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Medical expert reports must consider systems issues to help stop doctors being scapegoats for wider failings
  • Sep 1, 2022
  • Latest Journal

It should be mandatory for medical expert reports to consider the role systems issues may have played in an adverse patient outcome, according to the Medical Protection Society (MPS).

MPS, which protects and supports the professional interests of more than 300,000 healthcare professionals around the world, said medical expert reports currently focus on scrutinising the actions of the individual doctor which risks doctors being scapegoats for the failings of the settings in which they work.

In its report - Getting it right when things go wrong: the role of the medical expert – MPS said organisational or systems failures which may have played into an incident must be included in expert reports as standard, and will call on the GMC to set this out in Good Medical Practice, the guidance which stipulates what is expected of all registered doctors. The MPS report also sets out a number of steps aimed at widening the pool of appropriately qualified medical experts who are currently engaged in clinical practice.

Dr Rob Hendry, MPS Medical Director, said: “In clinical negligence claims, coroner, criminal and regulatory cases, the standard a doctor will be measured against is set to a very large extent by the medical expert witness – it is a crucial role.

“In giving an opinion on whether or not the care provided by a doctor has fallen short of a reasonable standard, it would seem fair to the doctor that the medical expert considers all relevant circumstances. Any individual performance concerns must of course be addressed, but doctors should not be scapegoats for the failings of the settings in which they work. Sadly, we see this all too often in cases against doctors.

“Patients and families also deserve a thorough  explanation of what has happened and reassurance that the same thing will not happen again, and taking a broad focus and identifying all factors contributing to an adverse incident is vital in achieving this.

“This however does not always happen and many expert reports focus solely on the actions of the individual without considering the wider context. In reality, patient harm arising from medical error is rarely attributable to the actions of a single individual. Inadequate staffing levels, lack of resources, or faulty IT systems are just some issues which can contribute to adverse incidents. Doctors confront these issues every day and have little influence over them.  

“This focus on the actions of the individual doctor in expert reports plays into the blame-based system of accountability which exists across healthcare, instead of a culture of openness and learning which helps to improve patient safety.

“We believe it should be mandatory for all expert reports to consider systems issues when providing an opinion on the standard of care provided by a doctor.

“Adding this requirement into the Good Medical  Practice guide would reinforce it and empower doctors, many of whom believe their expert reports must focus solely on the individual. The GMC is currently consulting on updates to this key guidance to ensure it is fit for future practice, so there is an opportunity to make this important change swiftly. We hope it will be seized.