Friday, 8 July 2011

Louis Pasteur as applied to medical regulation

Louis Pasteur on his death bed admitted to his family that Claude Bernard was right: "Le germ n'est rien, c'est le terrain qui est tout". It is not the germ but the environment that's everything.

So what has that got to do with medical regulation? Environment matters a great deal in how disease develops, if at all. Just like it is not enough for a germ to exist to cause the illness but the environment in which it finds itself defines what happens next, the same principle can be applied to performance of doctors. However, the regulators have refused to examine the environment and as one General Medical Council Fitness to Practice member said to the wrongly accused doctor: "It is you who has to answer the charges not them (them in this case were the NHS managers)."

Even research paper relevant to human resources management of performance was rejected by GMC FTP into evidence when it was mentioned that environment determines the performance.

Whistleblowers got persecuted and eliminated by the state system showing evidence of multiple incompetencies.

Those who fail to perform in inadequate and hostile environments are frequently unfairly judged. There is never any shortage of case law from the High Court to be used where ethnic minorities pleaded unfairness of treatment due to pressures at work and who were disregarded by the regulator and the courts.

On the other hand, those professionals who would fail in healthy environment can go on practicing in unhealthy one for the same environmental reasons. It is like a germ that thrives in environment toxic to others and multiplies. In work situation it means that more of the same ilk get jobs until institution is so rotten it has to close down.

Now in UK, Mid Staffordshire inquiry is underway and exposure of multiple failures unfolds before our eyes.
The Royal College of Surgeons noticed poor level of care and admitted that they failed to follow up some of their concerns BMJ article reported. The Royal College of Surgeons allegedly reported in 2007 that "the situation in theatre appeared to be
“fraught.” One surgeon, named as D, seemed unable to work
under stress, the atmosphere became very tense, a number of
staff refused to work with him, and several complaints had been
made about him, including three of assault. D “lacked insight”
and blamed others for his problems. But Mr Black said that the
team did not consider at the time that D needed to be reported
to the General Medical Council".

BMJ article says nothing of how The Royal College of Surgeons defined "insight" of struggling surgeon. It appears to me that there is lack of understanding as to what insight is. So here is the definition:
1. the ability to perceive clearly or deeply; penetration
2. a penetrating and often sudden understanding, as of a complex situation or problem
3. (Psychology) Psychol
a. the capacity for understanding one's own or another's mental processes
b. the immediate understanding of the significance of an event or action
4. (Psychiatry) Psychiatry the ability to understand one's own problems, sometimes used to distinguish between psychotic and neurotic disorders

However, regulators do fail regularly to use word insight as applied to themselves as they fail to consider:
incite [ɪnˈsaɪt]vb (tr) to stir up or provoke to action
[from Latin incitāre, from in-2 + citāre to excite]

Doctors do suffer from provocations and during Labour government's "New Ways of Working" policy doctors lost the necessary authority. It is not possible to have required respect from staff if consultant is described as "white elephant in the room" as in the Department of Health policy: New Ways of Working.

Major adjustments and personal growth would be required by many to make progress towards better health care in UK. Knowing the difference between incite and insight is fundamental to that. Could, those who write the reports at The Royal College of Surgeons please, concentrate on what they do well and leave out their use of pseudo psychology for political motives?

Even if The Royal College of Surgeons did write to Healthcare Commission the report could have been suppressed unless a whistleblower was there to deal with it. Reporting surgeon to GMC may have led to nothing as the same Chair of Healthcare Commission was also at GMC council.
It is inescapable conclusion to which I arrive that it is easier for many to go along and survive short and medium term professionally than risk it all and be forgotten for ever.

However, antibiotics do exist as does the concept of change of culture.


Dr Rita Pal's New Book

Dr Rita Pal's New Book
North Staffordshire Whistleblower Click on photo to read

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