Blame, Name and Shame

Stuff carries the story today of a doctor who has won a high court decision to preserve his name suppression. Apparently he had missed a 15kg cancerous cyst in a woman in 2003.

“The GP has been fighting to keep his name and the practice where he works secret since being found guilty of professional misconduct by the Health Practitioners Disciplinary Tribunal in 2006.”

The woman involved is understandably upset, telling the Press that “it sucked” that the doctor concerned continued to treat patients who were unaware of the misconduct finding.

“The patient said she wanted a radical change from the health system so the names of medical professionals found guilty of professional misconduct were made public.”

And that’s where you lose me. Assigning blame then naming and shaming may well work in politics, but it really does suck in medicine. 

Medicine is not the hard science that it is perceived to be. People seldom exhibit all the classical symptoms of a disease and the margin for error is considerably wider that most patients like to contemplate. Mistakes in medicine range from an unfortunate set of circumstances though errors of judgement and neglect right up to absolute incompetence. The latter is exceedingly rare.

It should be noted that most doctors will make serious errors sometime in their careers. Medicine is far too complex to pretend that simple humans can be anything but fallible. Most mistakes will not end in serious consequences, sometimes through sheer luck and sometimes through the good graces of a more alert colleague. When medical disasters do happen, they are rarely simply the fault of one doctor, but a series of errors of which the doctor’s is only the most noticeable.

Because the judgement of mistakes is very complex, there is a tribunal of experts for adjudicating this. It consists of a chairperson, usually a doctor, three other doctors and one layperson (usually with some familiarity with medical errors). A finding of misconduct is usually made when the error could have been avoided with due care (or, in the case of sexual misconduct, with better judgement).

Misconduct covers many types of error. Very few of them involve incompetence or gross negligence. When they do, there is usually some specific penalty to the misconduct (being struck off the register, usually temporarily). There is also a specific plan for rehabilitation, including retraining, if necessary. If a Name and Shame policy is adopted, this would ensure that the doctor in question would have his career completely destroyed. While this may make some injured patients understandably happy, it would ensure three very bad outcomes for health in general:

1. No doctor in his right mind would report any serious error. We will not be able to put systems in place to prevent the same errors in the future. 
2. Doctors will be destroyed for single mistakes, mistakes which they will probably never make again, anyway. This is manifestly unfair and very wasteful of valuable doctors.
3. Even doctors who make mistakes of incompetence and gross neglect are rehabilitatable. Doctors are expensive to make. Most bad ones can be made into reasonably decent doctors again.

Let’s face it, the desire to see a doctor’s mistakes made public has nothing to do with justice (there was no act of deliberate ill-will) and everything to do with the simple thirst for revenge.

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