it all… I know what it’s like to stopper in the shame and humiliation that comes with the perception of not being good enough. Mostly our punishment is a deafening, roaring monster within ourselves. And, if we are very, very lucky, we get a system that allows us to self-reflect, even better with some empathetic human support, and even better a respectful, inclusive way to analyse the system errors, which, almost always, are more contributory to any error than the part the individual played.
I’ve thought a great deal about the consequences of medical error. I wrote a novel about it. It’s the core of Dustfall. If perhaps a handful of people read the book, either medical, or not, and see into the heart of a doctor after failing a patient, then perhaps the six years of sentence struggling will be worth it.
- Cohen D. Back to blame: the Bawa-Garba case and the patient safety agenda. BMJ 2017;359:j5534
- Bawa-Garba: timeline of a case that has rocked medicine. Pulse UK. Jan 25, 2018
- Clarke R. The Hadiza Bawa-Garba case is a watershed for patient safety. BMJ Opinion. Jan 29, 2018.
- TSB. Some thoughts on Dr Bawa-Garba and our faith in the jury system The Secret Barrister. Jan 31, 2018.
- Brown S. Blame Culture. DFTB. Jan 27, 2018.
“Tout chirurgien porte en lui un petit cimetière dans lequel il va de temps en temps faire oraison. Cimetière d’amertume et d’hysope, auquel il demande la raison de certains de ses insuccès” René Leriche (1879–1955) [Philosophie de la chirurgie, 1951]
“Every surgeon carries about him a little cemetery, in which from time to time he goes to pray, a cemetery of bitterness and regret, of which he seeks the reason for certain of his failures.” Translation, Roberta Hurwitz
Hearts In Darkness