Lancet editorial (2020) 'Complicit silence in medical malpractice'

Esther12

Esther12

Senior Member (Voting Rights)
(more of the Lancet acting as if it's not part of the problem)

Thiis probably isnnt worth posting, but for those of you who have followed the PACE trial and enjoy being irritated by the hypocrisy of Horton and co: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30351-2/fulltext

The conclusion:

Apprenticeship, camaraderie, trust, and hierarchy have long been part of medical training and clinical practice. But re-examining the Paterson inquiry report, these qualities clearly also underpinned a system that allowed a doctor to perform procedures that, when examined independently, were clearly harmful. When professionals failed to speak out, they built a web of silence that ultimately was permissive of serious malpractice. In 2013, the GMC introduced a duty of candour, which puts a duty on any clinician involved in a patient's care to be open and honest when harm or near harm occurs. Only through building a system in which hospital management and senior clinicians encourage and demonstrate frank dialogue at all levels, from minor issues to larger problems, will serious cases like Paterson's be avoided again. Will this duty be enough to crack the nebulous dynamics of a doctor's allegiance to their colleagues, the obligation they have to their patients, and the fear and ambition they have for themselves?
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Interesting:

"Discuss risks before beginning treatment or providing care
6
Patients must be fully informed4 about their care. When discussing care options with patients, you must discuss the risks as well as the benefits of the options.

7
You or an appropriate person6 must give the patient clear, accurate information about the risks of the proposed treatment or care, and the risks of any reasonable alternative options, and check that the patient understands. You should discuss risks7 that occur often, those that are serious even if very unlikely, and those that the patient is likely to think are important. 8 "
 
MEMarge said:
Interesting:

"Discuss risks before beginning treatment or providing care
6
Patients must be fully informed4 about their care. When discussing care options with patients, you must discuss the risks as well as the benefits of the options.

7
You or an appropriate person6 must give the patient clear, accurate information about the risks of the proposed treatment or care, and the risks of any reasonable alternative options, and check that the patient understands. You should discuss risks7 that occur often, those that are serious even if very unlikely, and those that the patient is likely to think are important. 8 "
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@PhysiosforME
Can you advise what the " normal" process is pre GET.
Our physio had no info re adverse effects.
 
In 2013, the GMC introduced a duty of candour, which puts a duty on any clinician involved in a patient's care to be open and honest when harm or near harm occurs
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Uhh.... literally the entire NHS is guilty of willful violation of this. Blatant, deliberate violation, done with pride and hubris. Not even close to respecting that duty. In fact actually lying in court about us relating to harm, as well as in documentation, recommendations and even communication. And not just by omission or neglect but blatant contemptuous fabricated fiction that exists precisely as a counter to the actual lived reality of many patients.

It is true that The Lancet is complicit in medical malpractice, but it is not silent about it, it is rather very vocal about committing malpractice, insisting it must continue to do so. Horton hears a WHO and doesn't care about classification of disease, he believes in the magical mind-body split and must publish fiction as otherwise his beliefs don't stand a chance.
Only through building a system in which hospital management and senior clinicians encourage and demonstrate frank dialogue at all levels
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Notice the lack of a particular stakeholder in this: the patients. Which is the cause and continuation of this complicit malpractice, medicine is completely unresponsive to patient needs and input when they don't agree with strongly-held beliefs, even against tired old myths. As it always has been and as long as this state of affairs continue so will harm.

Screw you, Horton and The Lancet board, you are as much part of the problem as anyone. As is the BMJ and most of the official bodies in UK medicine pushing behavioral fairy tales in rejection of science, common sense and the duties and obligations of medical professionals.
 
MEMarge said:
Interesting:

"Discuss risks before beginning treatment or providing care
6
Patients must be fully informed4 about their care. When discussing care options with patients, you must discuss the risks as well as the benefits of the options.

7
You or an appropriate person6 must give the patient clear, accurate information about the risks of the proposed treatment or care, and the risks of any reasonable alternative options, and check that the patient understands. You should discuss risks7 that occur often, those that are serious even if very unlikely, and those that the patient is likely to think are important. 8 "
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I think the Harm paper that Graham and others wrote shows that this is not being done for patients with GET in part because practitioners are being told that no harm is possible and then not recording or following up outcomes. It is clear from patient leaflets that risks are not discussed and reporting of side effects are also not discussed.
 
NelliePledge said:
I didn’t have any such discussions about fluoxetine

even less so about pregabalin and then Amitryptiline which were subsequently added on.
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I think the get out clause there would be that the pharmacist should ask if you've ever used the drug before and you should receive a copy of the patient information leaflet with the prescription.

I'm not saying that's necessarily enough, mind. Just that this is probably how they would cover themselves.
 
Invisible Woman said:
I think the get out clause there would be that the pharmacist should ask if you've ever used the drug before and you should receive a copy of the patient information leaflet with the prescription.

I'm not saying that's necessarily enough, mind. Just that this is probably how they would cover themselves.
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It’s definitely not enough. I have had various apparently expected issues with drugs (including bad withdrawals) which were not on the leaflet. I have had doctors tell me a drug is clean and safe when it wasn’t. This really needs to improve.

(not that I think there are many drugs which are truly clean and safe long term)
 
It reminds me of a day when i was a freshly graduated nurse in a position that usually requires some experience, but regardless here i was.

We has a small operating room in the labor and delivery unit and there was this one doctor who used to come for emergency c-section unpleasantly drunk, usually swearing and a bit heavy on the knife. in fact i believe one of the babies needed suturing on one cheek.

He should have been reported.
 
Milo said:
in fact i believe one of the babies needed suturing on one cheek.

He should have been reported.
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And if a wet behind the ears, freshly trained nurse could see that then everyone else could too. So what stops people from coming forward? Should there be penalties if they don't? (I'm not aiming those questions directly at you @Milo :))

I've worked in the same company as others doing the same job in similar job grades. Occasionally, there's someone who is less than impressive. Usually you don't find out until you meet them on a client site. On the one hand they can do reputational damage to your employer, on the other you can't tackle that on a customer site. There are ways of addressing these things.

I don't understand why they can't be addressed in health services. i have even seen the example of someone with a drink problem be handled - called into HR, put on immediate "gardening leave" and given the opportunity to get help, agree to monitoring etc. or be let go.

Private companies that are nothing to do with healthcare have to address these things as a Health and Safety issue, if nothing else. My employment contract had a specific clause about it. Why are the health service so bad about this?
 
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