{"id":46134,"date":"2019-11-25T15:51:15","date_gmt":"2019-11-25T14:51:15","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=46134"},"modified":"2019-12-06T15:03:20","modified_gmt":"2019-12-06T14:03:20","slug":"giles-maskell-true-candour","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/11\/25\/giles-maskell-true-candour\/","title":{"rendered":"Giles Maskell: True candour"},"content":{"rendered":"<p class=\"standfirst\"><span style=\"font-weight: 400\">Currently the approach taken to duty of candour implies a false dichotomy between \u201cthings going well\u201d and \u201cmistakes being made\u201d<\/span><\/p>\n<p><!--more--><br \/>\n<a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/06\/giles_maskell.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-39428\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/06\/giles_maskell.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/06\/giles_maskell.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2017\/06\/giles_maskell-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a><span style=\"font-weight: 400\">Candour is a word that was rarely heard in hospital until relatively recently. Its traditional meaning was more or less synonymous with \u201cfrankness\u201d or \u201chonesty.\u201d In his <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/279121\/0898_iii.pdf\"><span style=\"font-weight: 400\">report<\/span><\/a><span style=\"font-weight: 400\"> into Mid Staffordshire NHS Foundation Trust, Robert Francis applied a specific definition in the context of healthcare: <\/span><i><span style=\"font-weight: 400\">\u201cThe volunteering of all relevant information to persons who have or may have been harmed by the provision of services, whether or not the information has been requested and whether or not a complaint or a report about that provision has been made.\u201d\u00a0<\/span><\/i><\/p>\n<p><span style=\"font-weight: 400\">Following one of his recommendations, this has subsequently been enshrined in UK law as a statutory duty of candour on NHS organisations, regulated by the Care Quality Commission. <\/span><a href=\"https:\/\/www.cqc.org.uk\/news\/releases\/bradford-teaching-hospitals-fined-failure-comply-duty-candour\"><span style=\"font-weight: 400\">Some organisations have already been fined<\/span><\/a><span style=\"font-weight: 400\"> for failing to take adequate measures to comply with this duty.<\/span><\/p>\n<p><span style=\"font-weight: 400\">No one can seriously question the principle that in most circumstances doctors should be honest with their patients. One problem however is that the approach currently being taken to this duty of candour implies a false dichotomy between \u201cthings going well\u201d and \u201cmistakes being made\u201d. It seems to be predicated on the notion that the normal state of affairs in healthcare is for things to go well, and that only occasionally will mistakes be made and harm result. My experience suggests otherwise.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As I get older and more and more of my friends and relatives require healthcare, it seems to me that things very rarely go entirely well. It may be something as simple\u2014to us\u2014as failure to insert a cannula at the first attempt, but it\u2019s often a lot more serious. Over the years, close friends and members of my immediate family have been subject to numerous adverse events including misdiagnosis and delayed diagnosis. There have been errors of omission, of process, and of communication as well as sundry medication errors including administration of toxic doses, and on one occasion administration of the wrong chemotherapeutic agent. These errors have spanned primary, secondary, and tertiary care, public and private sectors, hospitals little-known and world-famous.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Maybe my friends and family are particularly unlucky, but conversations with others who have found themselves in the role of concerned medical friend or relative suggest that there is more to it than that. I work in a specialty in which we have become more and more conscious of our errors in recent years\u2014<\/span><a href=\"https:\/\/www.ajronline.org\/doi\/full\/10.2214\/AJR.12.10375\"><span style=\"font-weight: 400\">estimated at 3-5% in routine daily practice and much higher for the interpretation of more complex studies<\/span><\/a>\u2014and making the reasonable assumption that radiologists are not the only doctors who make mistakes, this shouldn\u2019t come as a huge surprise.<\/p>\n<p><span style=\"font-weight: 400\">It has been estimated that for a single elective surgical admission, well over 100 people are involved in a patient\u2019s care. How likely is it that all of them and the equipment they use will have performed at the highest level at the same time? That none of those people was feeling ill, tired, distracted or depressed that day and consequently performed below par? Accepting our own fallibility and that of the systems in which we work is not to doubt the skill, commitment and good intentions of those delivering the care, nor to question our duty to learn from mistakes and suboptimal outcomes.<\/span><\/p>\n<p><span style=\"font-weight: 400\">I suggest that if we really want to be honest with patients, we could offer the following truly candid statement to almost every patient at the end of an episode of care:<\/span><\/p>\n<p><b><i>Given the uncertainties inherent in the course of human health and disease, the complexities of healthcare and the manifold disadvantages facing us\u2014not least our own human frailty\u2014things went about as well as could have been expected. To be perfectly honest they could probably have gone a bit better.<\/i><\/b><\/p>\n<p><em><strong>Giles Maskell<\/strong> is a radiologist in Truro. He is past president of the Royal College of Radiologists.<\/em><\/p>\n<p><em><strong>Competing interests<\/strong>: None declared.\u00a0<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Currently the approach taken to duty of candour implies a false dichotomy between \u201cthings going well\u201d and \u201cmistakes being made\u201d [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/11\/25\/giles-maskell-true-candour\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":40097,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[18893],"tags":[],"class_list":["post-46134","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-giles-maskell"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Giles Maskell: True candour - 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