Monday, January 14, 2008

The case of Dr Z

The complaintA report in the British Medical Journal yesterday is fascinating:
Dyer, Clare (2008-01-12). "Whistleblower who was excluded from work for five years wins apology". BMJ 336 (7635): 63.

The bullying of doctors and patients who raise concerns, and the gagging of information about those concerns is the most fundamental element of clinical risk. The various "Clinical Governance" policies put in place to (ostensibly) control clinical risk take no account of what actually happens.

What we are allowed to know about this story is that:
  • A junior doctor (known only as Dr Z) was excluded from her job in Cambridgeshire Primary Care Trust for 5 years. Her apparent crime was that she objected to inclusion of medical records in a research database without patient consent. Those medical records included her own.
  • The reason we do not know her name is that she is under a gagging order.
  • Many years before Dr Z suffered from a rare "serious life threatening condition". She wanted the details kept private.
  • However her medical details were distributed as part of this research to Addenbrooke's Hospital, Cambridge and from there to personnel involved in her employment.
  • Despite giving no consent she was harassed by the researchers.
  • The interesting (but common) response of her employers was to suggest that she was ill and to refer her to an "occupational health consultant". She was then put on "special leave from her employment".
  • Her employers tried to suggest that her "fitness to practice was an issue" and seemingly tried to (or actually did) refer her to the General Medical Council to be struck off.
  • Her employers generated false accusations that she had given a wrong name and address to her own doctor, and had falsified sick notes.
  • Her employers maintained that it "was not possible" that her records were held in the research database.
  • In September 2006 her employment was terminated.
  • Acting on her own she brought a libel action against her employers. The Trust admitted that all the accusations that they had made in their apparent attempts at bullying were false, and that her records were indeed in the research database.
  • In this case the person bullied was not only a doctor raising concerns about patients but also a research participant who was apparently told lies.
What can we say of all of this? The same basic elements are played out in variable form over and over again.
  1. Individuals are gagged and neither our profession nor patients nor the general public discover the truth.
  2. There is abuse through accusations of mental illness.
  3. The very bodies who are charged with integrity in medicine (such as the General Medical Council) are used by medical leadership to obfuscate the truth. At the same time the GMC shows no intent to deal with the powerful liars, falsifiers and bullies. Those individuals are neither named nor sanctioned.
  4. False accusations are made to divert attention from the real problems.
  5. There is almost no support for abused individuals.
There are implications for the confidentiality of medical data. This is another timely incident given the foolish inclination of the Labour government to take control by force of our medical records in a central "database".

John M. Grohol at Psych Central has written an interesting article "Why Would You Lie to Your Therapist?". Patients tell half-truths for many reasons. Concerns that the state or others will abuse the relationship of confidentiality is a powerful one.

We are entitled to ask several questions of Addenbrooke's Hospital, Cambridge:

Why have the full details not been placed into the public domain? What is this research, and has it been published? What are the names of the researchers involved? Did the work receive ethical approval? Did any publication state that some participants had refused consent? What action has been taken to deal with the individuals who bullied Dr Z?

Did any of the various agencies who are supposed to ensure integrity in this context do anything at all to assist Dr Z? Perhaps the General Medical Council did something, or Public Concern at Work, or the British Medical Association, or the UK Panel for Research Integrity, or the Ethics Committee at Addenbrookes Hospital, or the local Medical Staff Committee?

And why did the BMJ use the word "whistleblower"? Dr Z was simply doing her job. It is the job of a doctor to tell the truth in the interests of our patients (and in this case Z was one of those patients). Instead of dealing with her concerns she was bullied, told lies (and probably made ill). Whistleblowing has nothing whatever to do with this -- particularly since everything that the scientific community has to know and has to discuss has actually been suppressed.

Have we learned anything since Bristol? Or Shipman? Or Chan? .... or any of the incidents which have placed our patients and clinical science at risk?

Dr Z said in a statement:
"I raised concerns relating to unethical research practices which threatened patient confidentiality and were being conducted in breach of the law. I was then excluded from work for a period of five years, on the basis of allegations which the trust now concedes were groundless.
See also comments by Ferretfancier and Longrider

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Anonymous said...

I heard that Public Concern at Work (the "charity") did not offer her help.

Anonymous said...

The thing most annoying here is the fact that she was gagged. It was not up her to sign a an agreement that would cause harm to others. In the end the guilty are protected, dishonesty flourishes and information about the study is concealed. The next hospital learns that they can do whatever the sham fuck they like and at the end of the day it will all be submerged through quiet negotiation, and the public will never know.

PCAW above might not have helped, but this is the outcome they approve of. Secrecy.