Sir, - The reports published recently in your paper of the experiences of Mr John Gleeson when dealing with the National Maternity Hospital over the manner in which his wife was treated by them five years ago raise serious questions about the way in which doctors and hospitals react to patients and their families when medical care goes wrong. The heartache and anguish expressed by Mr Gleeson over the futile loss of his wife brought back to me and my family our similarly frustrating experiences when trying to discover what happened to my sister when she also was the victim of a similar serious act of medical negligence. Our family experiences have also been widely publicised in the Irish media in 1995 (The "Ward of Court" case).
As a practising obstetrician and gynaecologist I have had the opportunity of seeing the consequences of medical negligence from both the side of the patient and her family and also that of the profession. This opportunity may be unique. Based upon my experiences of these disastrous events I would like to make several suggestions as to how they might be better managed by the medical profession in the future:
1. When a patient suffers serious damage as a result of a medical negligence the doctor's duty of care does not cease, rather it increases. Initially, the necessary medical steps to try to reverse or limit the consequences of the negligent care must be instituted.
2. The doctor must remain in close contact with the patient and her family and explain to them what has happened and what is being done to rectify it. This contact should be undertaken by the senior person responsible for the patient's care (the consultant) and should not be delegated to the most junior member of the medical team, as, unfortunately, frequently happens. The most common reason for litigation in cases of medical negligence is because the patient and her family do not know what has happened to them or why. Relatives in general do not sue for money. If they did, how would Mr Gleeson and my mother and her family ever be adequately compensated for the losses they have suffered?
3. A doctor should not be afraid to say that he/she is sorry if a patient of his/hers has suffered serious damage as the result of medical negligence. To say that one is sorry because a patient has suffered in this way is a normal human response to another person's misfortune - it is not an admission of liability and it has an immediate and positive effect on both the patient and her relatives. It indicates to them that the doctor identifies with them in their loss and their struggle to deal with it.
4. Finally, a doctor must be honest with his/her patients and their families. While being honest may be difficult and traumatic for all concerned, the alternative of being less than honest or frankly dishonest will compound the problem even further. Medical care is based upon trust and that trust is of even great importance when the care fails the patient. Once lost it cannot be recovered.
Tragedies in medical care will always occur. The challenge in modern medicine is to limit their occurrence and to deal with their consequences in a humane and professional manner. If the recent experience in Bristol represents the way of the future, and the introduction of "clinical governance" into the NHS suggests that it will, we as a profession have a major challenge ahead of us to retain the confidence and support of our patients. The experiences of John Gleeson and my family should represent the past and should not be experienced by similarly unfortunate families in the future. -Yours, etc.,
N.B.: Because the judgment in the "Ward of Court" case instructed that the identities of all the parties should not be disclosed, we are unable in this case to follow our normal practice of publishing the writer's name and address, which are known to the Editor.