In denial of wilful blindness?

Hear no evil, see no evil, speak no evil

“There are none so blind as those who will not see. The most deluded people are those who choose to ignore what they already know.” These words of wisdom still resonate today – some 500 years after they were written by John Heywood. And there’s plenty of evidence that “those who will not see and choose to ignore what they already know” exist within the medical profession.

Take, for example, the report from the independent inquiry into the case of Dr Ian Paterson. He’s the breast surgeon whose unnecessary, inappropriate and ineffective operations on hundreds of women led to a criminal conviction. His 20 year prison sentence makes clear that he holds the ultimate responsibility for his unacceptable actions.

What’s that got to do with anyone else?

Bishop Graham James, who chaired the inquiry, doesn’t hold back in his report. He makes it perfectly clear that the scandal was far more than the reckless actions of a rogue surgeon. “The suffering described; the callousness; the wickedness; the failures on the part of individuals and institutions as well as Paterson himself – these are vividly described in what patients told us.”

The normal reaction to a scandal is to look at the organisational and legislative steps which should be set in place to avoid repetition of similar events. That should sort it, shouldn’t it? After all, Paterson was suspended in 2011. Surely things have tightened up a good bit since then? Well, Bishop James also states, “It is wishful thinking that this could not happen again… Our healthcare system does not lack regulation or regulators. This report is primarily about poor behaviour and a culture of avoidance and denial.”

An “offloading of responsibility at every level” enabled his actions. “This capacity for wilful blindness is illustrated by the way in which Paterson’s behaviour and aberrant clinical practice was excused… Many simply avoided or worked round him. Some could have known, while others should have know, and a few must have known.”

What’s this got to do with “normal” practice?

Paterson is an extreme case. No amount of legislation or policing will ever eliminate the chances of the occasional maverick slipping through the net. But as suggested earlier, there are numerous examples of “those who will not see and choose to ignore what they already know” in everyday medical practice.

Our previous blog posts have referred to the common problematic sub-cultures which have been identified by the General Medical Council. There are sub-cultures centred around divas and factions. There are groups of people where deference to specific individuals creates sub-cultures with patronage at their heart. Groups of embattled doctors are not uncommon. And then there are others who have separated from the mainstream and become isolated.

Just like the doctors who were working with Paterson, who was “hiding in plain sight,” it’s all too easy to develop wilful blindness to the existence of these sub-cultures or to their consequences. Their presence is disruptive to patient care and detrimental to staff well-being alike. Let’s add bullying, rudeness and carelessness to the mix.

Someone else’s problem?

If problematic behaviours are being noticed, rather than denied, then surely someone should say something? Definitely. But who? Could there be an element of wilful blindness to the fact that no-one is taking any effective action? That such lack of action actually sends the message to the perpetrators that says, “It’s ok, carry on with what you are doing.“? To think anything else would, in itself, be an act of denial.

Speaking up and saying, “That’s unacceptable,” can be an uncomfortable experience. It’s bad enough when dealing with a more junior colleague. Maybe worse when it’s a peer. And what about if it is a more senior doctor who is behaving inappropriately? There’s no doubt that these are tough conversations. But change won’t happen without them.

Doctors already dedicate themselves to learning how to have tough conversations with patients. This includes dealing with sensitive subjects, breaking bad news and saying no. How much time is spent developing ability to have tough conversations with colleagues? If improvements to patient care and staff well-being are the obvious outcomes then there has to be a professional duty for this.

How ready are you to have the tough conversations that will make a difference?

Stephen McGuire – Managing Director