When Listening Without Prejudice To A Careless Whisper, We Must All Be Praying For Time

Author:Mr Richard Manstoff
Profession:Clyde & Co

Despite the unwarranted taking of the title of at least one of my favourite tracks of all time, I felt moved to address the other side of the coin to the one movingly described in Nandi Jordan's article 'Listening without prejudice - why doctors need to listen and act on patients' concerns'.

There are some uncomfortable truths, and we need to say them, out loud.

The NHS is not a bottomless pit with unlimited resources.

Resources are scarce.

Humans make human errors, in every walk of life.

Nobody can fail to be moved on hearing of errors made by clinicians, sometimes small, which result in injury to those who they entered the profession wanting to assist.

And that includes the individual healthcare practitioner accused of and sometimes guilty of that inadequate or negligent care. It is often forgotten that such practitioners are left distressed and with crushing self-doubt as a result of what may have been one slip in an otherwise unblemished career. They must internalise and own that error to learn from it and to teach others, but they have to live with it. And some cannot. We hear of those who leave the profession following such events and, more tragically, of others who self-harm, engage in substance abuse or make tragic decisions as a result of the pressure and responsibility for patient well-being that all those involved in healthcare carry.

But is it as simple as doctors not listening to patients? I think not.

Of course, there are some cases where a practitioner will have failed to listen carefully or at all to a patient's concerns or those raised properly by family of friends of those patients. That is indefensible, and I am not here to defend such conduct. But...and we knew there was a 'but' to this, that is only half an answer.

No death or injury is 'acceptable', but there is an emotive question that must be answered with the best available science.

I return to the universal propositions given above and address the question by way of worked example.

Not every headache is a subarachnoid haemorrhage ("SAH").

An average GP will see four to six patients complaining of headache in a working week. In one GP practice with eight GPs, that is between 32-48 'headache patients' per week. The incidence of SAH is six per 100,000 per year. On the available data, assuming (which they do not) that all SAH patients presented via their GP (rather than via A&E where many will first present) an average fulltime GP with an average list size of 2000...

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