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Panorama Sunday, 24 June, 2001, 21:21 GMT 22:21 UK
Your comments on No More Broken Hearts?
No More Broken Hearts?, Sunday 24 June 2001

The forum is now closed.
The way things are going with litigation against doctors, we are going to end up like the Americans; lawyers parked in hospital waiting rooms. At least in America doctors are respected and PAID more!
Bilal (a Medical Student)

The NHS is too busy trying to defend itself than admitting when it has failed. There are over 15000 medical negligence cases pending against NHS. Also many thousands are denied the right of suing because of the cost (not many qualify for legal aid). Many others are denied because they are not informed. What it shows is that the first loyalty a doctor has is to his fellow doctors not his patients otherwise this catastrophe would have been prevented long ago. How many more are waiting to be discovered. The present culture within the NHS has to be changed for the benefit of the patient.
Malcolm le-hair
West Walton, nr Wisbech

I would like to congratulate your team for an excellent presentation. Bristol incidence is nothing new and not an isolated incidence. Time has come for the public and the profession to do something about it. Major surgical outcomes, mortality, complications must be analysed and published. There must be national data set and data collected must be accurate. All deaths must be audited by some independent body. The public must accept that complications are not always possible to avoid and some times death is inevitable. Doctor bashing should stop. There must be an open and honest admission of mistakes and if and when it happens doctors and nurses must be supported rather than a culture of blame which exists now. Professional regulation must be closely scrutinised. Every doctor must have a patient satisfaction survey conducted at least once in 2-3 years. Most doctors and nurses do work very hard and try their best to provide a good quality service to their patients, yet there are serious mistakes which do occur in the NHS and we must have the mechanism to learn from these mistakes.
Dr Prabhu

I must say that I was surprised by the content of the programme. Whilst the pain of losing a child is unimaginable, I feel that by focusing upon the events covered by the previous Panorama programme the producers have failed to recognise the tremendous steps that Bristol has taken to improve its record. The programme went to great lengths to highlight the pain and suffering of all those parents who so tragically lost their children during that time, whilst allocating only a few minutes at the very end of the programme to mention the current record of the Bristol Children┐s hospital. The new hospital is excellently equipped and supported by a first class surgical and medical team. The hospital now has a specialist cardiac ward, which I understand has one of the best records in the country. These facts were not given their deserved recognition in the documentary, as it sought to focus once again on the tragic errors of the past. I can only imagine that the producers felt the exploitation of people┐s grief would draw more viewers than the realities of the hospital's current record. I do not feel that focusing on the past failings, however tragic, was helpful to anyone, especially those parents who are currently going through the anguish of awaiting cardiac surgery for their children at Bristol. I must say that I am surprised at the BBC for broadcasting such a one-sided piece of work; I had always believed their programme makers sought a balanced and robust approach to such emotive issues.

How is it possible for a representative of the hospital consultants to come on your programme and tell me he is not going to admit in public how well or badly his colleagues are performing a public service for a further 15 years ? There was a time when doctors had access to very limited curative medicines, drugs and operations and depended heavily on their image to bring any benefit to people. In those times there may have been some excuse for such secrecy. Today it is utterly and profoundly unacceptable. When the BMA calmly assumes it can continue indefinitely as a doctor protection club rather than a guardian of health care standards, calm patient responses are no longer appropriate, outrage and aggression are now, unfortunately, essential. The Bristol case was extreme but the protectionist attitudes which allowed it to happen seem to be jealously guarded at the core of the BMA. In failing to change they are undermining the profession for the many dedicated, hard working and doctors that we actually meet. How many votes of no confidence do they need?

While fully desiring a clear guide for parents, as to the chances of congenital heart surgery, The Children┐s Heart Federation (CHF) understands that the complexities of risk stratification will mean little to families looking for reassurance as to their child┐s future. We are seeking to ensure that all paediatric cardiac centres have clear guidance in their dealings with parents, so that they are enabled to make choices. Making decisions on issues from continuation of pregnancy to which centre is best able to treat their child, can only be made if parent┐s are given access to the fullest information. We are also very aware of the pressures on teams treating our children, and are anxious that the burden of trust will not prove too great for those who have a talent to exercise within the NHS. Many parents may want to make known their views on the future of cardiac centres, as the whole children┐s service is currently under review by the Department of Health. CHF has organised a conference in London, on Saturday 15th September 2001, to consult as widely as possible on the issues affecting the service. Those interested in attending the conference can contact CHF on 020 7820 8517. CHF also run a helpline staffed by parents of heart children. Anyone requiring information or support can ring the helpline on 0 808 808 5000
Children's Heart Federation

Yes, Bristol WILL happen again - in another hospital, in another town, in another discipline. The RCS spokesman on your programme showed the general public just what dinosaurs some of them are! If you are good at your job, why be afraid of full quality audit? Future parents will be just as much in the dark about the proven experience of clinicians as past parents have been, but the potential irony is that these new parents will probably assume their baby will be treated by the best clinicians. I feel that, through years of complacency, clinicians and surgeons have brought this crisis upon themselves. One unreservedly trusts the paediatrician or GP to refer your baby to a unit that can provide historical evidence of the quality of outcome. He/she would be failing in their duty if they did not offer the best available treatment. Sadly, this is something that has never been achievable because many surgeons/teams have failed to keep adequate audit records of their work and therefore appear to be above scrutiny. Is it any wonder that parents have now lost faith in the system and are quite rightly apprehensive of the "Trust me, I'm a doctor" aphorism? I would like to know how NHS Trusts appoint these surgeons - is there not a comprehensive appointments process that requires the candidates to provide quantifiable and verifiable data to support their application? In commerce, you only get the job if you have a proven track record - why does the medical profession not embrace this? Finally (and sadly) I have to say that the Government's proposals for future 'centres of excellence' for at least 24 other medical/congenital conditions will not re-gain the public's confidence whilst the status quo remains.
Lymington, Hants

Although it is true that the doctors in question did show a degree of incompetence with regards to their surgical technique, the Panorama programme portrayed them as if they had tried to do harm to these children. The programme should also have emphasised the fact that the doctors are being increasingly exposed so that they can get support and perhaps extra training and NOT so that they can become the objects of criticism by an increasingly critical public. If the current atmosphere of medical criticism continues, the result will be a decrease in morale within the medical profession that is so profound that it will result in doctors no longer wanting to take on high risk cases, for the fear of losing their licence and becoming the subject of national criticism.
Dileep Wijeratne

If a customer knew that a product would more than likely be faulty before they bought it, chances are they wouldn't bother. If they thought the hassles worth while, they could at least take the product back for a refund/exchange and happily live to tell the tale another day. This can't happen in the medical profession - once a life is taken, that's it. That's a very high price to pay. Patients are frequently led to believe that they are in the best and most capable hands; they are expected to trust any surgeon, whether NHS or privately appointed, unreservedly. Yet when you consider the actual statistics, the real picture is far from consistent. It is these inconsistencies that urgently need addressing. No patient would choose a surgeon who held a poor record over a long period of time. Perhaps, most dangerous of all, is the obvious fact that some surgeons still undertake to perform operations despite knowing fully of their own poor performance record in such operations. How can this be? Are surgeons not required to have a conscience? For this reason, therefore, surgeons do need to be accountable - i.e. a policy of openness that engenders increased standards of care such as that in the US. Surgeons must put patients first, not their own professional agenda which would sometimes appear to be the case. Some form of industry regulation and personal accountability is needed - though the mechanism for this is likely to be fraught with difficulties. However, I feel that it needs to be extended right across the health profession - doctors and consultants alike often fail to adequately disclose the risks associated with certain treatments etc. It is left to the patient to stumble on this at a later date, when quite frankly it is far too late. This is appalling - as patients we are consumers, and do, believe it or not, have the right to be fully informed before we make such decisions, especially those concerning health. The consumers of health care should be making decisions about their treatment, particularly regarding the risks they are asked to take.

I agree with the issues raised in the programme regarding availability of information for the public, however I have a number of concerns. Any data placed in the public domain needs to be risk adjusted to demonstrate the local population of their hospital, which can be done, however we also need to assess the pre-operative condition of the patient. A surgeon may have a high mortality rate but this may be because he/she is prepared to operate on a patient who, due to the pre-operative state, has little, or no chance of survival. We may then question why surgery was performed, but patients do recover against the odds, and families like to believe that everything possible is attempted to save a life of a loved one. By not assessing pre-operative conditions of patients when producing mortality figures we will discourage surgeons from attempting to save the lives of very sick patients due to the fear that their mortality rate may increase. Raw mortality data alone is not a good indication of surgical performance, and the public need to be provided with truly meaningful data. I was also surprised at the attitude of the Royal College, who seem to accept the attitude of surgeons regarding their performance data being made ready available to the public. I can see that it is a culture change for the surgeons but why should the public wait 10-15 years for that culture change to take place? Surgeons are paid a very good wage for undertaking a very important job, however they work for the NHS, and as such the NHS should invest in systems to monitor surgical performance, both locally and nationally. Chief Executives are now ultimately responsible for the clinical practice of their employees, so surely it is also in their interest to ensure that they have faith in the people that work for them. Surgeons are gifted individuals who save lives on a daily basis, however they are not untouchable and if they are uncomfortable with the idea of data being made available to the public - hard luck!

I was disappointed by your programme. You failed to grasp the fundamental issue surrounding results and in failing to do this have further removed surgeons from being able to offer the best service. The fundamental point you have failed to grasp is risk stratification. If I were to ask you to grade all the pupils in a school using one single exam but did not tell you the age of the child how could you tell whether you had a studious 10 year-old or a failing 16 year-old. The point you missed is that without measuring the expected outcome, the actual outcome is meaningless. Even worse it is damaging. You see, surgeons will wish to avoid trouble and so will exclude those "high risk" cases from their practice by deeming them inoperable and by sticking to the safe cases will get good results. But you will be forcing surgeons to turn down many of the most needy who would benefit most from the surgery because their chance of success is lower than others. The groups that your programme will prompt them to exclude are: elderly, diabetics, previous heart attacks, high blood pressure, people continuing to smoke etc. Does this not sound familiar? Is this not the groups that struggle to get life insurance? You see what happens when you replace genuine need by the requirement for a safe return. By your haste to address an important issue you have only made it worse for these people. Secondly, why have you not addressed the issue of the falling number of heart operations in the UK over the last 3 years - over 19,000 in 1997 to just over 17,000 last year and continuing to fall? That is important and you have not addressed it.

If there is too much pressure on doctors to have high success rates then this may lead to some doctors becoming reluctant in taking on the more difficult cases.
A Yaqoob - Medical Student, Leeds

I am a Medical Director of an acute hospital and I don't see much of a change since Bristol. I don't blame individuals or doctors, I blame the system. 1. NHS doesn't have a good information system in place to analyse the outcome 2. There are lot of data on litigation cases at the Trust level and CNST -no one analyses and gives feedback or looks at concerns regarding doctors. 3. Most Trusts do not even analyse the complaints which they receive and give feedback to the doctors of nurses. Since Bristol some changes are taking place. They are too little too late for the Bristol babies but certainly not for the future patients of NHS.

In reply to David Balfour's question about why these doctor's are not being tried for murder - first of all how exactly have these surgeons committed murder? Murder is when you have the intention to kill, not when you are trying your best to save lives. Doctors recently have been portrayed in a very negative way by the media thanks to murderers like Harold Shipman. It is important however that people do not presume that every doctor who is investigated for negligence is a murderer. You need to be able to distinguish the doctors whose incompetence may lead to the death of patients from the MINORITY who actually intend to kill.
Dileep Wijeratne

Should not the same procedures to correct the problem be applied to all areas of the NHS? In particular it seems strange to me that you pick an area where there is probably already a high risk outcome due to the fragility of the new born. I'm sure, and this includes personal experience of the NHS, that if the same analysis were to be applied to gerontology and the treatment of the aged you would find even more startling results.

As a further thought to my earlier posting - may I add that I have little faith in the Royal College of Surgeons? My experience of contact with that august body was that they could not wait to say - hey this is nothing to do with us. The complaints system for the NHS is difficult, hard to navigate and lacks the automatic right to move on to the next stage if you remain dissatisfied with the answers you are given - reform is long overdue. Vis a vis the comments of the 2nd year student nurse - perhaps they should bear in mind that by the time they started training, Bristol had finally started acting upon the things that Steve Bolsin was saying - was his really the only voice in the wilderness? My belief is that gagging of medical and nursing staff is profoundly wrong. Change can only begin when there is an open and honest environment. As for Chief Executives - should they be culpable? I wonder what Mr Loughton might think
Jennifer Randell

What a very good but sad report tonight, concerning the deaths of those young children. As a parent of very thankfully, three healthy children, I cannot imagine the loss of a child in these circumstances. Parents should, and must, be able to have confidence in any surgeon, if their child needs an operation. These behind doors meetings and general secrecy in the every day running of the medical profession has to and must stop. Parents, if they so wish, must have the right to examine the results of the surgeon who is operating on their child. This will assure parents that their child is as safe as possible whilst in theatre.
Steve Fuller
Brighton & Hove

The comments made by the representative from the Royal Collage of Surgeons were ridiculous. How does he expect people to trust their surgeons when very little has changed? My brother died after being operated on by Dhassmana and I have seen what my parents went through at the time and more recently, finding out they were mislead about his chances of survival and that some of his organs were kept without their knowledge. The profession cannot afford to wait until the 'old school' doctors have retired to change it's policies.
Katherine Thorn

I am a student Nurse in my 2nd year of doing Children's pre-registration in Bristol. I thought this evening's programme was very interesting as always. Although what has happened is very bad, I would like to point out that there is a lot of good work being carrying out at Bristol, and I've seen this from a student's perspective.
T. Jones

We should respect our Dr's & surgeons if & when they earn our respect, not revere them just because they are who they are, as the head of the RCS implied in the programme. The time is long overdue for statuary accountability & monitoring, with up-to-date published results, monitored by a single, independent responsible body. Welldone the brave whistle-blower - but this should be a matter for public record, not individuals outrage and conscience. I hope he is in Australia because he wants to be and was not ostracised and driven away.
Gillian McCarthy

Yes, Bristol will happen again. The medical profession needs a thorough overhaul in their culture, GP's included. The partnership system in GP's surgeries means that they do not sort out their own problems with regard to bad GP's and bad practices. Also, as a partnership, they are probably too frightened of being sued for a colleague's conduct and therefore keep quiet. We need a central registry to record all complaints about any practicing doctor and from whom all health authorities should at least annually obtain all complaints before issuing a licence to practice in their area - whether NHS or private. It can no longer be left to Health Authorities or the GMC or the profession itself to regulate itself.
LJ Holmes

My belief is that the tragedy of Bristol represents the tip of the iceberg and I would love to access comparative data for surgeons at the Walsgrave Hospital in Coventry. As one of the mothers said - she did not want to think that what happened to her child could happen again. I feel the same way about my partner Richard.
Jennifer Randell

Unfortunately the Bristol misfortune has taught the Medical Profession little or nothing. My wife was a victim that should never have been. She was left to struggle to survive without clearly advisable intervention for 11 days. During that time she was subjected to 18 clinical errors some of which were very serious and easily avoided. Worse was to follow. A ventilator was deliberately stopped and she asphyxiated to death. This happened over a year ago now. I have been confronted by attempts to cover and obfuscate since starting to investigate. There has been very little openness and honesty shown so far. Perhaps it is because the failings, from management right through to the daily care, were so serious and so avoidable.
George Kuchanny

Like many surgeons, I would be very happy to publish my data. However, the NHS is so under funded that hospitals must CHOOSE between nurses/doctors and support staff such as secretaries and data managers. Proper accurate data collection will cost vast sums of money. As the old maxim about computers goes "Rubbish in, Rubbish out". The NHS is grossly under funded, no matter what the Government says. The gap between the UK and the rest of Europe is NOT closing as European countries continue to spend more. Will your viewers/listeners please tell the Government whether they would choose to collect our data or reduce the waiting times?
Charlie Chan

I thought that tonight's Panorama documentary was, as usual, very well done. I would very much like to see a BBC documentary which highlights how hard doctors work and how high the standard of care is in the UK compared with other countries. I have read and heard about cases of bad practice among the tiny minority of doctors and feel that the medical profession as a whole is being tarred with the same brush.
Iona Collins

I noticed in the programme that hospital management can now be held legally accountable. Why is this not also the case for surgeons who are negligent or incompetent? And why is it so difficult for private prosecutions against doctors? Surely there should be a system in place where the CPS prosecute doctors. I cannot understand how such rigid laws are in place to protect an individuals assets, i.e. your money being defrauded from your bank, and yet an incompetent doctor can make your life a living nightmare and legally it is your responsibility to prosecute them!

Interesting programme. However, the real problem is the chronic and persistent lack of resource in the NHS. There are too few people (not just doctors) and hospital conditions are poor. As shown, it takes a disaster for funds to be made available to change this. Most younger surgeons are happy for our patients to know our results and to be held accountable for them but current conditions mean I am aware that I could be doing my job better.
Andrew McCombe

I think that this is a very difficult subject to comment on but I do think that with the proper consultation and a well thought out decision, these struck off surgeons should be allowed to operate again. However they should undergo some training and a written examination in order to carry on. This could expose certain weaknesses in the surgeons knowledge and so where to improve the teaching.
Mark Williamson

The heart surgeons have been struck off for not acting professionally. They are protected from law simply because they are professionals. If they do not act professionally they should be arrested and tried in a court of law for murder like anyone else. Why aren't they?
David Balfour

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