A BMA survey shows doctors fears over reporting concerns about patient safety. But are they just being melodramatic?
It's worth paying attention to medicine, because when it goes wrong, people suffer and die. But how do we know when things are going wrong? This week the BMA produced a report on whistleblowers. Of the 384 doctors who responded to its survey (that was a dismal response rate of 12%, we should be clear), 40% said they would be too frightened of repercussions to report concerns about patient safety.
Of those who had spoken out, one in 10 were told this could have a negative impact on their careers. But are they being melodramatic? And what if life for whistleblowers was better?
A study in the New England Journal of Medicine this week follows up 26 whistleblowers from the pharmaceutical industry. In the US, speaking out is well remunerated and if you help the government bring a successful case, you keep a chunk of the settlement.
The money is big. In September, for example, Pfizer paid $2.3bn (£1.6bn) to settle allegations – backed by evidence from six whistleblowers — that it illegally marketed a painkiller called Bextra which has since been withdrawn. The 26 people in the NEJM study received an average of $3m for their trouble, with sums ranging from $100,000 to $42m.
They say money wasn't the issue – and to be fair most were already on high wages – citing motives such as personal integrity, a responsibility to protect public health, and a fear of being implicated themselves. Nearly all had tried to fix things internally first by talking to their boss, or filing an internal complaint.
But did the money help sweeten things? Almost all were placed under enormous pressure by their companies. Thirteen reported stress-related health problems including shingles, psoriasis, autoimmune disorders, panic attacks, asthma, insomnia, migraines, and more. Six reported divorces, severe marital strain, or other family conflicts.
The majority were clear, furthermore, that the money was no compensation for the years of conflict, and the damage to their careers. Only two still worked in the industry. One said he "should have taken the bribe", another said if she'd "stayed and took stock options" she "would've been worth a lot more". For at least eight, it was devastating. "I just wasn't able to get a job," said one. "It went longer and longer. Then I lost [my home]. I had my cars repossessed. I just went – financially I went under."
These stories come, remember, from a country that makes whistleblowers into millionaires. Here, we expect healthcare workers to speak out when they see people being harmed, but when they do, we offer no such assistance.
In fact, quite the opposite. Dr Stephen Bolsin was the whistleblower on the Bristol heart scandal, where children were dying unnecessarily. It ruined his career, leaving him unemployable in Britain. He is now working in Australia. The examples are endless.
The General Medical Council insists that doctors speak out, and ultimately blow the whistle, or be struck off. These are admirable ideals which everyone would like to think they could uphold, but we have also chosen to configure our society in a way that punishes people for doing the right thing. If we leave that unchanged, then we may have to accept our collective responsibility for the inevitable consequences: unnecessary deaths, and unnecessary suffering.