'A person who never made a mistake, never tried anything new.’ The very essence of scientific progress is to test hypotheses and analyse results. Learning from mistakes is integral in evolving knowledge and this was known long before Einstein made his now famous quote.
I mention this because I attended the excellent one day CET event run by Thea Pharmaceuticals held in Manchester recently (full review in a forthcoming issue). A lecture on papilloedema given by Mr Ali Yagan, a neurologist based in the city, noted that, since the Honey Rose case, referrals to his department of suspect disc swelling had risen tenfold.
Though undoubtedly many of these were justifiable, and the speaker went to great pains to emphasise that in cases where there was any doubt about possible papilloedema referral is always justifiable, there were also cases which optometrists might have previously felt confident enough not to refer but had done so due to fear of consequences were they to be proved wrong.
This reflexive defensive practice has not just affected optometry. A GP colleague of mine told me many of his colleagues now hate patients presenting with headache and suggested that referrals for MRI scanning where previously headaches were considered most likely due to innocuous reasons are more common.
Now consider the recent case of Dr Hadiza Bawa-Garba, convicted of manslaughter by gross negligence in 2015. More than 1,500 doctors have since signed a letter expressing their ‘deep-seated concerns’ at their colleague being struck off. In the letter, they argue the ruling threatens the ‘culture of openness’ that is critical to learning from medical error and would result in others not being honest in their own self-appraisals.
Clinical practice suffers when outcomes are focused solely on public reassurance. The public needs to remember the inexact nature of clinical practice.
